Type 1 In Midlife: Perimenopause, Menopause & Type 1 Diabetes

If type 1 diabetes suddenly feels different in your 40s or 50s, hormones may be part of the conversation. In this episode, Melissa sits down with Dr. Arti Thangudu, a triple board-certified physician specializing in Endocrinology, Diabetes and Metabolism, Internal Medicine, and Lifestyle Medicine, as well as a Menopause Society Certified Practitioner. Dr. Thangudu shares why she left a high-volume traditional endocrinology practice to create a different model of care—one built around time, access, transparency, and the doctor-patient relationship. Then we dive into the intersection women with type 1 diabetes are still struggling to get help with: blood sugar + perimenopause and menopause. Dr. Thangudu explains how fluctuating estrogen can change insulin sensitivity and contribute to blood sugar variability, why declining progesterone may show up as disrupted sleep, and why these changes can make diabetes that once felt relatively predictable suddenly feel very different. We also talk about what can happen when a woman with type 1 diabetes begins menopausal hormone therapy. Because estrogen can improve insulin sensitivity, insulin needs may change—and that makes communication between the doctor prescribing hormones and the clinician managing diabetes especially important. In this episode, we discuss: • Why perimenopause can change insulin sensitivity and blood sugar patterns • Estrogen, progesterone, sleep, mood, body composition, and insulin resistance • Why women with type 1 diabetes need doctors who understand the interaction between hormones and diabetes • How hormone therapy may affect insulin requirements • Why starting estrogen deserves closer blood sugar monitoring and communication with your endocrinologist • Hormone therapy, lifestyle changes, and where GLP-1 medications may fit into an individualized treatment plan • Hashimoto's and thyroid disease in women living with type 1 diabetes • Why more testing isn't necessarily better testing • The importance of having a clinician who knows how to interpret the tests they order • How to advocate for yourself when your symptoms are being dismissed • Why finding the right doctor isn't just about credentials—it is also about finding someone who listens, has time for you, and understands the complexity of your health Before You Trust a New Doctor or Practitioner: Do These 3 Things Dr. Thangudu shared three practical steps that may take only a few minutes but can help you make a much more informed decision about who you trust with your care: 1. Verify their board certification. Search Certification Matters and confirm that the doctor is board certified—or appropriately board eligible—in the actual specialty for which you are seeking treatment. A medical degree alone doesn't mean someone has specialty training in hormones, endocrinology, diabetes, or another specific area. 2. Check your state medical licensing board. Confirm that the practitioner has an active license and review any disciplinary actions or other issues associated with that license. 3. Then look at Google reviews. Once you've verified their credentials and licensing, look at patient experiences. Reviews shouldn't replace credential verification, but they may give you another window into how a practice communicates with and cares for its patients. As Dr. Thangudu emphasized, if someone doesn't pass those first two checks, move on. A reminder for women with type 1 diabetes If your body suddenly feels different, don't assume you're failing at diabetes. Blood sugar changes during perimenopause and menopause can have physiological drivers, and there are options. Hormone therapy, insulin adjustments, education, lifestyle support, and finding a doctor who understands how these pieces interact can all be part of the conversation. You deserve to have a doctor who listens when you say something has changed—and a relationship in which you feel heard, supported, and comfortable asking questions. About Dr. Arti Thangudu Dr. Arti Thangudu is a triple board-certified physician specializing in Endocrinology, Diabetes and Metabolism, Internal Medicine, and Lifestyle Medicine. She is also a Menopause Society Certified Practitioner and founder of Complete Medicine, a direct care endocrinology clinic focused on relationship-based care and transparent pricing. She also founded HeyHealthy, which works with self-insured businesses to provide proactive diabetes and hormone care, and hosts the Endocrine Matters podcast. Her work focuses on diabetes, thyroid disorders, metabolic health, obesity, cholesterol disorders, hormonal conditions, perimenopause, menopause, and creating a more transparent, patient-centered healthcare system. Please remember: This podcast is for education and support and is not a substitute for individualized medical care. Talk with your doctor before making changes to insulin, hormone therapy, thyroid medication, or other medications.   Connect with Dr. Arti Thangudu Complete Medicine Hey Healthy IG @drartithangudu   Connect with Melissa Slemp: Follow on: Instagram Tik Tok YouTube Linkedin   Check out Melissa's website   Purchase Melissa's book, Highs, Lows, & Hormones   Connect with other like-minded women in a supportive group coaching community: Highs, Lows, & Hormones Circle   Visit diabetessisters.org to join. It's free, easy to use, and a great place to find community and support.   Disclaimer: Nothing you hear on this Type 1 in Midlife Podcast should substitute for professional medical advice. Please always consult your medical professional before changing your diet, insulin dosages or health care plan.

