How Diabetes Affects Women Differently

From everydayhealth.com

Women with diabetes face unique challenges that their male counterparts do not, many of which directly relate to their menstrual cycles, hormone fluctuations, and vaginal health, making diabetes management more complex. As a result of these differences, women may have a higher relative risk of cardiovascular complications of diabetes and a more sharply reduced quality of life, and may experience more depression.

“It’s hard to believe just how different the impact of diabetes might be on women versus men, but we are truly juggling an entirely different batch of variables every single day that men and boys are not,” says Jennifer Smith, CDCES, RD, a Wisconsin-based certified diabetes educator for Integrated Diabetes Services. “Women need more support and education on how to navigate these additional factors.”

                                                                                                  Javier Díez/Stocksy

Diabetes and the Menstrual Cycle

Hormone levels in teenage and adult premenopausal women are always in flux. Compared with the male body, which maintains relatively steady and consistent hormone levels, a woman’s menstrual cycle means insulin sensitivity is constantly shifting.

“Your body’s hormone levels are changing every day, even during the weeks when you’re not experiencing your [menstrual] period,” says Smith. “Your body is always trying to prepare for the potential of pregnancy.” 

The hormones involved in your menstrual cycle include progesterone, oestrogen, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Smith says the constant shifting of these hormones can affect women with type 1 or type 2 diabetes, but it’s significantly more prominent in those with type 1 diabetes. Some women with type 1 diabetes experience a decrease in insulin sensitivity and increase in blood sugar during the second half of their menstrual cycle (after ovulation occurs) likely due to increases in progesterone, though more research is necessary.

You may notice increased insulin sensitivity and resistance during other phases of your menstrual cycle as well. “It can be pretty overwhelming to try to pinpoint exactly how your cycle is affecting your blood sugar,” says Smith. “For example, some women see a big impact on the day they ovulate, and others don’t. Some people have insulin resistance for two days before the start of their period, then they’re very sensitive to insulin for the first two days of their period. How these hormone fluctuations affect your insulin needs can vary a little bit from one person to the next.”

Diabetes and Pregnancy

Diabetes can make pregnancy complicated.

“Whether you [have] type 1 [diabetes], type 2 [diabetes], or prediabetes, the decision to pursue pregnancy comes with immense responsibility,” says Smith. “But many women today are experiencing successful pregnancies. Diabetes alone shouldn’t stop a woman from planning a pregnancy.”

If you’re pregnant, or trying to conceive, your doctor will recommend an even stricter level of glucose control than usual, to protect both yourself and your baby. Standard recommendations include striving to keep blood glucose levels between 70 and 140 mg/dL, with an A1C below 6.5 percent if it can be achieved without frequent hypoglycaemia (low blood sugar).

“The more you can prepare for pregnancy by working with your healthcare team to improve your diabetes management, the more you can reduce your risk of complications and a wide range of birth defects,” Smith says.

During the earliest weeks of pregnancy, consistently high glucose levels can increase the risk of miscarriage and organ-related birth defects. Women with A1C levels over 8 percent or an average blood glucose level over 180 mg/dL face the highest risk of these complications.

“Not every pregnancy is planned, but if you can plan ahead, try to find a great [healthcare] team to support you during your pregnancy,” says Smith. “You’ll need ongoing weekly support.”

Diabetes and PCOS

Polycystic ovarian syndrome (PCOS) is very common in women with diabetes, adding another challenge to diabetes management.

“Both PCOS and type 2 [diabetes] are rooted in insulin resistance, making them metabolically connected,” says Caroline Thomason, RD, CDCES, a certified diabetes care and education specialist based in northern Virginia. As a result, women with PCOS have a significantly increased risk of developing type 2 diabetes. And if a woman struggles to regulate her blood glucose and insulin levels, they can exacerbate symptoms of PCOS, including irregular menstrual bleeding, acne, and weight gain.

Some women with PCOS find support from diabetes medications, including metformin and GLP-1 agonist medications like semaglutide, which can improve insulin sensitivity, support weight loss efforts, and improve the body’s overall metabolism of glucose.

“Your lifestyle can play a big role in managing PCOS as well,” says Thomason. “Getting enough fiber and lean protein along with low-glycaemic carbohydrates is really important. Getting regular exercise is also one of the most powerful ways to combat insulin resistance in type 2 [diabetes] or PCOS by helping your muscles take up more glucose.”

Thomason encourages anyone with PCOS to discuss their medication options with their healthcare team and prioritize a healthy lifestyle.

Diabetes and Menopause

Menopause can bring new challenges and complications for women with diabetes.

“Perimenopause and eventually menopause lead to a natural decline in oestrogen, which increases insulin resistance and can potentially make diabetes management more challenging,” says Thomason. “A critical part of this phase for any woman with diabetes comes down to her lifestyle habits.”

Thomason emphasizes that weight gain during menopause is especially common. Weight gain around the abdomen in particular increases a woman’s risk of cardiovascular disease. Body-composition changes that occur during this transitional period may also be linked to higher rates of major depressive disorder among women with diabetes than men with diabetes.

Women with diabetes are also more likely to experience early menopause, which may mean facing the complications of menopause, such as weight gain and osteoporosis, sooner.

Your blood sugar targets, as well as your insulin doses, may need to be reassessed as your metabolism shifts throughout perimenopause, says Thomason. Beyond blood glucose management, the biggest impact you can have on your overall quality of life will come from adopting and maintaining a healthy lifestyle, she says.

“The more you can focus on consistent exercise (including resistance training), managing your stress levels, and eating a fibre-rich diet, the more you can mitigate the metabolic changes that come with menopause,” says Thomason.

Diabetes and Vaginal Health

Elevated blood glucose levels may also trigger a variety of factors that can directly affect your vaginal health as a woman with diabetes.

“Chronically high blood sugar can promote bacterial and fungal overgrowth, leading to more frequent urinary tract infections and yeast infections,” says Thomason. Excess sugar in the urine feeds the growth of the unwanted yeast and bacteria. Fortunately, by working with your healthcare team to improve your overall blood glucose levels, you can prevent the occurrence of these infections.

“High blood sugar can also damage nerves throughout your body, including your genitals,” says Thomason. “This [damage can lead to] reduced blood flow, reduced sensation, and uncomfortable vaginal dryness, too.” 

Vaginal dryness can be the result of several factors related to high blood glucose levels. Dehydration is usually the immediate cause, but over the long term, the damage done to the nerves and blood vessels that support the production of your body’s natural vaginal lubrication is often to blame.

Thomason also highlights the connection between chronically high blood sugar and female sexual dysfunction. “[Because hyperglycaemia] can alter your hormone levels, [it] can easily affect your libido and your overall sexual health,” she says.

The Takeaway

• Compared with men, women with diabetes face particular challenges to their health and overall quality of life, many of which are related to their vaginal health, menstrual cycle, and constantly fluctuating hormones.
• Blood sugar management can be tricky during certain parts of the menstrual cycle, and chronically elevated blood glucose can lead to vaginal infections and dryness, as well as sexual dysfunction.
• Women with diabetes are more likely to experience PCOS, pregnancy complications, and early menopause than women without diabetes.
• A balanced diet, active lifestyle, and stress management efforts can go a long way in supporting a woman’s quality of life as she manages diabetes and associated health conditions.
• https://www.everydayhealth.com/diabetes/how-diabetes-affects-women-differently/