Millions of women have diabetes. It is a major cause of death and a major
contributor to heart disease, which is the No. 1 killer of women.
Diabetes can create a multitude of problems in women. For example, deaths
from heart disease in diabetic women rose 23 percent over the past 30 years,
compared to a decrease of 27 percent in no diabetic women, according to the
U.S. Food and Drug Administration (FDA).
Women with diabetes have a greater risk than no diabetic women of developing
sexual dysfunction, yeast infections and urinary tract infections. Even for
women who do not have diabetes, up to 8 percent of pregnancies result in
gestational diabetes. Although this form of diabetes disappears after
delivery, women who have had gestational diabetes have a much greater risk
of developing type 2 diabetes later in life.
Additionally, women are prone to many diabetic complications such as eye
disease and stroke. In some cases, the rates of these complications are
higher for women than men.
About diabetes and women
One-tenth of American women - 11.5 million - had diabetes in 2007, according
to the National Institutes of Health (NIH). That number is up from 9.7
million in 2005, and nearly a third of cases are undiagnosed. Women account
for about half of the 246 million cases of diabetes worldwide, according to
the International Diabetes Federation.
These figures are continuing to rise alarmingly, mainly because obesity is
leading to more cases of type 2 diabetes. The number of diabetes cases more
than doubled from 1980 to 2002, the U.S. Centers for Disease Control and
Prevention (CDC) reported in 2006. The growing prevalence of diabetes
includes gestational diabetes, a temporary condition that can occur only
during pregnancy and that puts a woman at higher risk for developing type 2
diabetes later in life.
Diabetes is considered a serious health challenge for all women and, in
particular, women of color, including blacks, Hispanics, Native Americans,
Asian Americans and Pacific Islanders.
Nearly 1 in 4 black American women over the age of 55 have diabetes, which
is almost twice the rate of white women. Women of Native American and
Alaskan descent have three times the risk as compared to whites, and 25
percent of Hispanic women have been diagnosed with diabetes. Gestational
diabetes is estimated to be 50 to 80 percent more common in black American
women than in white women.
Diabetes is among the top 10 leading causes of death for women of all
Diabetic complications among women
Diabetes poses special problems and complications for women. For example:
Cardiovascular disease, the leading cause of death in people with diabetes,
is more serious among women than men, according to the U.S. Food and Drug
Administration (FDA). Diabetic women are more likely to die from a first
heart attack than diabetic men. Peripheral vascular disease occurs nearly
eight times more often in diabetic women than in no diabetic women,
according to the FDA.
The risk of diabetic ketoacidosis, a dangerous condition that can lead to
diabetic coma, is 50 percent higher for women than for men, according to the
FDA. Ketoacidosis, involving severe hyperglycemia and high levels of a waste
product called ketones, can result from poorly controlled diabetes.
Women with diabetes have a shorter life expectancy than women without
Pregnant diabetic women are at increased risk of diabetic retinopathy and
vision loss. Women in general may be at greater risk of blindness from
diabetes than men.
Diabetes increases the risk of several musculoskeletal disorders that are
more common in women than men, including osteoporosis and osteoporotic
fractures. Women with type 1 diabetes are seven to 12 times more likely to
experience a hip fracture than women without diabetes, according to the
American Diabetes Association. This increased risk is believed to result
from a lower bone mineral density. Women with type 2 diabetes generally have
higher bone density but have also been found in some studies to have an
increased risk of fractures.
People with type 1 diabetes face increased risk of other autoimmune diseases
that are far more common in women than men, including rheumatoid arthritis,
lupus, Addison's disease (adrenal insufficiency) and certain thyroid
disorders including Gravesí disease and Hashimoto's thyroiditis.
Diabetes increases the risk of endometrial (uterine) cancer and may increase
the risk of cervical cancer, breast cancer and some other malignant tumors.
Memory loss, cognitive impairment and mild forms of dementia are more common
in older diabetic women, believed to be a result of an acceleration of aging
on the brain caused by diabetes.
Diabetes increases the risk of yeast infections and urinary tract
infections. Diabetes may cause urinary difficulties such as overactive
bladder. Diabetes increases the risk and severity of urinary incontinence
(loss of bladder control) in elderly women, researchers have found.
Birth control pills can affect glucose (blood sugar) levels and interfere
with diabetes control.
Menstruation can cause fluctuations in the glucose levels of women with
Menopause often hampers glycemic control in women with diabetes.
Women may develop diabetic mastopathy, a condition in which no cancerous
lumps form in one or both breasts. Women on long-term dialysis for end-stage
renal disease, the leading cause of which is diabetic nephropathy, may face
increased risk of breast calcifications, research has suggested
Research suggests that diabetic women with certain conditions, including
cystic fibrosis (an inherited diseased that damages the lungs and pancreas),
fare worse than diabetic men and nondiabetic women with those conditions.
The influence of hormones is believed to account for the disparity.
Pregnancy issues in women with diabetes
Although pregnancy is no longer generally discouraged among women with
diabetes as it once was, women with diabetes who are planning to become
pregnant should be aware of the risks to mother and fetus.