If you're taking progesterone in perimenopause and suddenly noticing higher blood sugars, more insulin resistance, or changing insulin needs, you may be wondering: Is the progesterone causing it? And would taking it every day instead of cyclically make things more predictable? That question came directly from a woman in my community who is living with type 1 diabetes, using hormone therapy, and noticing increased insulin resistance during the days she takes progesterone. And it's an important question because when you're managing diabetes with insulin, even a small hormonal shift can show up in your CGM data, mealtime insulin needs, overnight glucose, or corrections that suddenly don't seem to work the way they normally do. In this episode, I unpack the difference between cyclical and daily progesterone, why progesterone is prescribed in the first place, and why the answer isn't simply that one dosing schedule is "better" for blood sugar. We talk about the important distinction between progesterone causing insulin resistance and insulin resistance occurring during the same phase of your cycle when you happen to be taking progesterone. I also explain why perimenopause makes this especially complicated. Your own progesterone production can become inconsistent as ovulation becomes less predictable, while estrogen fluctuations, sleep, stress, cortisol, and other factors can also affect insulin sensitivity. Inside this episode, we cover: Why progesterone matters beyond reproduction Cyclical vs. daily progesterone and why each may be prescribed Why some women notice higher insulin needs during progesterone days Mealtime insulin vs. background insulin patterns to watch Oral vs. vaginal progesterone Why micronized progesterone and synthetic progestins are not the same What the research currently tells us about progesterone and glucose metabolism Why there isn't enough evidence to say daily or cyclical progesterone is universally better for women with type 1 diabetes What to track before asking your doctor about changing your progesterone regimen Most importantly, don't dismiss what you're seeing. Your experience matters. Track your CGM patterns, insulin needs, sleep, symptoms, meals, and progesterone days over several weeks or cycles. Then bring that information into a conversation with your hormone prescriber and diabetes care team. The goal isn't simply to correct another high blood sugar. The bigger question is: How can we make your hormone therapy and your diabetes management work better together? If you have my book, Highs, Lows & Hormones: A Survival Guide for Women Managing Diabetes—from Monthly Cycles to Menopause, revisit Chapter 4, where we unpack progesterone, hormone-related symptoms, and why individualized care matters. You don't have to choose between supporting your hormones and managing your diabetes. Both deserve attention. Disclaimer: This podcast is for educational purposes and is not medical advice. Always discuss changes to hormone therapy, medications, or insulin dosing with your healthcare team.   Connect with Melissa Slemp: Follow on: Instagram Tik Tok YouTube Linkedin   Check out Melissa's website   Purchase Melissa's book, Highs, Lows, & Hormones   Connect with other like-minded women in a supportive group coaching community: Highs, Lows, & Hormones Circle   Visit diabetessisters.org to join. It's free, easy to use, and a great place to find community and support.   Disclaimer: Nothing you hear on this Type 1 in Midlife Podcast should substitute for professional medical advice. Please always consult your medical professional before changing your diet, insulin dosages or health care plan.

