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Diabetes & Women

                                           Nikheel Kolatkar





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 ethnicities.

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 diabetes.

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 diabetes.

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 being diagnosed.

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

Increased fatigue


Blurry vision

Slow-healing sores

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 physician.

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 drink.

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 diabetes.

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 in fiber

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 diabetes.

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 testing needed?

What are my target ranges for glucose and glycohemoglobin?

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 cycle?

How can diabetes affect my sexual health?

Are there ways I can avoid yeast infections?

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?

Courtesy: Nikheel Kolatkar