Women and Diabetes

By Elizabeth H. Holt, MD, FACE

Are you a female with diabetes? If so, you are one of about 11.7 million women in the United States with this disease, most whom have Type 2 diabetes, the diabetes that occurs when the body is unable to use insulin efficiently and gradually produces less insulin over time. About 5 to 10 percent have Type 1 diabetes, which is the diabetes caused by very low or absent insulin production.

Women may experience having diabetes differently than men. Some of these differences are obvious. For instance, women can develop vaginal yeast infections as a result of having high blood sugars, and women are more likely to have urinary tract infections when their blood sugars are elevated. The yeast organisms and bacteria that cause these infections feed on sugar, but the body’s immune system is unable to fight them off as effectively in the presence of high blood sugar levels.

Women can also experience irregular menstrual cycles and may find that their blood sugars are more difficult to control right before or during a menstrual period. Some women on insulin even find that they need to take higher doses of insulin in the days right leading up to their monthly menstrual cycle.

Pregnancy and diabetes

When a woman with diabetes is pregnant, she has to worry not only about how the diabetes affects her health during the pregnancy, but also the health of her unborn child. A woman who has diabetes before getting pregnant has an increased risk for miscarriage or having a baby with a birth defect. Her blood sugars can become difficult to control during a pregnancy due to increased insulin resistance. And if she has Type 2 diabetes controlled with medications other than insulin, she may be advised to change this medication regimen to insulin injections prior to conception due to the potential for adverse effects from the medications on the developing baby. If she has Type 1 diabetes, she may find that she needs to increase her insulin dosages through the first part of the pregnancy and make more frequent dose adjustments than she was previously making.

Women without diabetes can develop diabetes during pregnancy. This is called gestational diabetes and affects 2 to 5 percent of all pregnancies. After delivery, the gestational diabetes usually goes away, but the woman remains at high risk for developing Type 2 diabetes in the next 10 to 20 years, with 60 percent of these women eventually developing diabetes.

Because many of the risks of diabetes on a pregnancy can be reduced with good blood sugar control, especially during the early weeks of a pregnancy, it is important for a woman with diabetes to plan her pregnancy and delay conceiving until her blood sugars and hemoglobin A1C – a test that determines average blood sugar levels over a three-month period – are at target. Even before conceiving, she may need to use medications that are safe for pregnancy. This allows her to remain on a medication regimen known to work for her after she becomes pregnant.

Pregnancy planning starts by using reliable contraception whenever a couple is not actively trying to conceive and continuing contraception use until the woman and her healthcare team have determined that she is healthy and has her diabetes adequately controlled.

Genetics and diabetes

A child born to a mother who had diabetes during her pregnancy has a higher chance of becoming obese during childhood or the teenage years as well as developing Type 2 diabetes later in life. In fact, a recent French study showed that if a female has relatives with diabetes, her risk for developing diabetes is doubled. This risk is highest if the relative with diabetes is her mother (the risk is elevated more than fourfold), but the risk is also increased if the relative is her father. Interestingly, males in this study were not at higher risk for developing diabetes if they had relatives with diabetes.

Diabetes and the rest of your family

A woman is often the person in a family who is the medical decision-maker. She makes sure her children are up-to-date on immunizations and have their health checkups. If they get sick, she is likely the parent who will be providing most of the care for her children. Even when everyone in her family is well, the woman often takes the lead in planning her family’s meals and activities. As such, a woman’s role is critical in keeping her whole family well and preventing unhealthy behaviors that contribute to diabetes. She can make sure that regular physical activity is a part of each family member’s routine and prepare healthy meals and snacks. And she can lead by example by showing how she cares for her own health

Keeping healthy with diabetes

The number one cause of death in women with diabetes might surprise you. It is heart disease. You might have guessed it was breast cancer, but it is well behind heart disease as a cause of death in women; it is the cause of death in one in nine women. Heart disease kills two-thirds of women with diabetes, and they die at a younger age than women without diabetes. Diabetes seems to cancel out the protective effect on the heart and circulation that women get from estrogen before they enter menopause. Compared to women without diabetes, women with diabetes are twoand-a-half times more likely to have a heart attack and oneand-a-half times more likely to have a stroke. Further, after having a heart attack, a woman with diabetes is twice as likely to have another heart attack and four times more likely to have heart failure than a woman without diabetes. Forty percent of all heart attacks result in death. These statistics mean that women with diabetes need to be “heart healthy."

To achieve optimal heart health, women with diabetes need to address not only their blood sugars, but also other risk factors for heart disease. These risk factors include high cholesterol, high blood pressure (hypertension), abdominal obesity and cigarette smoking.

How can you reduce your risk for heart disease? Follow these guidelines:

  • Get your A1C to target. Generally this is less than 7 percent, but your healthcare team may have a different target for you.
  • Don’t smoke, and avoid second-hand smoke.
  • Control your blood pressure to under 140/90. Less than 130/80 may be a more appropriate target if you are at higher risk for heart, blood vessel, or kidney disease.
  • Maintain a healthy weight. Even a 5 to 10 percent weight loss can lower insulin resistance and reduce your risk for health problems.
  • Exercise regularly. Try to aim for at least 30 minutes of exercise five days per week. If you are out of shape, ask your healthcare team to help you develop an exercise plan starting at a slower pace and building up gradually.
  • Avoid saturated and trans fats in your diet. Saturated fats are solid at room temperature and trans fats are often present in commercially prepared foods. Instead, use monounsaturated and polyunsaturated fats. These “heart healthy” fats are present in olive oil, canola oil, nuts and nut butters, avocados, and fish such as salmon, mackerel, herring, lake trout, sardines and albacore tuna.

While having the disease presents challenges, women with diabetes can live long and healthy lives. By being aware of the potential effects of diabetes on your well-being, you have the opportunity to make changes to stay healthy longer, or to improve your health if you are already experiencing medical issues.