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

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.

What if the things that worked for your type 1 diabetes at 30 simply don't work the same anymore?

Your insulin needs change. Hormones change. Sleep, recovery, energy and body composition can change too. Yet everywhere we turn, we're being told there is another diet, supplement, workout, peptide or strategy we should be doing to fix it.

After 44 years of living with type 1 diabetes, I'm learning something important: I don't need my old body back. I need to understand the body I'm living in right now.

In this episode, I'm sharing five ways I'm rethinking what it means to age well with type 1 diabetes:

1. Stop expecting your body to respond like it did 20 years ago. Different doesn't mean worse. Hormones, insulin sensitivity, muscle mass, sleep, stress and recovery change—and our strategies may need to change with them.

2. More discipline isn't always the answer. Before eating less, exercising more, adding another supplement or assuming you need to try harder, ask: What has changed?

3. Become curious instead of critical. Blood sugar changes, hunger, poor sleep, slower recovery and changes in energy are not a grade on how well you're managing diabetes.

4. Change your definition of success. A1C, time in range, weight and insulin needs matter, but they aren't the whole story. Strength, muscle, bone health, energy, sleep, relationships and confidence in your diabetes decisions matter too.

5. Make advocacy part of your diabetes management. Don't automatically accept "that's just aging" or "that's just menopause." Ask questions about hormones, thyroid health, sleep, bone and muscle health, sexual and pelvic health, and changes in your insulin needs.

We're also talking about the pressure women feel to have the perfect CGM graph, perfect body, perfect diet and perfect routine—and why someone else's carefully selected moment shouldn't become the measuring stick for your health.

Aging with type 1 diabetes isn't about getting your 30-year-old body back. It's about learning how to care for the woman you are today.

I also share why I wrote Highs, Lows & Hormones and how we're continuing these deeper conversations inside the Highs, Lows & Hormones Circle, where women with diabetes can ask questions, learn from one another and feel supported as their bodies and diabetes needs change.

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 a women's health nurse practitioner also lives with type 1 diabetes herself?

In this episode of the Type 1 in Midlife Podcast, Melissa sits down with Dena Kranzberg, DNP, WHNP-BC, women's health nurse practitioner, certified personal trainer, and woman living with type 1 diabetes for 35 years.

Melissa and Dena talk openly about the intersection of type 1 diabetes, perimenopause, menopause, hormone replacement therapy (HRT/MHT), insulin sensitivity, strength training, nutrition, and metabolic health—and why these pieces of women's health shouldn't be treated in isolation.

Dena shares how her own experience with type 1 diabetes influences the way she cares for women, including one of her guiding principles: just as there is no single diabetes regimen that works for everyone, there is no one-size-fits-all approach to hormone therapy.

They also discuss why symptoms such as joint pain, brain fog, fatigue, sleep changes, body composition changes, mood shifts, tinnitus, and changing blood sugars may deserve a closer look during perimenopause—even when hot flashes aren't part of the picture.

You'll also hear Dena's personal experience beginning hormone therapy in her 30s, becoming a competitive bodybuilder while managing type 1 diabetes, and why she believes strength training is one of the most important habits women can build for glucose management, muscle, bone health, and healthy aging.

Most importantly, this conversation is a reminder that your experience is real, your symptoms matter, and you don't have to wait until things get worse to start asking questions.

In this episode:

• Type 1 diabetes and changing insulin needs during perimenopause
• Estrogen, progesterone and testosterone
• Individualizing hormone replacement therapy
• Symptoms of perimenopause beyond hot flashes
• Muscle as a tool for glucose management and healthy aging
• Strength training, protein and body composition
• HRT, joint pain, sleep, energy and metabolic health
• Advocating for yourself when something has changed
• Why women's health needs a more holistic approach

If you're a woman with type 1 diabetes navigating perimenopause or menopause or simply wondering why your body and blood sugars suddenly seem to be playing by different rules, this is a conversation you'll want to hear.

Whether you're experiencing symptoms or simply want to better understand your body, this conversation is filled with practical education and encouragement.

Connect with Dena Kranzberg:

IG

@denabetic

@denathednp

Linkedin

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.

Most women have heard the words pelvic floor, but few of us truly understand what it does—or how much it influences our everyday lives.

In this episode, I'm joined by Dr. Casey Mosos, pelvic floor physical therapist, dry needling certified clinician, and perinatal exercise specialist. Casey specializes in helping women overcome pelvic pain, endometriosis, bladder concerns, painful intimacy, pregnancy and postpartum recovery, and so much more.

What makes this conversation especially meaningful is that Casey also lives with endometriosis herself, bringing both professional expertise and personal understanding to the women she serves.

Together, we discuss why pelvic floor health deserves far more attention, especially as women move through midlife and menopause. We also explore how hormones, vaginal estrogen, and chronic conditions like type 1 diabetes can impact pelvic tissues and why so many women are silently living with symptoms they assume are simply "part of getting older."

In this episode, we discuss:

• What the pelvic floor actually is and why it matters
• Common symptoms women should never ignore
• Pelvic pain and why it is never something you should simply "live with"
• Endometriosis and its long-term impact on women's health
• Painful intercourse and what can be done about it
• The important role of vaginal estrogen for tissue health
• Bladder leakage, urgency, and pelvic floor dysfunction
• Constipation and bowel health
• Pregnancy and postpartum recovery
• Why pelvic floor therapy is about so much more than Kegel exercises
• The connection between chronic disease, hormones, and pelvic health
• When it's time to seek help from a pelvic floor physical therapist

Whether you're experiencing symptoms or simply want to better understand your body, this conversation is filled with practical education and encouragement.

