Birth Control Options and Diabetes

[kabith]

I know that you guys are probably going to say "You should ask your doctor!" But to be honest, the doctors that I have don't seem to really know the answer to this question, so I thought I would see if anyone here has any input. Input based in fact OR experience would be appreciated.

As some of you know, I have type 1 diabetes and have for a long time. I used the combination pill from 2011-2013, until my university health care provider took me off of them because she was worried about clotting (because I had two migraines the whole time I used it). I was not on any form of birth control for a period of time, and recently got back on the combo pill (almost exactly 2 months ago.) I use insulin therapy to manage my diabetes, which involves tracking my blood glucose levels (BGs) and counting carbs, and then administering insulin via injections based on a mathematical calculation of those two factors.

In college, I noticed my average blood glucose levels rising over time, but also rising into a range that wasn't good for my health. I assumed it was because of the campus food that I wasn't able to accurately carb count, stress levels, and inconsistent exercise. When I was taking off of the pill, it was my last semester of college and I was living off campus, with more control of the food I ate and the schedule I was on. My BG levels started to come down, and I thought it was because of these lifestyle changes.

However, for the past few months, I have not been able to control my BGs at all. It seems like I am extremely insulin resistant, meaning I have to take significantly more insulin in order to bring my BG into my target range. This is extremely unhealthy and expensive, as the more synthetic insulin you take, the harder it is to manage weight (I have also gained about 50 pounds in a three year period). I asked my diabetic friends online if they had any advice, and one of them said it was probably because I started hormonal birth control again. This actually makes perfect sense, because my BGs were significantly harder to control both times I was on the combination pill. Insulin is also a hormone, just like estrogen, and I have had to adjust some of my other hormonal medications because I was on pills that contained estrogen, so I am thinking insulin is being affected by the estrogen in the pills as well.

I have done some research myself about the subject, but what I have been able to find is pretty limited. My doctors have never even mentioned what an impact contraceptives could have on my blood sugars, even my endocrinologist who is supposed to be the one who helps me manage my diabetes. Some studies say that progestin-only methods don't seem to affect insulin resistance (source: http://www.ncbi.nlm.nih.gov/pubmed/1530790), while other studies do not make any distinction between the different hormonal methods tested. Most websites say that IUD or barrier methods are the best bet, but I am really not all that comfortable with either of those (I suffer some pretty significant anxiety whenever I even think about getting it done, even though I think it would be worth it in the long run). I had my eye on the implant, but now I am not so sure if that is a good idea.

Does Scarleteen have any contacts that may be more knowledgeable on this subject than my current healthcare providers that I could call/email? Are there any other diabetics in the community that have dealt with this issue before? What do you suggest I do if my doctors are not knowledgeable enough in the subject?

Sorry if this is out of the scope of Scarleteen, I'm just not really sure where else to look at the moment.

[Heather]

Can you remind me where you're at, Kabith? Because obviously, ideally, what would be best is to find you a provider who is more knowledgeable you can see in person, as this is pretty far above our pay grade!

[kabith]

Of course! I live in Olympia right now.

[Heather]

I thought I had it right that you were in WA, just wasn't sure I was remembering correctly!

You know, let me shoot an email to one of the best GYNs I know in Seattle, and see if she can't give me a referral for you in Olympia. Unless, that is, you ever get to Seattle, in which case I'd suggest you make an appointment with her, because she truly is a genius, and is also excellent with providing very specific patient care like this.

[Heather]

Email sent, btw, will holler back when I hear back!

[kabith]

Either of those options may work. I would prefer to stay local if possible, but a trip up to Seattle may be worth it just for this. Thank you!

[Heather]

Okay, well, let's see if she has someone to suggest for you there first, and if not, I'm happy to refer you to her directly.

Apropos of nothing, I love Olympia. Such a cool city, and such a nice blend of urban things with funkiness and outdoor beauty.

[kabith]

If she has any suggestions that I could try first without an appointment, that would be nice haha. I'm hoping my current endocrinologists will be able to do some research for me as well, I am seeing him on Monday. But again, he deals more with the diabetes side than the birth control side, so a GYNs point of view would be very much appreciated.

Yes, Olympia is a wonderful place. I was born and raised here! I've lived in Tacoma before and commute to Seattle for work sometimes, but my heart will always be in Olympia I love the quirky festivals and the awesome restaurants P:

[Heather]

You got it, we'll see what she comes back with. But for sure, when it comes expressly to help with contraception, I think an OB/GYN is your best bet, period. They simply are almost always going to have had more education, and have done more continued education, with contraception than other kinds of healthcare providers.

And I like tacoma a lot, too! When I first moved to the PNW, I was in Seattle, and probably due to growing up in Chicago and then living in Minneapolis -- which is also a very cool, though mid-sized, city -- it just didn't land for me and I didn't care for it as a city. But had I first tried Tacoma, I might have been a lot happier. That said, I might not have kept running away to all of these islands and found one where I seem to like living best of all!

[kabith]

I hope so! The ones I have worked with have very little knowledge of diabetes, which is why I think I ended up in this predicament in the first place. I've even asked in the past if the methods they were prescribing would affect my diabetes management and I've essentially gotten a shrug and a "it should be fine" from everyone But I'm sure there have got to be some better ones out there, who have been educated on how different methods affect people with different diseases.

