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Diabetes in Women

There are two stages in a woman’s life in which they are more likely to suffer from diabetes, these are: pregnancy (gestational diabetes) and menopause. According to recent studies, diabetes type 2 is becoming one of the most common diseases among women. In fact, it is considered to be the fourth cause of mortality among them.

“Diabetes in pregnancy is a serious condition that is unique to women because of its potential to affect the health of both the mother and her unborn child. Approximately 2%–5% of all pregnancies in the United States are complicated by gestational diabetes, and this complication is most common among women of racial and ethnic groups at high risk for diabetes (blacks, Hispanics, American Indians, and Asian Americans). Moreover, the burden of diabetes falls disproportionately on women. More than half of all persons with diabetes are women. In addition, among the 8.1 million women aged 20 years or older with diabetes, older women and minority women are disproportionately represented.

The prevalence of diabetes is at least 2–4 times higher among black, Hispanic, American Indian, and Asian/Pacific Islander women than among white women. This excess of diabetes is even more profound for particular subgroups of women. Because of the increasing lifespan of women and the rapid growth of minority populations, the number of women in the United States at high risk for diabetes and its complications is increasing. The risk for cardiovascular disease, the most common complication attributable to diabetes, is more serious among women than men. Notably, women with diabetes lose their premenopausal protection from ischemic heart disease and have risk for this condition as great as or greater than that of diabetic or nondiabetic men. Furthermore, among people with diabetes who develop ischemic heart disease, women have worse survival and quality of life measures. Women are also at greater risk for blindness due to diabetes than men.

Research has shown that many risk factors for diabetes (weight gain, obesity, lack of physical activity) are more common among women than men in all population subgroups. In addition, the natural history of these factors and their relationship to diabetes are quite different among some subgroups of American women. For example, black women retain more weight postpartum than white women with comparable gestational weight gain, increasing their risk for obesity and its sequelae in subsequent pregnancies and at older ages. Obesity is associated with the prevalence of type 2 diabetes and is a risk factor for the development of this disease. Among women of minority racial or ethnic origin, there is earlier onset of obesity, and these groups experience disproportionately high levels of excess weight. This variation in risk profiles and cultural norms among the various populations of women with diabetes suggests that the interventions for mediating these risks should also vary accordingly. The results of the primary prevention trials now in progress should provide additional information that may benefit women at risk for type 2 diabetes mellitus.”1

“Signs and Symptoms of Diabetes Mellitus

Signs and symptoms of diabetes mellitus can be divided into three main categories namely (i) polydipsia (increased thirst and consequent increased fluid intake), polyuria (frequent urination) glycosuria (glucose in urine), polyphagia (extreme hunger or increased appetite), unexplained weight loss despite normal or increased eating, decreased of skin turgor (very dry skin), unexplained tiredness or irreducible fatigue, marked deceased in level of consciousness or dizziness, acetonic breath, nocturia, tachycardia (fast heart rate), dehydration and dry mouth or hyposalivation. It is worth noting that most people experience what is generally referred to as the classic triad of diabetes mellitus symptoms i.e. polyuria, polydipsia and polyphagia or the 3P’s of diabetes mellitus symptoms. (ii) those arising from specific long term lesion of diabetes mellitus e.g. microangiopathy particularly in the eye known as retinopathy (sudden vision changes), in the kidney referred to as nephropathy and in the nerves which shows as a tingling sensation or numbness in the hands or feet, a condition called neuropathy. (iii) those resulting from acceleration of increased predisposition to disease processes, e.g. atherosclerosis, frequent or recurrent skin and urinary tract infection.”2

Some of the main symptoms of diabetes are:

Weight Loss

It is very common in diabetes type I, even with a relatively normal diet. In this type, our body cannot use glucose properly since the pancreas has stopped producing the insulin needed for glucose to enter cells, so the body removes unusable glucose (and calories) through urine.

Continuous Need to Use the Bathroom

 This is another characteristic symptom of diabetes since our body tries to get rid of the excess sugar via urination.

Dehydration

This happens precisely because of the previous symptom. By going to the bathroom so many times to urinate, we not only eliminate sugar, but also water. Slowly, the body dehydrates, which can be dangerous.

