Women and Diabetes
Men are from Mars and Women are from Venus. They have different roles to play. Man the “protector” and woman the “child bearer”. Since their biology is different, they fare differently in disease states especially chronic diseases like diabetes, hypercholesterolemia and heart disease.
In childhood, girls usually have type1 DM while type2 DM is generally present in adults. PCOS – Polycystic Ovarian Syndrome, an insulin resistant state can adversely affect body image and menstrual cycles during adolescence. Young girls become obese, depressed and have altered metabolic profiles. This can affect their fertility and married life.
Marriage itself is a taboo especially in India. Brides with diabetes are looked upon as liable partners in marriage. The general feeling is that all the next generation will have diabetes. This is not true. Further, mood swings during hyper and hypoglycemia can give rise to stress in married life. This requires a lot of understanding to stay together.
Infertility is on the rise, mainly because of insulin resistance. Women in childbearing age need to take special care both in decreasing body weight and controlling sugars.
Gestational diabetes ie women who become diabetic for the first time during pregnancy and those already having diabetes, who become pregnant require frequent monitoring to keep optimum sugar control. Maternal complications like pre-eclampsia, hypertension, stillbirth, miscarriages and preterm delivery are common. Complications in newborn like large-to-weight babies and congenital abnormalities are to be avoided. Then again the women are put on Insulin therapy, with withdrawal of tablets, which can give rise to marked fluctuations of blood glucose.
Cardiovascular disease & atherosclerosis is on the rise in diabetes women, while there is decline in the same in diabetic men. Women tend to have lipid abnormalities which are more atherogenic. They have greater number of small dense low density lipoproteins, which pass through the arteries easily increasing the burden of occlusive artery disease and then increasing rate of heart attack and cardiac failure which is more common in women than men more so after menopause.
Menopause itself is a highly insulin resistant and atherogenic state. The female sex hormones like oestrogen and progesterone which have protective action on blood vessels and metabolism is suddenly decreased. This enhances the already existing abnormalities and makes them susceptible to cardiovascular and metabolic complications.
Women biologically live longer than men increasing the burden of the single elderly. Family and social neglect may add to the disease burden if adequate love and support is denied.
HOW WOMEN ARE DIFFERENT?
Every cell in the body is either male or female (XX or XY). The defects in genes in XX is easily manifested in women, but is protected by the Y genes in men. Hereditary defective genes causing disease therefore will manifest in women easily. When compounded with sedentary lifestyle and caloric rich diets causing obesity, lifestyle diseases like diabetes, hypertension, heart disease are more aggressive. Metabolic changes secondary to the above produce imbalance of thyroid, adrenal, pituitary and sex hormonal requirements.
WHAT IS TO BE DONE?
- Diabetes prevention strategies must focus on maternal health and nutrition and health behaviours prioritising specific needs of women.
- Promote opportunities for physical exercise in adolescent girls to adapt healthy lifestyle.
MD FICP FACP FACE (USA) PGDDM (UK)
Fellowship In Diabetes (India)
Senior Consultant, Diabetes & Thyroid Specialities Center