What’s Special about Diabetes for Women.

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Nora Saul, M.S, R.D., L.D.N., C.D.E.

Nora Saul is a Certified Diabetes Educator and Manager of Nutritional Education at the Joslin Diabetes Center

Are men really from Mars and women from Venus? If I knew or had at least written the book, I would be a lot wealthier.

Certainly there are biological differences between men and women that are reflected in the impact of diabetes.  So that is what I am going to address in today’s column—what is special about diabetes for women.

For women, differences often start in adolescence. Hormone levels tend to fluctuate just before, during and after the menses each month.  High estrogen levels often correlate with insulin resistance and women may find that their blood sugars are higher a few days before their periods and then return to normal when their period starts.

The only way to compensate for this is to check your blood sugar frequently and look for patterns over a few months.  This will help you know if you need to made adjustments in your medications, food or exercise patterns.

Rates of ketoacidosis (a very dangerous buildup of acids in the blood caused by a deficiency of insulin in the presence of very high blood sugars) are higher among females than males.   One self–induced cause of ketoacidosis is insulin omission.  As teenage girls feel pressure to avoid weight gain, those with diabetes may skip insulin injections as a way to continue to eat as they want without putting on additional pounds.

Instead of being used for energy or deposited as fat, the calories are lost in the urine.  While initially effective as a weight control method, insulin omission backfires, as it leads to dangerously high blood sugars and a cycle of poor control with complications.

In fact, the rate of eating disorders may be significantly higher among young women with type 1 diabetes than among women of similar age without diabetes.

Diabetes can also have a significant impact on women’s sexuality.  Sexuality has a physical, psychological, and social component and diabetes can affect all three.  The extent and mechanics of how diabetes affects women’s sexuality are still not fully understood.

Often it is difficult to separate out the influences of other underlying conditions, for example, depression or menopause, from that of diabetes.   Sometimes, high blood sugars themselves can drain energy and make a woman feel too fatigued for sexual relations.

Women with diabetes have a greater risk of yeast and urinary tract infections (UTIs).   This is due to both a reduced immune response and a higher concentration of glucose in the blood which provides an attractive environment for bacteria and fungi.

Yeast infections cause itching, discharge and pain during intercourse.  Urinary tract infections are associated with urinary frequency, urgency, burning and pain upon urination. The urine may be cloudy or bloody.    Women’s shorter urethra puts them at greater risk than men of developing UTIs. If left untreated, urinary infections can travel from the bladder up into the kidneys.   Both conditions can be treated, with either an antifungal (yeast infection) or antibiotic (UTI)

Some women, especially those prone to hypoglycemic unawareness may have a fear of hypoglycemia during intercourse.  This causes tension and stress and may interfere with a women ability to feel pleasure during sexual relations.   Checking blood sugar prior to intercourse, having snacks available and talking honestly with your partner can help allay anxiety and prevent hypoglycemia from interfering with sexual desire and pleasure.

One of the most difficult complications of diabetes to treat is neuropathy or damage to the nerves.  Although we usually think of the lower extremities being affected, nerves of any parts of the body can be damaged.   Neuropathy can reduce vaginal lubrication in women and cause intercourse to be painful.   This can occur in addition to other causes of dryness such as menopause.  Women should discuss the use of water-based lubricants or vaginal suppositories with their health care providers.   Damage to the cells that line the vagina can also interfere with arousal and orgasm.    Working with a gynecologist, can help you find the most effective treatment(s).

Heart disease, one of the most common complications of diabetes, is more serious among women than men. Usually prior to menopause estrogen protects women from developing coronary artery disease by decreasing the amount of low density lipoprotein  (LDL) and increasing high density lipoprotein (HDL) in the blood.  However, having diabetes, cancels out this protective effect. Women with diabetes, who have had a heart attack, have lower survival rates and a poorer quality of life than men.

Keeping blood sugar, cholesterol and blood pressure in control can help prevent the onset of heart disease.

And then there is the change of life.  As during puberty, hormone levels fluctuate during menopause and this can cause blood sugar levels to vacillate markedly.  Many women, whether they have diabetes or not find that they gain weight during the period preceding menopause and this can have consequences for the amount of medication(s) women with diabetes take.  In addition, a drop in estrogen level after menopause improves the environment for bacteria and yeast to invade the urinary tract, increasing the risk of developing one of these infections.

Keeping in close contact with your health care team can make it easier to navigate the “feminine” side effects of diabetes and maintain a long and healthy life.  And as far as I know neither Mars or Venus are particularly hospitable planets—that is probably why both sexes migrated to earth.

5 Responses to What’s Special about Diabetes for Women.

  1. Brenda says:

    This is one of the most depressing columns I have ever read!

  2. Ricci says:

    I think this is the most realistic article about the way being a woman affects diabetes that I have ever read. If you don’t start with the truth it is impossible to live in reality.
    I wish Nora were my dietician. The honesty in this article is refreshing.

  3. Amy says:

    I found that once I got my blood sugars under control, I stopped having UTIs.

  4. cassie says:

    I have many experiences with this. Prior to period my level rises greatly. With the insulin punp there is almost an increase of 10% basal. Then during it is about 6% increase from normal. But currently, since weight lose, I have had to do a decrease following period of 5% for two days.

  5. margarita says:

    I think it´s important to know the true, but you should continue with your life, don´t worry about too much about all these complications..You could always find the way to enjoy every minute of your life,,CONCENTRATE in all the things you can do and be happy…

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