Diabetes Update

Regardless of Type, Diabetes is Typically More Severe for Women

New data and longstanding research alike reveal that the consequences associated with diabetes are more detrimental for women than for men — and the evidence goes beyond gestational diabetes. According to officials at the Centers for Disease Control and Prevention (CDC), women who are living with diabetes are more susceptible to comorbid conditions such as heart disease, blindness, kidney disease, depression and urinary tract infections. Hormonal changes that occur during the menstrual cycle and the effects of menopause can also impact one’s blood sugar significantly, exacerbating the condition. Nurses and other healthcare providers can help their female patients who are living with diabetes to make healthier lifestyle choices and to be more educated as to roles that their dual diagnoses, and their body’s natural aging processes, play in relation to the disease.

Heart of the Matter

Heart disease, the most common complication of diabetes among women and men, takes a more grave toll on females, according to the CDC. The risk of developing heart disease is four times more likely among women compared to men, and women can expect worse outcomes following a heart attack. Although some may consider it to be a “man’s disease,” heart disease is the leading cause of death among women in the United States, according to CDC statistics. More than 280,000 women died in 2013 due to heart disease (or one of every four deaths).1 Furthermore, at least 68% of people older than age 65 who are living with diabetes die of some form of heart disease, of which coronary artery disease is the most likely diagnosis. Lifestyle changes that should be sought include smoking cessation, lowering cholesterol, limiting alcohol, and consuming more fibrous foods, whole grains and low-fat dairy as opposed to sugars and red meats.

The impacts of stress are also a major consideration. As a naturally occurring dynamic, stress can be difficult to manage, especially from a day-to-day perspective. According to the American Heart Association (AHA), practical advice for limiting stress includes counting to 10 before speaking or reacting to a stressful trigger; taking slow, deep breaths until that un-clenched feeling occurs; and taking a walk to the restroom or other location in an attempt to unwind. Waiting 24 hours to respond to stressful, non-urgent emails or engaging in a workout if time allows are also tactics that should be communicated. Of course, when it comes to stress, let alone heart disease, physical activity of any kind is considered to be a reliable aid. According to the AHA, a series of 3-4 workouts per week at 40 minutes in length can help reduce stress.

Kids and Kidneys

Though primarily not a lifetime condition, gestational diabetes can nonetheless significantly alter one’s life, including that of the unborn child. A condition that increases the risk for preterm birth and cesarean delivery, the development of gestational during pregnancy can also increase the risk for chronic kidney disease, which causes the kidneys to have difficulty filtering wastes from the blood. Studies have investigated the potential link between gestational diabetes and chronic kidney disease, including a study published this spring in the journal Diabetes Care. According to the recent research, women with gestational diabetes were found to be more likely to develop a high glomerular filtration rate, an estimate of how much blood per minute passes through the glomeruli, the tiny filters within kidneys that extract waste from the blood. Though the authors of the study, which was conducted as part of a National Institutes of Health-funded effort, concluded that more research would be required to draw a more conclusive correlation, the study also identified a trend in which women who had gestational diabetes and later-life diabetes were also more likely to have an elevated urinary albumin to creatinine ratio — an indication of kidney disease. (Women who had only gestational diabetes were not at increased risk for an elevated urinary albumin to creatinine ratio.)

Menstrual Cycle and Menopause

Blood sugar levels can be difficult to predict before and during a women’s monthly period due to changes in hormone levels, and the body’s tendency to produce less estrogen after menopause (which can also increase the risk of heart disease) can result in similarly chaotic blood sugar levels. Women who live with diabetes may also experience longer or heavier periods, and food cravings that can make managing diabetes more difficult. Women may also gain weight, which increases the need for insulin or other diabetic medications. Hot flashes and night sweats can occur and disrupt sleep, which further results in blood sugar management being more difficult.

If blood sugar levels change for a prolonged pattern after menopause, patients may need to change the dosage of any diabetes medications they’ve been prescribed. Diabetic patients should be encouraged to check their blood sugar often and track the results to determine if there could be a pattern of fluctuation. Those taking insulin may require more in the days before their period. While many women will not require treatment for menopause symptoms, relief strategies do exist, including changes to eating habits, increasing physical activity and/or medications such as low-dose hormonal birth control, menopausal hormone therapy and over-the-counter products.

Diabetes Development

Women also appear to be at greater risk of generally developing diabetes more so than men, generally speaking, the more time they spend working. According to a new study published by BMJ Open Diabetes Research & Care, women who work in excess of 40 hours per week had a 63% greater risk of diabetes compared with those who worked between 35 and 40 hours per week. Meanwhile, men who worked longer hours did not see increased risk. It remains undetermined why the gender difference existed in the study, which examined data from more than 7,000 Canadians tracked over 12 years, but it may involve what women do with their time off, according the report — meaning that women were perceived to spend their time away from work engaging in stressful acts.

1. Xu JQ, Murphy SL, Kochanek KD, Bastian BA. Deaths: final data for 2013. National Vital Statistics Report. 2016:64(2):1-119.

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