Risks to the expectant mother can include preeclampsia (a condition
involving high blood pressure and proteinuria), polyhydramnios (excess
amniotic fluid during pregnancy), edema (swelling) and urinary tract
infections. Additionally, complications such as diabetic retinopathy and
diabetic nephropathy may become aggravated.
Risks to the fetus can include miscarriage, birth defects and respiratory
distress syndrome (RDS). Any woman with diabetes who is considering having a
baby should first have a physical examination and preconception counseling.
The American Diabetes Association (ADA) recommends that women with diabetes
control their glucose (blood sugar) levels for three to six months before
trying to conceive. This is because glucose irregularities can alter the
mother's metabolism and as well as the intrauterine environment where the
baby grows, resulting in complications such as birth defects.
Women with diabetes will also have to monitor their glucose levels more
carefully and frequently during pregnancy because insulin and other hormone
levels fluctuate during this time.
Another diabetic pregnancy issue is gestational diabetes, which occurs when
nondiabetic women develop diabetes during pregnancy. Gestational diabetes
ends when the pregnancy does but increases the mother's risk of developing
type 2 diabetes later. Women can reduce their risk of gestational diabetes
through exercise and a sensible diet.
Sexual dysfunction in women with diabetes
Diabetes can cause sexual dysfunction in women and men. Problems with sexual
function in women may include:
Decreased lubrication of the vagina
Pain or discomfort during intercourse (dyspareunia)
Decreased vaginal sensitivity (often
due to autonomic neuropathy)
Difficulty reaching orgasm
Additionally, as many as 35 percent of
women with diabetes experience diminished or no response to sexual
stimulation, according to the National Institute of Health.
Risk factors and causes of diabetes in women
Many diabetes risk factors affect women and men. Examples of these include:
Family history - Individuals with a family history of diabetes have
an increased risk of developing the condition.
Race - Certain races are more
prone to developing a specific type of diabetes than others. For instance,
black Americans, Hispanics, Native Americans and Asians are more likely to
develop type 2 diabetes than whites. Whites have higher rates of type 1
diabetes than people of other races.
Weight - Overweight or obese individuals have an increased risk
of developing type 2 diabetes. In fact, about 80 percent of people who have
type 2 diabetes are considered to be overweight or obese.
Activity level - Low levels of physical activity and poor exercise
habits increase the odds of developing type 2 diabetes.
Other lifestyle factors - Cigarette smoking and alcohol abuse
increase a person's risk of developing type 2 diabetes, although moderate
use of alcohol may help prevent diabetes, according to some research. Other
potential risk factors for diabetes include stress and inadequate sleep.
There are also certain diabetes risk factors that affect only women. These
include polycystic ovarian syndrome (PCOS) and gestational diabetes. PCOS is
a genetically complex hormonal disorder that causes irregular menstruation,
excessive hair growth and obesity. Though it often appears during
adolescence, it may not become apparent until later in life when a woman has
difficulty becoming pregnant.
PCOS is significant as it is considered a major risk factor for the
development of type 2 diabetes in women. With a prevalence of 5 to 10
percent, PCOS is considered to be the most common hormonal disorder in women
of reproductive age in the United States.
PCOS causes small cysts on the ovaries, as well as an increase in the level
of androgens (male hormones). This can lead to infertility problems or even
the development of insulin resistance. Insulin resistance occurs when normal
levels of insulin produced by the pancreas are unable to get to the cells.
As a result, the risk for type 2 diabetes goes up.
Gestational diabetes is a type of
diabetes that can occur only during pregnancy. Black American, Hispanic,
Asian and Native American women have an increased risk of developing this
condition. Gestational diabetes is also more common among obese patients and
those with a family history of diabetes.
About 5 to 10 percent of women with gestational diabetes develop type 2
diabetes after pregnancy. Patients who have had gestational diabetes have a
20 to 50 percent chance of developing type 2 diabetes within five to 10
years of their pregnancy.
In addition, medications including estrogens and injected contraceptives may
lead to secondary diabetes.
Signs and symptoms of diabetes in women
Symptoms of type 1 diabetes typically develop over a short period of time.
With type 2 diabetes, symptoms generally develop at a slower pace. Sometimes
people have only mild symptoms or do not experience symptoms at all. It is
not uncommon for a woman to have type 2 diabetes for 10 years or more before
For this reason, it is important for women at risk to be aware of the
symptoms. Symptoms of diabetes may include:
Frequent urination (polyuria)
Excessive thirst (polydipsia)
Extreme hunger (polyphagia)
Unexplained weight loss
Frequent infections, including yeast
infections, urinary tract infections, skin infections and thrush Dry, itchy
skin (pruritus) Numbness or tingling in hands or feet Red, swollen or tender
gums or gingivitis
Dark, velvety patches in the folds of the skin may indicate a skin disease
called acanthosis nigricans, which often involves insulin resistance,
polycystic ovarian syndrome or diabetes.
