Navigating sex with type one diabetes and an insulin pump

I was diagnosed with type one diabetes at the tender age of seventeen and a year later, was prescribed an insulin pump. At the age when I was beginning to explore the world of sex, I was reminded to use contraception but not given any advice on how to navigate my new body. When my insulin pump was installed, my hidden disability suddenly became very visible, and I retreated: how could I explore intimacy when I resembled a robot?

Type one diabetes is an autoimmune disease that destroys the insulin-producing cells in the pancreas, which hampers the body’s ability to control blood glucose. As a result, type ones like me are required to take insulin either via injection or a pump, which is a small device attached to the body that continuously delivers insulin.

Current clinical guidance largely fails to recognise that type one women and people with vaginas are sexual beings, leaving us to deal with issues such as body confidence, managing low blood sugar (known as a “hypo”) during sex, and how to communicate our type one status to new sexual partners on our own. Type ones have sex, but how are we supposed to feel sexy?

Pumps are a very physical reminder of disability: they are attached to skin and, if they have tubing that’s connected to an accompanying glucose monitor, you will need to have a pocket in which to store this

“Finding sexy underwear that can hide a pump is impossible. There are clothes with areas to insert a pump, but they don’t look nice,” says Holly, 36, who was diagnosed with type one at 18 months old. “I wish there was a market for lingerie that makes my pump part of the design. Being attached to a machine made me feel like I couldn’t hide my disability.”

Pumps are a very physical reminder of disability: they are attached to skin and, if they have tubing that’s connected to an accompanying glucose monitor, you will need to have a pocket in which to store this. Companies such as Anna PS and Hid In market type-one inclusive underwear, though these products often feel stiff and utilitarian rather than sexy.

Type one diabetes is an incredibly complex condition, and people living with it often struggle to communicate their type one status to new sexual partners. Twenty-eight-year-old Emma, diagnosed at the age of 12, says: “I’ve never brought up diabetes with a one-night stand – it feels too personal.” Twenty-two-year-old Kate, diagnosed at the age of seven, continues: “A few years ago, I had a hypo with a one-night stand. I felt awkward bringing it up as the person didn’t know I was diabetic. I went to the bathroom and sorted it out myself.”

“I was anxious about going on the pill because of the blood clotting risk, and having diabetes meant my doctor was keen for me to go on contraception”

Many type one people with vaginas also experience anxiety about how contraception might affect their diabetes. Some doctors may be more likely to recommend contraception because being pregnant with diabetes carries risk of health complications. As Diabetes UK notes, when pregnant, glucose levels need to be tightly under control — else there is a higher risk of miscarriage, experiencing problems with eyes and kidneys, and giving birth to a larger baby which could necessitate a C-section. “When choosing a new contraception, I research any potential side effects which could impact my diabetes,” says Kate. “I was anxious about going on the pill because of the blood clotting risk, and having diabetes meant my doctor was keen for me to go on contraception.”

Type one diabetes can also facilitate vaginal dryness and being on the contraceptive pill can further increase this risk, which can make penetrative sex uncomfortable and impact body confidence. Sex and relationship therapist Rhian Kivits suggests: “[Vaginal dryness] can be handled by being prepared with a lubricant, or with coconut oil which is my preferred option because it’s natural. Good management of diabetes can also reduce problems with thrush and cystitis.”

When it comes to confidence, many type ones find that it helps to plan ahead if they know that sex is on the cards. “Checking blood sugars before and after sex, and being prepared for hypos will help you focus on feeling good and embracing your sexy side”, advises Kivits. “It’s possible to detatch the pump for up to an hour, if that’s what you would prefer, but it’s also possible to work around it.”

The nuances of type one and sex are often overlooked and spoken of in clinical terms, but we’re here, having sex, just like everyone else

During one-night stands, communication is important. “Let your partner know that you feel vulnerable or anxious about your pump or monitor. New partners might be unfamiliar with the reality of living with type one,” says confidence expert and author of How to Feel Beautiful Lizi Jackson-Barrett. “Some people like to introduce potentially uncomfortable conversations through humour, or you could suggest a game of ‘two truths and a lie’ where one of your truths could be related to your type one status.”

People living with type one diabetes deserve to feel empowered during sex, whether it’s with a long-term partner or during a one-night stand. The nuances of type one and sex are often overlooked and spoken of in clinical terms, but we’re here, having sex, just like everyone else. Type one bodies have been pricked and poked but are beautiful in spite of their scars.

Kivits adds: “What is sexy to each of us is a very personal thing. Just because you might not want to wear lacy g-strings because of your insulin pump, it doesn’t mean you aren’t sexy.”
 
Featured image is an illustration of a person with a vagina reclining back on their elbows, as if lying on a bed or sofa, with their hands over their breasts. They are only wearing their underwear, to which an insulin pump is attached
 
Page last updated May 2021