What if the blood sugar changes that feel completely random…aren't random at all? Women with diabetes have access to more data than ever: CGMs, insulin pumps, cycle trackers, Apple Health, sleep data, exercise data, and more. But having more numbers doesn't necessarily mean we understand WHY our blood sugar is changing. And when hormones enter the picture, especially during perimenopause, the mystery can get even harder to solve. In this episode, I'm joined by Riley Gerszewski, founder of HerDiabetes, an iOS app created to help women connect glucose data with menstrual cycle and hormone patterns. Riley shares the story behind the app and why a conversation with a woman struggling to understand changes in her glucose throughout her cycle made him realize there was an important piece missing from diabetes technology. We talk about how HerDiabetes brings information from Apple Health together so women can begin seeing their glucose patterns across different phases of their cycle—not just one frustrating day at a time. We also discuss why this matters so much during perimenopause, when estrogen and progesterone become less predictable and insulin needs may feel like a moving target. In this episode, we talk about: • Why more diabetes data doesn't always equal more understanding • How menstrual cycle hormones can affect glucose patterns and insulin needs • Why perimenopause makes those patterns harder to predict • How HerDiabetes combines cycle and glucose data • Seeing time-in-range and other glucose trends across cycle phases • Tracking symptoms, mood, energy, sleep and other changes alongside the data • Creating a cycle report you can bring to your healthcare provider • Using data as a tool for better self-advocacy • Privacy and why HerDiabetes keeps health information locally on the user's device • The hormone therapy features currently being beta tested • What's ahead for perimenopause, postmenopause and Android users One of my biggest takeaways from this conversation is something I tell women all the time: We didn't suddenly forget how to manage diabetes. Our bodies changed. The more we can recognize our individual patterns, the better questions we can ask—and the more confidently we can advocate for the care and support we need. And if this conversation sounds familiar because you're trying to make sense of your own changing insulin needs, hormones, or perimenopause symptoms, my book Highs, Lows & Hormones: A Survival Guide for Women Managing Diabetes—from Monthly Cycles to Menopause was written to help you start connecting those dots. HerDiabetes is currently available for iOS through the Apple App Store. Riley is also looking for women using hormone therapy who are interested in participating in the HRT beta program. Interested participants can join the beta by emailing [email protected] with the subject line "sign me up." Riley will follow up with you directly with instructions. Also connect with Riley Gerszweski: Website Linkedin Download HerDiabetes app on Apple   Connect with Melissa Slemp: Follow on: Instagram Tik Tok YouTube Linkedin   Check out Melissa's website   Purchase Melissa's book, Highs, Lows, & Hormones   Connect with other like-minded women in a supportive group coaching community: Highs, Lows, & Hormones Circle   Visit diabetessisters.org to join. It's free, easy to use, and a great place to find community and support.   Disclaimer: Nothing you hear on this Type 1 in Midlife Podcast should substitute for professional medical advice. Please always consult your medical professional before changing your diet, insulin dosages or health care plan.

What if your diabetes appointment gave you enough time to talk about what is actually affecting your blood sugar? In this episode of Type 1 in Midlife, Melissa sits down with Savannah Elkins, PA-C, and Katie Wakeland, AG-ACNP, co-founders of Type 1 Telehealth. Both Savannah and Katie have lived with type 1 diabetes for decades, and both worked in traditional endocrinology before recognizing a gap in the kind of individualized, relationship-based care people with T1D often need. We talk about why diabetes care has to go beyond A1C and numbers on a CGM report—and what can change when a provider has the time to ask about the person behind those numbers. Katie and Savannah share how their own experiences with type 1 influence the way they care for patients, why diabetes burn out and fear of being judged at appointments matter, and how they use CGM, pump and insulin data with curiosity rather than as a scorecard. And, of course, we talk hormones. We dig into menstrual cycles, pregnancy, perimenopause and menopause, and why women can find themselves caught between providers—an endocrinologist who understands diabetes but may not specialize in reproductive hormones, and a women's health provider who understands hormones but may not understand the nuances of type 1 diabetes. We also discuss the importance of tracking symptoms and insulin needs, looking at changes in total daily insulin, and bringing objective information into appointments when something in your body no longer feels the same. In this episode, we talk about: Why Katie and Savannah created Type 1 Telehealth The limitations they experienced working in traditional endocrinology