Diabetes and Hot Flashes

If you’re a woman approaching or in menopause, hot flashes may be the bane of your existence. Those all-too-familiar bursts of heat can mean discomfort and much misery. Women who have diabetes may have hot flashes that can be linked with low blood sugars, too. Read on to learn more about hot flashes and what you can do to help keep them at bay.

What exactly are hot flashes?
Hot flashes are sudden feelings of intense warmth that can come on over a few minutes or, more likely, all of a sudden. They are often accompanied by other symptoms, such as redness of the face or neck, sweating, rapid heartbeat, headache, and then feeling chilled once the flash has passed.

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“Night sweats,” or hot flashes that occur at night and result in excessive sweating, can be particularly disruptive to sleep. Recurring night sweats can lead to insomnia.

While hot flashes can occur in anyone for a variety of reasons, they’re very common in women who are approaching menopause (perimenopause) or who are menopausal. (Men can also have hot flashes due to androgen deprivation therapy.) There’s no rhyme or reason to them, either: they can vary in intensity, they can come and go quickly or linger, and they can persist for months or even for years. Hot flashes are also more likely to occur in women who are overweight or who smoke. African-American women are more likely to get hot flashes than Caucasian women; women of Asian descent are less likely to experience them.

What causes hot flashes?
The cause of hot flashes is somewhat of a mystery. However, scientists believe that they’re related to imbalanced levels of hormones, such as estrogen and progesterone, and changes in the body’s thermostat, which is located in the hypothalamus in the brain. When a hot flash occurs, blood vessels in the skin dilate, causing blood to move into the area — hence, the redness and heat.

While hot flashes can sometimes appear to occur for no particular reason (other than to be annoying), there are certain factors that seem to trigger them. These include:

• Spicy foods
• Alcohol
• Hot beverages
• Caffeine
• MSG (monosodium glutamate)
• Smoking
• Warm temperatures
• Stress
• Anxiety
• Hyperthyroidism
• High blood pressure
• Certain medicines, such as raloxifene (brand name Evista), tamoxifen (Nolvadex, Tamoxen, Tamofen, Soltamox), tramadol (Ultram, Conzip, Rybix ODT, Ultram ER), and nitroglycerin (Nitro-Bid, Nitro-Dur, and others)

What’s the link between diabetes and hot flashes?
It’s not uncommon for women who are perimenopausal to have a higher risk of developing diabetes. Fluctuating hormone levels may lead to spikes and dips in blood sugar levels, and can also lead to insulin resistance. Add insult to injury: many women find that they develop food cravings and sleep poorly during this time of their life, which can cause weight gain and raise the risk of diabetes.

Women who have diabetes and who have hot flashes may find that, on top of the usual symptoms, they may feel shaky, confused, and/or weak. Why? It’s likely that low blood sugar is a trigger for hot flashes. Pay close attention to when your hot flashes occur, such as before a meal or after exercising, especially if you take insulin or certain types of diabetes pills that can cause lows, including sulfonylureas and meglitinides. Also, it’s a good idea to check your blood sugar if you have a hot flash that’s accompanied by typical symptoms of lows.

How to deal with hot flashes
There are many suggested ways to handle hot flashes. Lifestyle changes are often recommended first, such as:

• Trying to avoid or minimize triggers (see above)
• Dressing in layers
• Sipping on ice water
• Sleeping with a fan or the air conditioner turned on
• Using a “cooling” pillow and sheets
• Exercising regularly

Natural remedies are often touted, too. These include the use of herbs and essential oils. Black cohosh, dong quai, evening primrose oil, and soy are popular, as well as peppermint, lavender, geranium, and clary sage oils. Be careful using these remedies, however. Most of them are not well tested, and all of them can have potential harmful side effects. Talk with your health-care provider about the risks and benefits of using these.

The “big guns” are medications. Hormone replacement therapy (HRT) is probably the most effective way to treat hot flashes. Estrogen, with or without progesterone, helps to balance out hormone levels in the body, thus reducing or even eliminating hot flashes and improving quality of life. And HRT can help with other menopausal symptoms, such as vaginal dryness and discomfort. However, HRT hasn’t been without its controversies, and it may not be appropriate for some women. The good news is that a low dose of HRT for a short period of time is believed to be safe, along with being effective. Weigh the pros and cons of using HRT with your provider.

If you choose not to or cannot use HRT, there are non-hormonal medicines that may work. For example, certain antidepressants (fluoxetine [Prozac], paroxetine [Paxil], venlafaxine [Effexor]) can help minimize hot flashes. Brisdelle is a newer medicine that contains paroxetine and is specifically aimed at hot flash treatment. Other medicines may help too, such as those used to treat nerve pain (gabapentin [Neurontin], pregabalin [Lyrica]), and clonidine (Catapres, Kapvay, Nexiclon, Clophelin, and others), a blood pressure medicine. Of course, all medicines have potential side effects, so decide with your provider if any of these are an option for you.

What else can you try? Acupuncture has been found to be effective in managing hot flashes and night sweats. And research indicates that managing stress through meditation is also helpful in easing hot flashes, as well.

Also, don’t overlook nutrition: following a Mediterranean diet (which emphasizes fruits, vegetables, beans, and whole grains) is beneficial, as is getting plenty of omega-3 fatty acids in your diet (found in foods such as salmon, tuna, mackerel, flaxseed). Soy foods may also help — these include unsweetened soy milk, soy nuts, and tofu.

For more information about hot flashes and menopause, in general, visit The North American Menopause Society’s website.

Want to learn more about staying healthy as an older woman with diabetes? Read “Menopause: What to Expect, How to Cope,” and “Top 10 Health Tips for Women Over 65.”