Women and Diabetes: What You Need to Know

Beyond genetics and family history, how do you know if you’re susceptible to the condition? We speak to Dr Marilyn Lee, consultant physician and endocrinologist at Khoo Teck Puat Hospital, to find out. Dr Lee is also a member of the social group Ladies First, which has partnered the Health Promotion Board to launch Singapore’s first Health Calendar on Diabetes that is targeted at women. The calendar is available for download at www.hpb.gov.sg/womens-health

 

What are the difference between the various types of diabetes?

Type 2 diabetes is the most common type. This usually occurs when the body is resistant to insulin (ie the body does not respond to insulin). Type 1 diabetes, on the other hand, is defined by a deficiency of insulin.

 

Gestational diabetes is a form of diabetes that affects pregnant women. It happens because the body is not able to produce enough insulin to meet the body’s increased need for it during pregnancy. This condition occurs in 15 to 20 percent of pregnant women in Singapore, but usually disappears after the woman has given birth. If it persists, it may be because the woman had a pre-existing diabetic condition that was undiagnosed. This form of diabetes may increase the risk of pre-eclampsia (a life-threatening condition that causes high blood pressure, among other things), and an increased risk of requiring cesarean section delivery. It may cause the baby to get too big, resulting in more difficult natural birth, and the baby may be born with low glucose levels, increasing in an increased risk of fits. There may also be an increased risk of stillbirth.

 

What are the warning signs of diabetes in women? Do they differ from symptoms in men?

Some symptoms of diabetes include increased thirst and urination, feeling tired and lethargic, weight loss, and an increased frequency of genital infections. Changes in vaginal pH can make women more susceptible to genital infections and many things can alter vaginal flora including intercourse, douching, medications, hormonal changes (pregnancy, menopause, monthly menstrual cycle). Furthermore, women have a shorter urinary tract, making them more prone to urinary infections.

 

Which groups of women are the most susceptible to developing diabetes?

 Overweight and obese women: They have more adipose tissue (fat cells), which render them more resistant to insulin.

 

Women with a family history of diabetes: The chance of inheriting type 2 diabetes is harder to assess as some individuals do not develop the disease until they are much older. We know that many genetic and environmental factors interact to produce type 2 diabetes. It is estimated that about 25 percent of the relatives of someone with type 2 diabetes have had, have, or will eventually develop diabetes. If one parent has type 2 diabetes, about 15 percent of the children will eventually develop it; if both parents have type 2 diabetes, the risk may be as high as 75 percent.

 

Women with polycystic ovarian syndrome (PCOS): PCOS is associated with gradual weight gain and obesity, as well as insulin resistance. There is a lot of evidence to show that high levels of insulin contribute to increased production of androgens (male hormones), which worsens the symptoms of PCOS.

 

Women who take steroids: Steroids cause a dose-dependent increase in glucose levels. The mechanism by which they cause high glucose levels is multifactorial, including increasing glucose production and inhibiting glucose uptake in tissues.

 

Is there a particular age group of women that are more susceptible to diabetes?

The risk of diabetes increases with age in both men and women.

 

What should one do if diabetes is suspected?

This applies to both men and women. If you suspect you have diabetes, you should see your healthcare provider so that blood tests can be done to confirm if you have developed the condition.

 

What are some of the things women can do to prevent diabetes?

Of course, one should always try and lead a healthy lifestyle. This means exercising regularly, eating healthful food, and maintaining a healthy body weight. Stay away from carbohydrate-rich foods as these can raise your blood glucose levels, as well as deep-fried and high-salt foods and fatty meats as these can affect your cholesterol and blood pressure.

 

What are some common myths surrounding diabetes?

The most common myth is that consuming too much sugar causes diabetes. Diabetes is not caused by eating sugar; rather, it occurs either because the pancreas stops making insulin completely (type 1 diabetes), or because the body doesn’t produce enough insulin and/or is unable to use insulin properly (type 2 diabetes).

The second myth that needs to be debunked is that having to start insulin means it’s the end of the road for you. If you have type 1 diabetes, you must take insulin to survive once you’ve been diagnosed — this is the only form of treatment.
People with type 2 diabetes, however, may initially be able to manage their diabetes with a combination of healthy eating and exercising.  Many people start on tablets when they are first diagnosed, and in time, many will need to go on insulin. This is because the condition changes over time. Starting on insulin will help you to better manage your diabetes which, in turn, lowers your risk of developing complications.

 

People on insulin can still go about their normal daily activities. They may need to adjust the dose of insulin or have a snack before exercising to avoid the risk of low blood sugar. If the diabetic person has an underlying heart disease, neuropathy (nerve involvement leading to numbness in the feet) or retinopathy (eye disease), he/she should speak to his/her doctor regarding what exercises are safe to do.