Why type 1 diabetes could almost be considered a specialty of its own Diabetes burnout and the emotional weight of feeling "graded" at appointments Looking beyond A1C to time in range and glucose variability How hormones can affect insulin sensitivity and blood sugar Menstrual cycles, pregnancy, perimenopause and menopause Why women with T1D often need a collaborative healthcare team Using CGM, pump and insulin data to identify changing patterns How to prepare for a healthcare appointment and advocate for what you need Why finding the right provider can change your experience of living with type 1 diabetes Savannah and Katie currently provide medical care through Type 1 Telehealth to patients aged 13 and older in Texas. They also discuss the distinction between their Texas medical practice and coaching support outside the state. About the guests Savannah Elkins, PA-C, and Katie Wakeland, AG-ACNP, are the co-founders of Type 1 Telehealth. After working in traditional endocrinology—and living with type 1 diabetes themselves, they recognized how difficult it can be to provide truly individualized diabetes care within short, overbooked appointments. They created Type 1 Telehealth around a different idea: give people enough time to talk, ask questions, understand their data, and receive care that considers both diabetes and everyday life. A reminder from Melissa: You are more than your A1C. If something has changed with your blood sugar, insulin needs, sleep, cycles, symptoms or hormones, get curious about it. Track what you're noticing, bring that information to your healthcare team, and keep asking questions.   Connect with Savannah and Katie: Website - Type 1 Teleheath IG @type1telehealth     Connect with Melissa Slemp:   Follow on: Instagram Tik Tok YouTube Linkedin   Check out Melissa's website   Purchase Melissa's book, Highs, Lows, & Hormones   Connect with other like-minded women in a supportive group coaching community: Highs, Lows, & Hormones Circle   Visit diabetessisters.org to join. It's free, easy to use, and a great place to find community and support.   Disclaimer: Nothing you hear on this Type 1 in Midlife Podcast should substitute for professional medical advice. Please always consult your medical professional before changing your diet, insulin dosages or health care plan.

Finding a doctor who understands type 1 diabetes and the hormone changes of perimenopause and menopause can feel challenging. But you may not need to start over with an entirely new healthcare team. In this solo episode, I'm sharing how to start the conversation with the practitioners you already know and trust, what to bring to your appointment, and how to know when it may be time to find someone new. Your endocrinologist doesn't have to be a menopause expert, and your menopause practitioner doesn't have to manage your diabetes. What matters is finding providers who understand that blood sugar and hormones intersect and are willing to work together. In this episode, we talk about: How to start a conversation with your current doctor What symptoms, CGM data, and insulin changes to bring to your appointment Questions to ask about menopause and hormone therapy When to ask for a referral or look for a new practitioner What to look for in a provider who will listen and collaborate with you You know your day-to-day patterns better than anyone. The goal isn't to replace your doctor's expertise. It's to come prepared so you can ask better questions, advocate for what you need, and build a healthcare team that supports you through this stage of life. The more clearly, we understand our symptoms and patterns, the better prepared we are to ask questions, communicate what we need, and participate in our own care.     Resources to Help You Find a Practitioner Here are the practitioner directories, telehealth options, and other resources I recommend as a starting point: The Menopause Society Practitioner Directory Midi Health Alloy Additional menopause practitioners, endocrinologists, telehealth providers, and directories: Dr Heather Hirsch's list of providers When searching, remember that menopause expertise is only one piece of the puzzle. Ask how comfortable the practitioner is caring for someone with type 1 diabetes, how they approach metabolic health, and whether they're willing to coordinate with your endocrinologist or diabetes care team. Prepare for Your Doctor Visit Chapter 5 of my book, Highs, Lows, and Hormones, is called "Prepare for Your Doctor Visit Like a Pro." Inside, I share questions you can take with you to discuss hormone testing, hormone therapy, diabetes-specific considerations, and more. You'll also find resources to help you track symptoms and better understand what may be changing before you walk into the appointment. Get your copy of Highs, Lows, and Hormones: Related Episodes + Articles These episodes and articles can help you prepare for your appointment, understand what you're experiencing, and start a more productive conversation with your healthcare team. You can also share them with your practitioner if they help explain what you've been experiencing. Recommended podcast episodes: Ep 161 with Sascha Vrolijk Ep 172 with PA Dena Kranzberg and type 1 diabetic Ep 174 with Dawn Adams, with research