Type 1 Diabetes in Midlife: The Night My Blood Sugar Hit 23 (And What Finally Helped)

It was 3 AM, and I’d been fighting lows all day.

No amount of juice, glucose tabs, or cereal would hold my numbers in a safe place. I’d gone to bed having eaten a little extra just to be safe. I still woke up to my meter reading 23.

If you live with Type 1, you know what that number means. The shaky, sweaty, can’t-think-straight feeling of it. And the quieter fear underneath: I did everything right, and my body still didn’t cooperate.

That night was the night I stopped accepting that this was just how it had to be. But to explain why it mattered so much, I have to back up.

How I got here: a Type 1 diagnosis at 34

I was diagnosed with Type 1 diabetes in 2009, at 34. No family history. No warning I understood at the time.

Looking back, the signs were there. Blurry vision after carb-heavy meals. Fatigue I couldn’t shake. A cold that lingered too long. Waking up at night to use the bathroom, more and more often. Clothes fitting looser without trying. And then, by the end of the third month, a thirst unlike anything I’d ever felt.

I kept dismissing myself. I wasn’t that overweight. I was still young. I had no idea Type 1 could start at any age. It was the furthest thing from my radar.

The last straw came after a family reunion in Iowa. I was driving home alone, a 10-hour trip, hit with the kind of fatigue that lands like a freight train. I stopped at nearly every gas station just to stay awake and quench a thirst that wouldn’t quit. The next morning, I called my doctor.

My blood sugar was over 350. My A1C came back over 14. Complete shock.

I was lucky. My doctor was well-educated, suspected Type 1 right away, and sent me to an endocrinologist for confirmation. A misdiagnosis at that stage could have meant real complications and a much longer road to stability.

After the shock wore off, I went all in. I was afraid to eat anything those first days, calling in every morning until we found the right balance. But I learned. I found my rhythm. About four years went by. Not perfect, still good days and bad, but a new normal I could mostly trust.

Then, at 38, things stopped making sense again

Blood sugars that followed no pattern I could explain. One morning I woke up with a soaking wet chest and sweaty shins. My first instinct was to check for a low, but that wasn’t it. So I did what most of us do: I started Googling, and scared myself with everything from nighttime fevers to cancer.

Over time, I started noticing patterns. Higher blood sugars leading up to my period. Extreme lows right around the start of my cycle. Mood swings. Acne I’d never had even as a teenager. Fatigue that hit like a freight train around my period. Then new ones crept in: trouble concentrating, a feeling of gravel under my eyelids at night.

I had no idea this was the beginning of perimenopause. No one talked about it. No one warned me.

Why perimenopause makes Type 1 diabetes harder

Here’s what I understand now that I didn’t then. During perimenopause, estrogen and progesterone fluctuate, and those two hormones directly affect how sensitive your body is to insulin. When they swing, your insulin needs swing with them. That’s why your blood sugar can feel unpredictable even when your food, dosing, and routine haven’t changed at all.

I asked questions at every appointment. One OB-GYN mentioned hormones but had no test to confirm it. My endocrinologist didn’t have much to add. The one concrete suggestion anyone gave me was to try vitamin B.

So I was on my own, chasing numbers I couldn’t control, wondering if this was just what the rest of my life was going to feel like.

That’s the backdrop the night of the 23 landed against. Not one bad night in isolation. The top of a long pile of them.

What actually changed things

That night, I decided that no matter the cost, I needed a CGM and an insulin pump. I was still on multiple daily injections and manual checks. Getting the approvals took time, but my endocrinologist was supportive. When the technology finally came through, I felt a small, real sense of peace.

Around the same time, I was connected with other women through Diabetes Sisters. Through that community, I learned about the DIY Loop system, a phone app with algorithms built by people in the diabetes community themselves. It talks to both a Dexcom CGM and an insulin pump like the Omnipod, turning them into a closed-loop system, sometimes called an artificial pancreas. If your blood sugars trend low, it slows or suspends insulin. If they trend high, it delivers a little more to keep you in range.

After watching a friend use it and seeing how excited she was, I went all in and learned it myself.

It didn’t make me perfect. I still have days where the numbers make no sense. But it gave me my nights back. It gave me a floor I could stand on. Through years of experimenting with diet, movement, supplements, and a lot of patience, I’ve kept my A1C consistently between 5.6 and 6.2.

I’ll add one more honest thing here, because I think it matters. At one point, when the symptoms and life stresses were just too much to carry alone, I went on antidepressants for a while. That doesn’t make you weak or dysfunctional. That makes you resourceful.

What this whole journey taught me

You’re not failing when the old rules stop working. The variables changed. Your strategy gets to change with them.

I spent years thinking I was doing something wrong. That if I just tried harder, logged more carefully, controlled tighter, I’d get back to the management that used to work. But the problem was never my effort. My body was changing, and no one had told me the strategy needed to change with it.

Most of the doctors I saw simply weren’t taught how perimenopause and Type 1 collide. I don’t say that to be bitter. The gap is real, and it isn’t their fault, but you and I are the ones standing in it. The more I talked openly with other women, the more I realized how many of us were in that exact spot, quietly assuming we were the only ones.

We weren’t. You aren’t.

Where I stand today

I’m feeling better than I have in the last five years. That says a lot.

And now I have something I didn’t have before: real knowledge, hard-earned experience, and a genuine desire to help other women with Type 1 navigate this season without suffering as long as I did, or figuring it out alone.

There’s no single approach that works for everyone. Every woman’s hormones, management, resources, and stress load are different. But with patience and the right support, relief is genuinely achievable.

You are not broken. You are not just too old to feel good anymore. Your body is changing, and your strategy can change with it.

This isn’t about more control. It’s about working with your body instead of fighting it.

You’re not crazy. And you are absolutely not alone.

Common questions about Type 1 diabetes in midlife

Does perimenopause affect blood sugar in Type 1 diabetes?

Yes. Fluctuating estrogen and progesterone during perimenopause change how sensitive your body is to insulin, which can make blood sugar more unpredictable, even when your food and dosing stay the same.

Can Type 1 diabetes start in adulthood?

Yes. Type 1 can be diagnosed at any age. I was diagnosed at 34, with no family history. Adult-onset Type 1 is more common than many people realize and is sometimes mistaken for Type 2 at first.

Why does Type 1 feel harder to manage after 40?

The routines that worked for years can stop working because midlife hormone shifts change your insulin needs. It’s usually not a discipline problem. It’s a sign your strategy needs to adjust to a body that’s changing.

Nothing here is medical advice. I’m sharing what I’ve learned living with Type 1 diabetes through midlife, not practicing medicine. Always work with your own care team on changes to your management, devices, or medications.