Steps for Staying on Target. If you suspect that your blood glucose levels are affected by your menstrual cycle, there is a way to find out for sure. If you are already recording your blood glucose levels on a daily basis, look over the past few months.

Mark the date that your period started for each month. Do you see any pattern? Are your blood glucose levels higher or lower than normal during the week before your period? If you are not recording your blood glucose levels, now may be a good time to start.

If you find your blood glucose levels harder to manage on a monthly basis, there are some steps you can take to get things back on track. Changes in blood glucose levels could be due to normal changes, PMS, or both. Some women find that they need to adjust their insulin dose before their period and again once they start. Think about charting your symptoms along with your glucose levels. It will also help your detective work to note how you are feeling throughout the month, not just before your period, to see whether you can detect any sort of pattern.

If you have unexpected blood glucose readings - either too high or too low - or wide swings in your glucose levels around the time you get your period, there are some strategies you can try.

Try one strategy at a time, so you know which one is the most effective. If your blood glucose levels tend to rise about the time you expect your period, consider these options:

• If you use insulin, gradually increase your dose. Work with your health care team to add small increments, so that insulin levels are higher the last few days of your cycle, when blood glucose levels normally rise. One to 2 additional units of insulin may be all it takes. It will take a little trial and error to figure out the right dose for you. As soon as menstruation begins, estrogen and progesterone levels drop. When this happens, return to your usual dose of insulin to lower your risk of hypoglycemia.
• Eat at regular intervals, when possible. This will keep your blood glucose levels from swinging too much. Large blood glucose swings could contribute to some of the emotional and physical symptoms of PMS, which may in turn make variations in blood glucose levels worse.
• Try to avoid eating extra carbohydrates. Keep a handy supply of crunchy veggies - for example, celery, radishes, or cucumbers - and dip them in fat-free salsa.
• Cut back on alcohol, chocolate, and caffeine. They can affect both your blood glucose levels and your mood.
• Be especially careful about your salt intake, which causes bloating. Use pepper, fresh or powdered garlic, cayenne pepper, or scallions to add some zing to food.
• Try to exercise regularly. Many women find that regular exercise diminishes mood swings, prevents excessive weight gain, and makes it easier to manage blood glucose levels.

If you have a tendency toward low blood glucose before your periods, consider the following options:

• If you use insulin, work with your health care team to gradually decrease the amount of insulin you take a few days before your period starts. A decrease of 1 or 2 units of insulin may do the trick.
• Reducing diabetes medications may help, especially if you are concerned about having to take extra food. Ask your provider about the safest way to go about this.
• Try spreading your carbohydrate intake over the course of the day. Multiple small meals can help to even out your glucose levels.
• Eat a small amount of carbohydrate foods before you exercise.