Here’s What Your Diabetes Risk Looks Like by Decade—and How To Lower Yours

From parade.com

Key Points

• Many people with type 2 diabetes are undiagnosed, increasing risk of serious complications.
• Risk rises with age, obesity, poor diet, inactivity and hormonal changes like menopause.
• Specific habits can reduce risk at any age.

Type 2 diabetes has serious health implications (including increasing the risk of cardiovascular disease), yet according to the Centers for Disease Control and Prevention, 27.6 million of the 40.1 million people in the U.S. with diabetes don’t know they have it. 

Undiagnosed diabetes is dangerous because when chronically high blood sugar is left untreated, it can damage blood vessels and nerves throughout the body. This can cause irreversible harm to the body’s organs before symptoms even start. This is why it’s crucial to know your diabetes risk and know how to manage your diabetes if you do have it. 

“Most patients [with type 2 diabetes] are asymptomatic because of its slow onset,” says Dr. Kevin Pantalone, DO, an endocrinologist and the director of diabetes initiatives at Cleveland Clinic. Related to this, Dr. Pantalone explains that many people have type 2 diabetes for a full five years before it’s diagnosed. “This is why screening for diabetes is so important.”

Dr. Pantalone explains that diabetes is diagnosed through blood tests that measure blood sugar levels. Preventing and managing your risk for type 2 diabetes looks slightly different, depending on your age. Here’s how you can manage your risk depending on how old you are.

                                                                                      Allen Chen/Getty Images

How To Lower Your Risk of Type 2 Diabetes in Your 20s and 30s

The number of people under 40 being diagnosed with type 2 diabetes is on the rise. Dr. Pantalone says that while there are genetic and environmental factors that influence the risk of type two diabetes, one primary reason for this is due to obesity. “Obesity increases insulin resistance, which makes it harder for the individual to control their blood sugar,” he notes. 

This means, he says, that habits that cause obesity (including improper diet and lack of exercise) directly contribute to the risk of type 2 diabetes. With this in mind, if you are in your 20s or 30s and want to lower the risk of diabetes, the most powerful way to do this is by having healthy diet and exercise habits in place.

“While one can’t change their genetics and may not be able to change their environment, one can try to lead a healthy lifestyle largely through maintaining physical activity levels and following general nutrition recommendations,” Dr. Pantalone explains.

How Type 2 Diabetes Risk Changes in Your 40s

Dr. Pantalone says that type 2 diabetes risk increases drastically after age 45 and continues to increase with age. That makes getting screened for diabetes in your 40s especially important. 

If you are a woman and developed gestational diabetes during pregnancy (which Dr. Pantalone explains is due to changes in hormones and weight), it’s important to know that you have a higher likelihood of developing type 2 diabetes later in life. With this in mind, it’s crucial to be screened for type 2 diabetes in your 40s if you had gestational diabetes during pregnancy.

The same diet and lifestyle habits that lower the risk of diabetes in your 20s and 30s also apply to your 40s. Especially because metabolism can slow after 40, making it easier to gain weight, maintaining a nutrient-rich diet and exercising regularly becomes especially important.

How Type 2 Diabetes Risk Changes After 50

For women, menopause can impact the risk of type 2 diabetes. “Menopause is associated with many hormonal changes, especially lower levels of oestrogen, and women will report weight gain during menopause. Weight gain is often accompanied with a change in body composition, specifically a reduction in muscle mass and an increase in fat mass, which can increase the risk of developing type 2 diabetes,” Dr. Pantalone says.

What can you do to mitigate this risk? Again, it comes back to having healthy habits in place, but in addition to having a nutrient-rich diet and exercising regularly, Dr. Pantalone says it becomes increasingly important to consistently get enough sleep and have healthy stress management habits in place. He explains that this is because lack of sleep and prolonged stress can both influence weight gain, which in turn increases the risk of type 2 diabetes. 

Dr. Pantalone reiterates that the risk of type 2 diabetes increases with age; the older you are, the more important it is to be screened for diabetes. That said, he emphasizes that maintaining healthy habits plays a major role in reducing this risk and is something people of all ages should keep in mind. “A person in their 20s with severe obesity could have a higher risk than a 55-year-old person of normal weight; there are lots of factors that influence one’s risk across the age spectrum,” he says.

With that in mind, it’s never too early—or too late—to start implementing healthy habits. They’ll lower your risk of type 2 diabetes both now and in the decades to come.

https://parade.com/health/diabetes-risk-by-decade-according-to-cleveland-clinic-endocrinologist

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/
  

How Does Diabetes Affect Menopause?

From diatribe.org

Dawn Adams, a midwife and diabetes researcher, shares her experience going through menopause with type 1 diabetes – plus tips for managing both.