About Dr. Casey Mosos

Dr. Casey Mosos is a pelvic floor physical therapist, dry needling certified clinician, and perinatal exercise specialist passionate about helping women feel empowered in their bodies. She specializes in treating pelvic pain and endometriosis, a condition she personally lives with, giving her both clinical expertise and firsthand understanding of the challenges many women face.

Originally from Pennsylvania and raised in the Florida Keys, Casey earned her Doctorate in Physical Therapy from the University of St. Augustine for Health Sciences. Through education rooted in evidence and real-life experience, she helps women better understand their bodies and find hope for healing.

Connect with Dr. Casey Mosos

Instagram: @dr.caseymosos

Business Instagram: @insideoutpelvicpt

Website: Inside Out Pelvic Health and Wellness

Email: [email protected]

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.

In this final episode of my three-part hormone series, we're talking about the hormone many women overlook: testosterone.

Most women associate testosterone with men, but it plays a critical role in women's health too. From muscle maintenance and metabolism to energy, motivation, confidence, recovery, and insulin sensitivity, testosterone influences far more than most of us realize.

If you've been feeling weaker in the gym, struggling with brain fog, noticing changes in body composition, or simply feeling less motivated than you used to, low testosterone may be part of the conversation worth having with your healthcare provider.

In this episode, you'll learn:

✔ Common physical symptoms of low testosterone ✔ Why muscle is one of the most powerful tools for metabolic health ✔ The connection between testosterone and insulin sensitivity ✔ Mental and emotional signs that may be overlooked ✔ Possible signs your testosterone levels may be too high ✔ Questions to ask your healthcare provider ✔ Why symptoms—not just lab numbers—matter when evaluating hormone health

Throughout this series, we've explored how estrogen helps us feel balanced, progesterone helps us feel calm, and testosterone helps us feel strong.

Most importantly, I want you to remember this:

Your symptoms are not random. They are information.

When you learn how to recognize patterns and connect the dots, you become a stronger advocate for your health and your future.

Resources Mentioned

📘 Highs, Lows & Hormones: A Survival Guide for Women Managing Diabetes from Monthly Cycles to Menopause

Inside the book you'll find:

• The Symptom Hormone Matching Guide (Chapter 4)
• Symptom tracking worksheets
• Hormone education designed specifically for women managing diabetes
• Practical tools to help you communicate more effectively with your healthcare team
• Access to 12 companion resources and guides

Get your copy of the book through the link below.

If this episode encouraged you, please share it with another woman who needs this conversation today.

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:

Type 1 In Midlife Coaching 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've ever been told, "Your thyroid labs are normal," yet you still struggle with fatigue, brain fog, stubborn weight gain, or unpredictable blood sugars, this episode is for you.

I'm joined by Dr. Amie Hornaman, known as "The Thyroid Fixer," to unpack one of the most overlooked pieces of women's health—your thyroid.

We explore why thyroid dysfunction is so common in women living with type 1 diabetes, the powerful connection between Hashimoto's and autoimmune disease, and why standard thyroid testing often misses the full picture.

Dr. Amie also explains how thyroid hormones influence insulin sensitivity, metabolism, energy, and even menopause symptoms. Most importantly, she shares practical ways to advocate for yourself so you can stop settling for "normal" when you know something still isn't right.

Whether you've been diagnosed with hypothyroidism, Hashimoto's, or you're simply searching for answers, this conversation will help you better understand your body and feel more confident asking the right questions.

In this episode, you'll learn:

• Why the thyroid is often called the body's "master gland" • The connection between Hashimoto's and type 1 diabetes • How thyroid function affects insulin needs and blood sugar • Why TSH alone doesn't tell the whole story • Which thyroid labs provide a more complete picture • How menopause and thyroid health influence one another • Why many women continue to struggle even after starting thyroid medication • Practical ways to advocate for the care you deserve

If this episode encouraged you, please share it with another woman living with diabetes. The more we understand our hormones, the better equipped we are to advocate for our health.

Resources mentioned: • Dr. Amie Hornaman's book, The Thyroid Fix • The Thyroid Fixer Podcast • Connect with Dr. Amie at dramie.com

Connect on IG @dramiehornaman

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:

Type 1 In Midlife Coaching 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 a person living with Type 1 diabetes spends more than four decades navigating the condition—and then helps shape the future of healthcare?

In this episode, I'm joined by Hanna Boëthius, patient advocate, international speaker, consultant, and person living with Type 1 diabetes for more than 41 years.

Together, we explore why lived experience matters, why people with diabetes deserve a seat at the table when decisions are being made, and how healthcare can move from simply treating patients to truly partnering with them.

We discuss:

• What life with Type 1 diabetes looked like in the 1980s compared to today • Why patient voices belong in healthcare conversations • The difference between patient-centered care and true collaboration • How women continue to be underrepresented in research • Why diabetes management must be individualized • The challenges and opportunities of diabetes technology and data • The role of peer support and community • How to advocate for yourself during medical appointments • Why "Nothing About Us Without Us" is more important than ever

Whether you've lived with diabetes for decades or are newly diagnosed, this conversation is a powerful reminder that your experience matters, your voice matters, and you deserve to be an active partner in your care.

Connect with Hanna Boethius:

IG @hannadiabetesexpert

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:

Type 1 In Midlife Coaching 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.