attached for doctor to reference Recommended articles: Perimenopause and Type 1 Diabetes: Why Blood Sugar Gets Harder to Manage Myths & Facts About HRT: What Women with Diabetes Need to Know   Want More Support? If this is where you are right now and you're still feeling stuck about what to do next, you don't have to figure it all out by yourself. You can work with me through one-on-one coaching or join my Highs, Lows, and Hormones Group Coaching Circle, where we're having these conversations and working through the real-life challenges of navigating blood sugar, hormones, and midlife with type 1 diabetes. Learn more / schedule a consultation: Join the Highs, Lows, and Hormones Group Coaching Circle: And if you haven't already, hit the + to follow the podcast so you don't miss upcoming episodes. You can also share this episode on Instagram and tag me @type1amidlife. I'd love to hear where you are in the process of finding a practitioner who can support both your diabetes and your changing hormones. You deserve a healthcare team that listens, collaborates, and helps you feel informed and supported as you move through this season of life.     Connect with Melissa Slemp:   Follow on: Instagram Tik Tok YouTube Linkedin   Check out Melissa's website   Purchase Melissa's book, Highs, Lows, & Hormones   Connect with other like-minded women in a supportive group coaching community: Highs, Lows, & Hormones Circle   Visit diabetessisters.org to join. It's free, easy to use, and a great place to find community and support.   Disclaimer: Nothing you hear on this Type 1 in Midlife Podcast should substitute for professional medical advice. Please always consult your medical professional before changing your diet, insulin dosages or health care plan.

What happens when the diabetes management you've relied on for years suddenly stops working the way it used to? For many women with type 1 diabetes, perimenopause can feel a little like being diagnosed all over again. In this episode, I'm joined by Erika Forsyth, LMFT, a Licensed Marriage and Family Therapist who specializes in supporting children, adolescents, adults, and caregivers living with diabetes. Erika has lived with type 1 diabetes since 1990 and brings both her professional expertise and lived experience to the emotional, social, and behavioral side of diabetes. She's also a strong advocate in our diabetes community, serving on the American Diabetes Association's Mental Health Advisory Group and Safe at School Working Group, the Touched by Type 1 Medical Oversight Committee, and the board of You're Just My Type. She's also a frequent contributor to the Juicebox Podcast Mental Health Series and a speaker at diabetes conferences around the country. And now, Erika is navigating perimenopause herself—which makes this conversation especially personal. We talk about the unpredictability of perimenopause, changing insulin needs, sleep disruption, brain fog, emotional overwhelm, diabetes distress, and something Erika describes so powerfully as body grief: grieving the body and patterns you once understood while still having to care for that changing body every single day. Erika was also an advanced reader of Highs, Lows & Hormones, and in this conversation she shares how she's using pieces of the book—particularly the Symptom-Hormone Matching Guide—to better understand what she's experiencing, connect the dots between hormones and blood sugar, and prepare herself for conversations about hormone therapy. We also talk about: Why perimenopause is about much more than insulin resistance The emotional weight of adding hormones to an already complicated diabetes equation Why unpredictability does not mean you're failing at diabetes Diabetes burn out, distress, anxiety and isolation How hormone changes can affect relationships and communication Why HRT conversations can feel overwhelming—and why you don't have to figure everything out at once Learning to experiment rather than expecting yourself to immediately "fix" your blood sugar How to recognize when it may be time to seek additional emotional support Advocating for yourself when your endocrinologist or OB/GYN doesn't have the answers Giving yourself permission to learn your body again One of my favorite reminders from this conversation is something Erika pulled directly from the book: This season is not the end of stability. It's a bridge to a new one. Most importantly, we talk about why unpredictability does not mean failure. If perimenopause has left you wondering, Why can't I manage my diabetes the way I used to? this conversation is for you.   Connect with Erika Forsyth: IG @Erika_Forsyth_LMFT erikaforsyth.com   Connect with Melissa Slemp:   Follow on: Instagram Tik Tok YouTube Linkedin   Check out Melissa's website   Purchase Melissa's book, Highs, Lows, & Hormones   Connect with other like-minded women in a supportive group coaching community: Highs, Lows, & Hormones Circle   Visit diabetessisters.org to join. It's free, easy to use, and a great place to find community and support.   Disclaimer: Nothing you hear on this Type 1 in Midlife Podcast should substitute for professional medical advice. Please always consult your medical professional before changing your diet, insulin dosages or health care plan.

