The menopause transition with T1D: blood sugar, symptoms, and sleep

Type 1 diabetes (T1D) is a lifelong disease resulting from the loss of insulin-producing cells required to manage blood sugar levels. Many factors (e.g., medications, exercise, sickness) can influence blood sugar levels, including changes to circulating sex hormones. The fluctuation of female sex hormones during the menstrual cycle often requires insulin dose changes for women living with T1D. 

When menstrual cycles end during menopause, levels of these sex hormones decline substantially, causing a wide range of symptoms that can include night sweats, depressive symptoms, muscle pains, sleep disruption, and more. Importantly, adults with T1D are already more likely to experience poor sleep and this is even more common among women. In some women, supplementation of sex hormones, called hormone replacement therapy, can help reduce some menopause symptoms, like hot flashes.

Menopause in women living with T1D

A 2025 study asked post-menopausal women living with T1D if and how they perceived changes in their blood glucose compared to pre-menopause. The study included 159 women between the ages of 45 and 65 who had gone at least one year since their final menstrual period. 

How does menopause influence glucose levels?

Eighty-five percent of women reported a change to their glucose regulation after their final menstrual period and 67% of them considered the changes “moderate” to “huge”. Compared to pre-menopause, participants reported that their blood glucose levels overall were unchanged or somewhat higher. However, most (61%) reported an increase in frequency of hyperglycemic events and 38% reported more hypoglycemic events, demonstrating greater fluctuations in blood glucose levels than before menopause. 

Compared to pre-menopause, insulin dose was reportedly unchanged for most participants and HbA1c was unchanged or lower (55%). Still, 40% of participants reported higher HbA1c after the final menstrual period. As for continuous glucose monitor data, responses were split evenly among “lower”, “unchanged”, and “higher” for their time in target glucose range compared to pre-menopause. 

Menopause and sleep quality

Most participants (57%) were identified as currently (post-menopause) having poor sleep quality, in line with BETTER registry data showing that poor sleep quality is especially common among women living with T1D. However, sleep quality was not associated with perceived post-menopausal glycemic changes. Instead, poor sleep quality was more common among participants with T1D-related complications (e.g., eye and foot complications).

Severity of menopause symptoms

Menopause symptoms, both physical and psychological, were more severe after the final menstrual period than before. The worsening of symptoms was associated with more perceived changes to blood glucose. Participants using hormone replacement therapy perceived similar changes to their glucose regulation during the menopause transition, but they reported less severe menopause symptoms than non-users. 

The effects of menopause on T1D are variable

This study highlights that while menopause could impact T1D management, its effects on individuals vary widely. Overall, women in this study reported greater fluctuations and more extreme glucose values during menopause than previously, without major changes to HbA1c or insulin use. 

Data on the impact of both menstrual cycles and menopause on management of T1D are limited, and more studies are needed to understand how to best manage these life stages. Although this study highlighted important self-reported insights, there were no objective measures (e.g., HbA1c values or continuous glucose monitor data) to support them. Also, many women in this study were long past menopause and those that were more than 5 years from their final menstrual period reported less changes to their glucose regulation, likely indicating that some impacts are minimized or forgotten with time. In the future, studies following more participants as they go through menopause with both self-reported and objective measures can help to better understand and care for this population. 

Want to get involved in research?

If you live with T1D (or if your child does) in Canada, and would like to contribute your lived experience to research, join the BETTER registry today!

Reference:

Speksnijder EM, Simsek S, Bisschop PH, Stenvers DJ, Siegelaar SE; MenoPause Consortium. Perceived blood glucose regulation after menopause: a cross-sectional survey in women with type 1 diabetes in the Netherlands. Diabetologia. 2025 Nov;68(11):2499-2510. doi: 10.1007/s00125-025-06518-z. Epub 2025 Aug 16. PMID: 40817932; PMCID: PMC12534243.