Why Diabetes Is Riskier for Women

One out of every 10 American women is living with diabetes, which causes more deaths each year than breast cancer and AIDS combined. Still, most Americans don’t see it as a serious disease. Here’s why women should worry... Are you overweight and hate working out? Were you diagnosed with gestational diabetes during a past pregnancy? If you answered yes to either of these questions, you’re at risk for developing diabetes, a chronic, incurable disease that raises the risk of heart disease, kidney failure and more. Diabetes poses special problems for women. It increases your chances of having complications during pregnancy, such as birth defects, miscarriage and large babies. And women with the disease are also more likely to die younger. “If you see a 40-year-old woman with chest pain, she’s [not] likely to have a heart attack,” says Andrew Drexler, M.D., an endocrinologist and director of UCLA’s Gonda Diabetes Center. “But if she’s diabetic, that’s not true.” The federal government spends billions each year conducting diabetes research, with scientists searching for more efficient ways to manage the disease. What are the latest advances and how are women affected by the disease? For answers, we sat down with Drexler, who heads one of the nation’s leading diabetes treatment centers. Read on for his recommendations. What’s the difference between type 1 and type 2 diabetes? Type 1 is an autoimmune disease that destroys islet cells [which produce insulin] in the pancreas. Insulin controls [blood sugar levels] in the body. [With] type 2 diabetes, the insulin is there, but it doesn’t work – not because the insulin isn’t normal but because the body doesn’t respond to it well. The body compensates by producing more insulin. Type 1 used to be called "juvenile onset diabetes" and type 2 "adult onset." We’ve eliminated those terms because many people didn’t fit [into those categories]. Now more kids have the adult form and vice versa. What causes diabetes? We really don’t know what causes type 1. There’s no way of avoiding it. There is a genetic component to it, but we don’t fully understand the trigger. That’s why even if we were to catch it early, we couldn’t prevent it. Type 2 is [largely caused] by eating too much and not being active enough. The data are pretty strong that the problem is the calories – not the type of food. Read 13 Ways to Prevent Diabetes. Which type is more common? Between 90%-95% of diabetics have type 2. We’re seeing an increase in both types, but type 2 is being called an epidemic. That appears to be true worldwide. As obesity becomes an epidemic, so does type 2 diabetes. It's that simple. Are the symptoms the same for type 1 and 2? Type 1 develops rather quickly, with dramatic symptoms occurring within a week to a month. Symptoms include frequent urination, weight loss, blurry vision and thirst. [Symptoms are] the same with type 2, but it develops more slowly. Can someone be diabetic and not know it? The feeling used to be that 50% of type 2 cases were undiagnosed. It’s better now, but still grossly undiagnosed. [Being diagnosed with type 2 diabetes] is more likely to happen as you get older. Actually, something like 25% of people in their 80s have diabetes. What problems do women have in managing diabetes? Women are thought to have a harder time with weight than men. Excess weight makes everything worse: It makes it harder for insulin to work. You can’t produce enough insulin for your body’s needs. The more overweight you are, the more you have to produce. How does pregnancy affect a woman with diabetes? When a woman’s pregnant, the placenta produces hormones that make women more insulin-resistant. That’s why they develop gestational diabetes and often end up on insulin when pregnant. Nature doesn’t care a lot about you: It cares about you having children. There are a number of hormones made by the placenta – most are designed to be good for the baby and the hell with you. What role does diet play in preventing or managing diabetes in women? A restricted diet isn’t the most important part of preventing diabetes; women have to eat the right things. [The best diet for diabetics includes whole grains, fresh fruits and vegetables, low-fat cheeses and yogurt, and baked or broiled fish and meats.] How does menopause affect diabetes? Menopause doesn’t have any direct impact on it. But women often find it hard to control their diabetes because menopause is stressful, and with any stress, diabetes is going to get worse. Stress hormones cause a number of actions that can counteract insulin’s effect. For example, stress causes the release of glucose by the liver, which raises blood sugar. Can you manage diabetes without medication? Most type 2 patients end up on medication. (The starting medication is metformin.) Exercise is critical. Most doctors would say that cardiovascular exercise [is important], but there’s some evidence that increasing muscle [through resistance training] may help as well by increasing the use of glucose. What about insulin? Patients may want to stay off insulin, but most physicians feel we don’t start insulin soon enough. At some point, in almost all cases, medications fail, and when they do, the only alternative is insulin. The goal isn’t staying off insulin; the goal is keeping blood sugars under control. Gastric bypass surgery is sometimes touted as a type 2 remedy. Is this true? It seems effective. Often diabetes gets better as the weight comes off. But gastric bypass surgery also has complications. Doctors have to determine how obese an individual needs to be before you expose them to surgery. At this point, most [doctors] would consider the procedure for only really obese people – those with a body mass index (BMI) of 30 to 35, which is a measure of body fat based on height and weight. [To calculate your BMI, click here.] For example, a woman who’s 5’4” and weighs 175 pounds would have a BMI of 30. Once you get above a BMI of 35, benefits outweigh risks. One type of gastric bypass surgery, the duodenal switch, is getting a lot of attention for supposedly curing diabetes. What should people watch for with this procedure? [The surgery] bypasses absorption. [It limits the amount of calories and fat absorbed from food.] But there’s some concern that you’re not absorbing enough vitamins. Most [doctors don’t] see this as a cure for diabetes. It’s a cure for morbid obesity and diabetes. What about 7-day wireless blood sugar monitors, which chart trends in blood glucose levels after a diabetic punches in daily information from finger stick tests? Do they work? They can be very helpful, and we’re recommending them. But the Food and Drug Administration (FDA) says they shouldn’t [replace] finger sticks [in which a needle pricks a finger to test blood sugar level] because the monitors aren’t accurate enough yet. For example, if someone goes to bed with 120 blood sugar, according to a monitor, and wakes up with 250, does that mean they need more insulin overnight – or do they have too much and are rebounding? We need better products [to monitor blood sugar levels]. What’s your best advice for women with diabetes? Don’t try to pretend it doesn’t exist. Learn how to control it, rather than letting it control you. As a society, we’re not good at exercising and following a diet. There are clearly genetic factors that make it harder for us to lose weight as we get older. We don’t know why, and this will be a major area of research over the next 20 years. But it’s good to work with a diabetes counselor [who can create healthy diet and exercise plans]. The key point is to eat a healthy, balanced diet. There is no gimmick diet. It’s a marathon, rather than a sprint. It’s all about behavior modification. Want to learn more? Check these websites for information: Lifescript's Diabetes Type 2 Health Center Centers for Disease Control and Prevention Diabetes Fact Sheet National Diabetes Information Clearinghouse (NDIC) National Institute of Diabetes and Digestive and Kidney Diseases American Diabetes Association CDC-Take Charge of Your Diabetes: Pregnancy and Women’s Health How Much Do You Know About Diabetes? In the United States alone, 23.6 million people have diabetes. And 5.6 million of them don’t even know it. Unfortunately, misinformation about diabetes is rampant – and mixing up the facts about this disease can have dire consequences.