If you're waking up, looking at your CGM and wondering, What in the world happened overnight? don't automatically assume you did something wrong. Your insulin needs aren't static, especially through the reproductive years, perimenopause and menopause. Hormone shifts, cortisol, sleep, stress and changes in insulin sensitivity can all affect how much background insulin your body needs. In this episode, I'm breaking down basal insulin—the steady background "drip" of insulin your body needs throughout the day and night—and why it still matters whether you use multiple daily injections, a pump in manual mode, or an automated insulin delivery system. I'll walk you through my simple framework: Find the pattern: When is glucose consistently rising or falling? Find the driver: Could hormones, cortisol, sleep, food, exercise or insulin timing be contributing? Find your mode: Is your current insulin delivery strategy meeting your body's needs right now? We'll also talk about overnight glucose patterns, dawn phenomenon, why one unusual night doesn't necessarily mean your settings are wrong, and what information can be helpful to bring to your diabetes care team before making adjustments. Because sometimes you didn't suddenly get "bad" at diabetes. Your body changed—and your insulin strategy may need to change with it. My book, Highs, Lows & Hormones, includes a companion basal testing resource designed to help you gather your own patterns and take better questions to your diabetes care team. Important: Insulin adjustments should be made with guidance from your qualified diabetes care team. This episode is for education and is not individualized medical advice.   Watch over on my Youtube channel @Type1inMidlife   Connect with Melissa Slemp:   Follow on: Instagram Tik Tok YouTube Linkedin   Check out Melissa's website   Purchase Melissa's book, Highs, Lows, & Hormones   Connect with other like-minded women in a supportive group coaching community: Highs, Lows, & Hormones Circle   Visit diabetessisters.org to join. It's free, easy to use, and a great place to find community and support.   Disclaimer: Nothing you hear on this Type 1 in Midlife Podcast should substitute for professional medical advice. Please always consult your medical professional before changing your diet, insulin dosages or health care plan.

I get asked this question all the time: What do you actually take every day? So today, I'm opening up my supplement cabinet for a little show and tell—from the hormones I use morning and night to magnesium, vitamin D, omega-3s, creatine, amino acids, gut support, and a few things I'm currently experimenting with. But this episode comes with one BIG disclaimer: please don't copy my routine. Everything I take has evolved over time based on my labs, symptoms, health history, conversations with my practitioners, and what I'm trying to support at this stage of life. Because social media can make it very easy to believe we need one more supplement simply because someone else is taking it. Instead, I want this episode to make you curious about your body. In this episode, I share: What I currently take from morning to bedtime My daily hormone therapy routine The supplements I consider my non-negotiables What I take only as needed or experiment with Why labs, symptoms, quality, and sourcing matter Why I don't believe more is always better Questions to ask yourself—and your healthcare provider—before adding something new Don't copy my medicine cabinet. Let mine start a conversation about yours. And as always, talk with your healthcare provider before adding or changing supplements or hormone therapy. 🎥 If you want the full "show and tell," watch this episode on the Type 1 in Midlife YouTube channel, where you can actually see what I'm holding up and talking about. You'll also find my recommended supplement list and other resources linked below. Links to share below show notes: Watch over on my Youtube channel @Type1inMidlife   See the professional-grade supplements I personally recommend and talk about on the podcast. Shop anytime through my Fullscript dispensary—and save 15% when you sign up. Shop Melissa's favorite supplements   Connect with Melissa Slemp:   Follow on: Instagram Tik Tok YouTube Linkedin   Check out Melissa's website   Purchase Melissa's book, Highs, Lows, & Hormones   Connect with other like-minded women in a supportive group coaching community: Highs, Lows, & Hormones Circle   Visit diabetessisters.org to join. It's free, easy to use, and a great place to find community and support.   Disclaimer: Nothing you hear on this Type 1 in Midlife Podcast should substitute for professional medical advice. Please always consult your medical professional before changing your diet, insulin dosages or health care plan.