Feeling Hungry Often

Also called polyphagia, it happens with diabetes type II. This happen because the level of insulin is very high in the body so there is a decompensation that causes excessive hunger.

Sexual Problems

With diabetes, you can experience hormonal and sexual issues, including a decrease of interest in having sex due to depression or fatigue. Women with this issue can also experience painful sexual intercourse due to vaginal dryness.

“Complications due to poor glycemic control affect many organs and systems, and can have both acute and chronic character. Diabetic complications may also directly or indirectly affect the quality of sex life of patients. Research shows the wide distribution of a variety of sexual dysfunctions in patients with diabetes are more frequent than in the healthy population. Doctors are aware of existence of this complication and importance for the patient.

Problems in the sex life of patients with diabetes have a multifactorial pathogenesis. Organic changes directly caused by the disease are of great importance. Another group includes the psychological factors that may directly result from diabetes or be closely related to the disease. Problems concerning sex life in men often have a biological background, while women are dominated by psychogenic etiology.

Difficulties in sex life can be caused by changes in the vascular, nervous, endocrine and metabolic systems. Patients may exhibit sexual dysfunction resulting from concomitant diseases, which are a consequence of diabetes. The deterioration in the quality of sex life is significantly affected by depression. The context of sexual problems also includes the impact of stress, obesity, negative assessment of body image, self-esteem drop, reduced quality of the partner relationship, problems with finding sexual partners and social isolation, and the fear of pregnancy, resulting from fear of possible diabetic complications in the mother or the child.”3

Infection

A very characteristic symptom in women. It can appear on the skin, genitalia and the urinary tract.

It is true that diabetes can appear at any time in a woman’s life, but as mentioned before, there are two periods in a woman’s life in which they are more likely to suffer from it.

Diabetes During Pregnancy

It’s also known as gestational diabetes. During the development of the fetus, the woman’s body experiences various metabolic changes, requiring more energy for the gestation of the child and thus, increasing the level of insulin in the blood. “These include adaptations to the cardiovascular, renal, hematologic, respiratory, and metabolic systems. One important metabolic adaptation is in insulin sensitivity. Over the course of gestation, insulin sensitivity shifts depending on the requirements of pregnancy. During early gestation, insulin sensitivity increases, promoting the uptake of glucose into adipose stores in preparation for the energy demands of later pregnancy. However, as pregnancy progresses, a surge of local and placental hormones, including estrogen, progesterone, leptin, cortisol, placental lactogen, and placental growth hormone together promote a state of insulin resistance. As a result, blood glucose is slightly elevated, and this glucose is readily transported across the placenta to fuel the growth of the fetus. This mild state of insulin resistance also promotes endogenous glucose production and the breakdown of fat stores, resulting in a further increase in blood glucose and free fatty acid (FFA) concentrations”4

This doesn’t necessarily cause serious issues during pregnancy. However, it is possible that if the mother suffers from diabetes during pregnancy, the child may be born obese. With more pregnancies, there is also a very high risk of gestational diabetes eventually occurring, with a 65% chance that diabetes type II will end up developing.

Some factors that can influence women from suffering gestational diabetes are: being over 30 years old, if there is a family history with diabetes and if they are overweight.

Diabetes During Menopause

Menopause may last for over ten years in a woman’s life, beginning when the body begins to lower its production of estrogen and progesterone (the main female hormones). Due to these hormonal changes, glucose control begins to diminish, increasing insulin sensitivity and a reduction of estrogen, causing not only diabetes, but also cardiovascular problems.

Diabetes type I can appear at any age, but it is most common for it to be diagnosed in children. The exact cause is unknown, but it is thought that it may be due to genetic factors. The body doesn’t produce enough insulin, so patients end up needing daily injections of this hormone to compensate.

“Glycosylation of functional proteins may cause ovarian dysfunction or type 1 diabetes. Autoimmune mechanisms can also be linked to menopausal age. Loss of ovarian function and subsequent decline in endogenous estrogens, can explain these differences in risk. It is observed that oophorectomized women have less favorable glucose and insulin levels that may explain the link between premature menopause and diabetes risk.