People bash on Tacoma a lot, but it is still a nice place. There are some beautiful and historical parts of town, I just loath the traffic (too many cars to drive easily, too little public transportation to bus easily, too big to bike easily.) I know Seattle is about 1,000,000 times worse though. I hope to visit the islands more in the future, I have mostly stuck to the mainland. They are known for their beautiful hiking trails

[Heather]

Well, one thing you should know -- in case you don't -- that you can always do is to ask your healthcare providers to confer with each other via phone or email. So, you can ask your endocrinologist to please talk with your OB/GYN to put their heads together and combine their general knowledge and their knowledge of you as a patient.

We can ask for something like that by just saying, "Hey Dr. Whateveryournameis, can I give you the contact information for my other doctor, and would you mind getting in touch with them to figure out together what might be best for me?"

[kabith]

I actually never even thought of that, that is a great idea! I will ask about that tomorrow

[Heather]

Sweet! So, there's one additional thing to be tried that hasn't been tried yet, at least!

Btw, I just reviewed some contraception info from the ARHP and they are listing diabetes as a risk factor for combined methods, which, given that you also feel strongly it had adverse effects for you, I would personally take as a no for continuing to use combined methods. They are also listing Depo and other progestin-only methods as only theoretically a possible contraindication, rather than as something proven or shown to be an issue.

So, having done some extra review, if you want my opinion -- which, as a given, should not be held over the opinion of a healthcare provider seeing you, who is a doctor, and who also has your whole health history in their hands, besides -- I would also weigh in per methods like the IUD, condoms, and cervical barrier methods probably being your very safest bet. Natural family planning is another.

In fact, given that you already are in about as serious a practice as it gets per observing and monitoring changes in your body, I imagine you'd be a rock star with charting fertility, and combining charting and condoms perfectly -- where you don't have intercourse during likely fertile times at all, and use condoms when you do have intercourse at all other times -- can be highly effective, as effective as an IUD alone, and might be something it sounds like you'd feel pretty good about? You could always also keep some Plan B on hand (which is also progestin-only) in case of possible goofs and if you'd feel better about only using a hormonal method very occasionally/only for emergencies.

Just throwing those things out there for you while they're all still fresh in my mind!

[kabith]

Thank you for your input, I do value it. I would be interested in looking into natural family planning, but I think it also depends on how much "charting" there is involved. Not saying that I am lazy or anything, but I do spend a significant time out of my everyday life just charting the diabetes side of my health, and if fertility charting is also a daily intensive thing, it may be too much for me to try and juggle (at least at this time!) I will do some research on it, since the last time I looked was when I was a teenager. If you have any articles/guides that you find pretty comprehensive, could you point me in that direction? I'll do a quick search on Scarleteen after this post just to see what you guys have on the subject.

I really am concerned with preventing pregnancies, because having unplanned pregnancies with the current state of my diabetes would be pretty traumatic, for both my body and the body of a child, if I ended up going through with the pregnancy. That is why I am so obsessive over having good reliable birth control, because I want to be intimate now and be able to plan a pregnancy at a time when my body can handle it. I understand the risk that comes with intercourse, regardless of the method used, and I am alright with those risks. I just want to minimize that risk to as low as possible. I really do like the idea of an IUD, but I have this irrational fear behind the procedure and the pain associated with IUD insertions, and the possible after affects (heavy bleeding for the rest of the time using it, or the pain that can be caused by it being dislodged, etc.) If it truly is the most effective method besides having my tubes tied or being really good at the natural family planning, I feel like I should give it a shot. But I really don't know how to handle the anxiety. Like, if they could knock me out and have me wake up 10 minutes later when it is all over, with just some mild discomfort for the rest of the day, maybe that would be ok, but I haven't heard of that being done. Ack

Anyway, thanks for throwing your ideas out there Heather, and letting me bounce my ideas off of you. Hopefully my doc will have something to say tomorrow, and hopefully your contact will get back to you!

[kabith]

Quick little update! Chatted with my endo today, and he agreed that I should try a different method. He also said that he has three other patients who use the implant, and that the implant doesn't appear to affect their diabetes. He also agreed to chat with other doctor if I asked him to, with is what you suggested I do once I talk to a GYN.

Let me know if you hear anything from your contact! Otherwise I am going to discuss this with my current gyno in a few weeks during my yearly exam.

[kabith]

Hello!

I have a gyno appointment next week, but I just wanted to check up on the status of that contact!

[Keda]

I think Heather just went on leave (unless she hasn't left yet or just can't help but read the forums :p ), so she might not be able to get back to you for a few weeks.

[Redskies]

kabith: Keda's correct that Heather is on sabbatical, but she will be having occasional check-ins with the volunteers during that time, and especially as this was something the two of you were discussing before she went on sabbatical, we'll ask her if she heard anything back for you during the next check-in.

[Eddie C]

Kabith: Would you mind helping us by letting us know what do you exactly need right now? I know you said you have your appointment sometime the next week so how can we help you?

[Heather]

So sorry to have dropped this ball! I just heard back from my colleague, because she has been in Australia on holiday for weeks. She said she could not think of anyone in Olympia offhand, but if you would like her to look around when she's back, she would be happy to do that, so just let me know.

[kabith]

Thank you everybody! That sounds good to me