GLP-1s are exploding, and women living with type 1 diabetes are paying attention. But beyond the weight-loss headlines and social media success stories, what do women with T1D really need to know? Returning guest Kelly Schmidt, RD, LDN, joins me for an honest conversation about GLP-1s, insulin sensitivity, weight, food noise, muscle, hormones—and why this decision is about much more than taking another medication. Kelly is a registered dietitian, strength coach, creator of the GRACE Method, and a woman living with Type 1 diabetes. She helps women manage blood sugar beyond just carbs and insulin by bringing together functional nutrition, muscle-building strategies and hormone education. Kelly is also a contributor to my book, Highs, Lows & Hormones, and has personally used GLP-1 therapy for years. In this episode, we talk about why women with T1D are turning to GLP-1s, Kelly's personal experience, potential benefits beyond weight loss, preserving muscle, digestion and side effects, sourcing and medical supervision, cost and long-term sustainability. And we tackle a piece I don't want women overlooking…hormones. In this episode, we talk about: What GLP-1 is and how these medications work Why women with type 1 diabetes are increasingly interested Kelly's personal experience after years of GLP-1 use Insulin sensitivity, food noise, cravings and changing insulin needs Potential benefits beyond weight loss Muscle preservation, protein and strength training Hydration, fiber, digestion and common side effects Why medication source and medical supervision matter Perimenopause, menopause and the hormone therapy conversation How HRT and GLP-1 therapy may coexist Insurance coverage, cost and accessibility Long-term use and sustainability Why lifestyle foundations still matter—even when medication is helping   If you're over 40 and suddenly using more insulin, gaining weight or feeling like your body has changed, could perimenopause or menopause be contributing? Should hormone therapy be part of the conversation before—or alongside—a GLP-1? This isn't about deciding whether GLP-1s are good or bad. It's about asking better questions. What problem am I actually trying to solve? As Kelly puts it: Know thy need. Know thyself. Know thy source. 🎧 Listen in before you decide whether a GLP-1 is the right tool for you.   Connect with Kelly Schmidt: Website IG @diabeticdietitian YouTube T1D Whole Health Review Session with Kelly Schmidt, RD   Connect with Melissa Slemp:   Follow on: Instagram Tik Tok YouTube Linkedin   Check out Melissa's website   Purchase Melissa's book, Highs, Lows, & Hormones   Connect with other like-minded women in a supportive group coaching community: Highs, Lows, & Hormones Circle   Visit diabetessisters.org to join. It's free, easy to use, and a great place to find community and support.   Disclaimer: Nothing you hear on this Type 1 in Midlife Podcast should substitute for professional medical advice. Please always consult your medical professional before changing your diet, insulin dosages or health care plan.