Another explanation for an early menopause among type 1 diabetic women may be related to prolonged hyperglycemia and/or other long-term complications of the disease. In addition, peripheral hyperinsulinemia and insulin resistance occurs among approximately one-half of individuals with type 1 diabetes. Hyperinsulinemia is associated with the polycystic ovarian syndrome (PCOS) and is characterized by hyperandrogenemia and amenorrhea. Because insulin and androgen levels are highly correlated in women with PCOS, one may speculate that the young age at menopause in women with type 1 diabetes may be mediated, in part, through peripheral hyperinsulinemia and/or hyperandrogenemia. However, the occurrence of PCOS in women with type 1 diabetes has rarely been reported. Thus, factors unrelated to long-term diabetes may also be important determinants of the menopause transition.

Type II Diabetes & Menopause

Type II diabetes, also known as insulin-resistant diabetes mellitus, is the most common form of diabetes. Type 2 diabetes mellitus is a heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion, and increased glucose production. In type II diabetes the patient’s body either cannot produce insulin or cannot effectively use the insulin it produces. There are many reasons why women over forty are most likely to be diagnosed with type II diabetes. Lower levels of the hormones estrogen and progesterone, and human growth hormone contribute to lower metabolism and obesity which is the major cause of type II diabetes”5

Diabetes type II is the most common form of diabetes, which appears mostly in adulthood. It occurs mainly due to unhealthy habits such as a sedentary lifestyle, poor diet and obesity. Until a few years ago, it was very common in the adult population, but lately it also appears in children and adolescents. With the advent of the fast food industry (foods are very high in fat) and a decrease in exercising habits, obesity if much more prominent. It is therefore necessary to begin to change these habits and maintain an ideal weight.

“Both biological and psychosocial factors are responsible for sex and gender differences in diabetes risk and outcome. Overall, psychosocial stress appears to have greater impact on women rather than on men. In addition, women have greater increases of cardiovascular risk, myocardial infarction, and stroke mortality than men, compared with nondiabetic subjects. However, when dialysis therapy is initiated, mortality is comparable in both males and females. Diabetes appears to attenuate the protective effect of the female sex in the development of cardiac diseases and nephropathy. Endocrine and behavioral factors are involved in gender inequalities and affect the outcome. More research regarding sex-dimorphic pathophysiological mechanisms of T2DM and its complications could contribute to more personalized diabetes care in the future and would thus promote more awareness in terms of sex- and gender-specific risk factors.”6

 

References:

(1) Centers for Disease Control and Prevention. (2001). Diabetes and women’s health across the life stages. A public health perspective. Washington (DC): US Department of Health and Human Services. Available online at https://www.cdc.gov/diabetes/pubs/pdf/women.pdf

(2) Adinortey, M. B. (2017). Biochemicophysiological Mechanisms Underlying Signs and Symptoms Associated with Diabetes mellitus. Advances in Biological Research, 11(6), 382-390. Available online at https://pdfs.semanticscholar.org/6ad6/f19c8688355b541cf5d46f343c3b5e51ea24.pdf

(3) Piątkiewicz, P., Krasuski, T., Maksymiuk-Kłos, A., & Owczarek, K. (2017). Sexual dysfunction in diabetic patients—an important and overlooked complication. Clinical Diabetology, 6(4), 119-125. Available online at https://pdfs.semanticscholar.org/a0e0/91fcf02b3e6b0193bd92a7de536d9afb0924.pdf

(4) Plows, J., Stanley, J., Baker, P., Reynolds, C., & Vickers, M. (2018). The pathophysiology of gestational diabetes mellitus. International journal of molecular sciences, 19(11), 3342. Available online at https://www.mdpi.com/1422-0067/19/11/3342

(5) Chandrasekhar, V. (2016). Diabetes and Menopause. J Anesth Crit Care Open Access, 6(4), 00233. Available online at https://pdfs.semanticscholar.org/54a9/a7505d92f3c12e0852cf0d65081830fabf09.pdf

(6) Kautzky-Willer, A., Harreiter, J., & Pacini, G. (2016). Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocrine reviews, 37(3), 278-316. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890267/

 

Robert Velasquez
13 October, 2018

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Hello everyone, my name is Robert Velazquez. I am a content marketer currently focused on the medical supply industry. I studied Medicine for 5 years. I have interacted with many patients and learned a lot...read more:

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