Symptoms vary from person to person and can also be caused by many other
conditions. Women experiencing any of these symptoms are encouraged to see a
Women should be aware that certain complications may cause different
symptoms as compared to men. A woman who suffers a heart attack, for
instance, may have less typical symptoms. Women are less likely than men to
feel severe chest pain and are more likely to report a feeling of severe
heartburn in the upper abdomen or pain in the breast.
Unless a woman is familiar with these atypical symptoms, she may delay
getting to the hospital. Because cardiovascular conditions are common among
patients with diabetes, women should learn all they can about specific
complications that can occur.
Diagnosis methods for diabetes in women
Although symptoms can point to diabetes, the only way for a physician to
diagnose it is with blood tests. A physician who determines that a test
result is outside of the normal range may order repeat glucose tests to
verify results or additional tests to determine the causes of the
abnormality. Common tests for diagnosing diabetes include:
Fasting plasma glucose test (FPG). This screening test for diabetes is often
conducted when people have a routine physical examination. A blood sample is
taken after the patient has not eaten for at least 10 hours. Normal fasting
glucose is below 100 milligrams per deciliter of blood (mg/dL).
Glucose challenge test. Many pregnant women receive this test to screen for
gestational diabetes. The patient is given 50 grams of a sugary solution to
drink. A blood sample is drawn an hour later. If results are abnormal, an
oral glucose tolerance test is used to confirm diagnosis.
Oral glucose tolerance test (OGTT). This may be used in diagnosing
gestational or other forms of diabetes. Preparation includes eating a
high-carbohydrate diet for a few days and then fasting for at least 10
hours. Normal glucose is below 140 mg/dL two hours after consuming a sugary
The American Diabetes Association (ADA) recommends that anyone (female or
male) age 45 or older have a fasting blood glucose test, especially if
overweight or obese. If results are normal, the patient should be retested
again every three years. A patient diagnosed with prediabetes should be
checked for type 2 diabetes every one to two years. For overweight patients
younger than 45, a physician may recommend testing if any other risk factor
for diabetes is present.
Treatment options for women with diabetes
After a diagnosis, the most important goal is generally to stabilize glucose
(blood sugar) levels. A woman's physician will recommend a target glucose
range. The patient will strive to keep her glucose level within her
physician-recommended range with a plan that typically includes diet and
exercise and that may include medications.
Type 1 diabetes and latent autoimmune diabetes of adulthood (LADA) require
insulin therapy and frequent glucose monitoring. Insulin is also used to
treat some other cases of diabetes, such as many women who have gestational
Usually the first line of treatment for type 2 diabetes is meal planning and
physical activity for glucose control and weight loss. Losing weight and
increasing activity levels can help lower reduce insulin resistance.
Exercise also reduces glucose levels by taking glucose from the blood and
using it for energy. Healthy eating helps glucose levels stay lower. If
these steps are not enough to bring glucose levels down near the normal
range, the physician may recommend antidiabetic agents or insulin or both.
Women (and men) with diabetes often also have high blood pressure and
unhealthy cholesterol levels as well. These conditions may also be treated
with a combination of diet, exercise and medication.
Prevention methods for diabetes in women
Studies have shown that lifestyle changes can prevent or delay the onset of
type 2 diabetes in women at risk of developing the disease. Some of the most
common strategies include:
Eating a healthy diet, especially one that is low in fat and sugar and high
Losing excess weight and maintaining a healthy weight
Exercising regularly, to help lower glucose (blood sugar) levels and help
the body use insulin
Controlling cholesterol levels
Controlling high blood pressure (hypertension)
Limiting alcohol intake
Quitting smoking or not starting to smoke
It may also help to get adequate sleep and control stress.
In addition, a major federal research project has found that breastfeeding,
besides its other health benefits for the woman and baby, can help prevent
diabetes in the mother. Data for about 157,000 women from the Nurses' Health
Study and the Nurses' Health Study II showed that the longer participants
breastfed, the more they reduced their risk of becoming diabetic.
Breastfeeding may also reduce the child's risk of childhood obesity and
Questions for your doctor
Preparing questions in advance can help patients have more meaningful
discussions with their physicians regarding their conditions. Patients may
wish to ask their doctor the following questions about diabetes and women:
Do I have or am I at risk of developing diabetes?
What sort of diagnostic testing might I
have to undergo?
How often should I have these tests?
What do my test results show? Is more
What are my target ranges for glucose
What are my treatment options, and
which do you recommend?
Do I also need to control my blood
pressure, cholesterol or anything else?
What exercises should I do, and are
there any I should avoid?
What sort of diet should I follow? Do
you recommend I see a dietitian?
What monitoring tests will I need to
have, and how often?
How can diabetes affect my menstrual
How can diabetes affect my sexual
Are there ways I can avoid yeast
Does diabetes increase my risk of
osteoporosis, fractures or other bone problems?
Will it be safe for me to have a baby?
What affect could my diabetes have on a
pregnancy and on my baby?
What lifestyle changes can I make to
reduce the risk of diabetes or diabetic complications in myself, my children
and my husband?