What happens when the diabetes strategies that worked for years suddenly stop working the same way? For women with type 1 diabetes entering perimenopause and menopause, changing estrogen and progesterone can affect insulin sensitivity, blood sugar patterns, sleep, weight, mood, and the amount of insulin we need. Yet for years, many women have walked into diabetes appointments with these concerns only to discover that no one was connecting the dots. In this episode, I welcome back Dawn Adams, midwife, diabetes advocate, researcher, and woman living with type 1 diabetes since 1993. Dawn has helped bring the lived experiences of women with diabetes into international research on menopause and women's health. We talk about why those lived experiences matter, what researchers are finally beginning to document, and why the next step has to be translating research into better conversations and better care. We also talk about: Why women with type 1 diabetes have often felt unseen during perimenopause and menopause What women are reporting about changing blood sugars, insulin needs, weight, sleep, brain fog, and other symptoms Why CGM, insulin pump, and insulin-dose data could help researchers better understand hormonal changes The growing research around menopause and diabetes Hormone therapy and why the conversation has changed significantly since the original WHI headlines Why symptoms and lived experience matter—not just age or lab values The need for diabetes technology to better support women through hormonal transitions How women can use credible research to advocate for better conversations with their healthcare providers One of my favorite reminders from this conversation is that if we have the information, we can ask better questions. That is also why I wrote Highs, Lows & Hormones: A Survival Guide for Women Managing Diabetes—from Monthly Cycles to Menopause. Dawn was one of my advanced readers, and during our conversation she shares why having reliable, evidence-based information can give women the courage to advocate for themselves. This conversation is about more than menopause. It's about making sure the women coming behind us have better information, better support, and hopefully a much easier path than many of us had. About Dawn Adams Dawn Adams was diagnosed with Type 1 Diabetes during her final year of teacher training in 1993. After more than a decade working in education, she retrained as a midwife. Dawn advocates for diabetes research through #dedoc, the International Diabetes Federation Blue Circle Voices Network, and Menopause Together. She is a member of the TREND Diabetes Committee and is frequently invited to speak at international conferences on diabetes and women's health. She has collaborated with researchers from Ulster University, Diabetes UK, and University College London on the experiences of women with diabetes during menopause and has worked with Abbott Laboratories to highlight stigma surrounding diabetes and menopause. Dawn also facilitates peer-support networks for people living with diabetes locally, nationally, and globally.   Listen to Dawn Adams in EP 25   Research Referenced in This Episode Dawn referenced several research papers exploring the experiences of women living with diabetes through menopause, women's health, and the need for more sex-specific diabetes research. Women Living With Diabetes: Overlooked and Under-Recognized, the Psychosocial Impact Published: July 2026 Explores the often-overlooked psychosocial experiences and challenges faced by women living with diabetes. http://dx.doi.org/10.1111/dme.70389 One Size Does Not Fit All: The Need for Sex-Specific Precision Medicine in Diabetes Technology Published: May 2025 Highlights the need to consider sex-specific differences when developing and using diabetes technology and calls for a more individualized approach to diabetes care. https://doi.org/10.1177/19322968251340673 Supporting Women in Menopause Published: March 2025 Addresses the need for greater awareness and support for women navigating menopause alongside diabetes. https://doi.org/10.1111/dme.70039     Women's Experiences of Living Through Menopause With Type 1 and Type 2 Diabetes: A Scoping Review Published: May 2024 Examines the available research surrounding the experiences of women with both Type 1 and Type 2 diabetes as they navigate menopause. https://pure.ulster.ac.uk/ws/portalfiles/portal/241398893/Review_Protocol_.pdf A Pilot on the Endocrine Effects of Hormonal Replacement Therapy on Menopausal T1 Diabetics Using Wearable Sensors Published: November 2022 Explores the use of wearable diabetes technology to examine the endocrine effects of hormone replacement therapy in menopausal women living with Type 1 Diabetes. https://doi.org/10.3390/ecsa-9-13215   Connect with Dawn Adams: IG @t1dawnie   Connect with Melissa Slemp:   Follow on: Instagram Tik Tok YouTube Linkedin   Check out Melissa's website   Purchase Melissa's book, Highs, Lows, & Hormones   Connect with other like-minded women in a supportive group coaching community: Highs, Lows, & Hormones Circle   Visit diabetessisters.org to join. It's free, easy to use, and a great place to find community and support.   Disclaimer: Nothing you hear on this Type 1 in Midlife Podcast should substitute for professional medical advice. Please always consult your medical professional before changing your diet, insulin dosages or health care plan.