Menstruation, pregnancy, breastfeeding, menopause, assisted reproduction, and loss of pregnancy – these are life events experienced by many women with diabetes. Each one impacts glucose variability, but many of these areas are under-researched and under-reported, meaning substantial evidence is lacking to support these women. 

Having experienced the glucose rollercoaster with menstruation, four pregnancies, breastfeeding, and type 1 diabetes, I’m now at the stage where menopause has become a topic close to my heart. 

Over the past year, my conversations with other women with diabetes have shown a willingness to learn more about our collective perimenopause and menopause experiences. Online surveys, Tweetchats, WhatsApp groups, and menopause education have highlighted the moderate to severe impact of perimenopause (the transition to menopause) on the lives of women. 

With the advent of continuous glucose monitors (CGMs), insulin pumps, and artificial pancreas systems, we can see such variabilities in our graphs and time in range data – something that would have been unimaginable 20 years ago. 

Recurrent themes from the community include a lack of awareness and support from healthcare professionals regarding menopause and diabetes. Women have described feeling like they are “hitting a blank wall” when asking for guidance from healthcare providers to manage the effects of perimenopause on their glucose levels and insulin requirements. A common comment is, “I wish I had known more about the symptoms of perimenopause earlier.” 

Menopause is defined as starting 12 months after the last menstrual period and can last for 10 years or more. Perimenopause starts 6-15 years earlier, meaning that in the U.K., where I live, roughly 13 million women are dealing with some sort of menopause. And a proportion of those women have diabetes.

What happens during perimenopause?

During perimenopause, menstrual patterns change. Periods may become lighter or heavier, or more irregular than usual. 

The associated blood sugar fluctuations can also become increasingly challenging. The gradual decrease in oestrogen during perimenopause can increase insulin resistance which, for people living with type 1 diabetes, means that blood glucose levels and insulin needs may become increasingly unpredictable. 

This may also be the case if the womb or ovaries are removed for any reason. Oestrogen and progesterone are two key hormones affecting perimenopause. Oestrogen has a glucose-lowering effect, while progesterone has a glucose-raising effect. While research is ongoing in this area, some strategies may help minimize the impact of perimenopause on glycaemic variability (more on that later).

What do menopause symptoms look like for women with diabetes?

Although not all women have the same experiences of menopause, many have said that it negatively affects their physical and emotional health. Perimenopause and menopause share many of the same symptoms including: 

• Hot flashes and night sweats

• Anxiety and depression

• Mood swings

• Disrupted sleep

• Irritability

• Weight gain

• Dry skin or rashes

• Reduced concentration

• Loss of confidence

• Sexual dysfunction  

Menopause is also associated with metabolic dysfunction leading to weight gain, impaired insulin sensitivity, high blood pressure, and high cholesterol. 

It can be confusing as women with diabetes transition to menopause as some of these symptoms aren’t that different from those of hypoglycaemia; many find it hard to differentiate between the two.

It varies for each person, but many women find that menopause is an emotional rollercoaster. The symptoms can be mistaken for depression, so keeping a record of all symptoms experienced may help make appointments with a healthcare provider more productive, particularly if you are struggling emotionally. 

Can hormone replacement therapy help?

There is little information for women and healthcare providers for this stage of life. Currently, the National Institute for Health and Care Excellence (NICE) offers no recommendations for women with type 1 diabetes, only advising that women with type 2 diabetes have specialist guidance if hormone replacement therapy (HRT) is deemed necessary. 

There is conflicting advice about HRT treatments for women with diabetes. One woman I spoke to said that her healthcare provider knew nothing about HRT and diabetes. There is also a commonly held belief that HRT isn’t an option for women with diabetes. 

The tragedy of this is that many women experiencing menopause have avoided any treatment, despite feeling that life is bleak due to hormone depletion. As women with diabetes, we know how difficult life is when essential hormones are absent or not functioning as well as they should. 

Since the day we were diagnosed with type 1 diabetes, we have taken insulin; that was our first encounter with replacing a hormone. For some of us, thyroid insufficiency also means that thyroid hormone medication is necessary to keep us functioning. For those diagnosed with exocrine pancreatic insufficiency (which prevents food from being digested properly), pancreatic enzyme replacement therapy is prescribed.

All of this suggests that HRT may help with managing menopausal symptoms in women with diabetes. However, this should be carefully considered with a healthcare provider as the potential risks and benefits need to be evaluated on an individual basis.

Tips for managing menopause with diabetes

Despite the lack of guidance in this arena, there are some treatments and strategies women with diabetes can employ that may help manage symptoms of menopause:

• Frequently monitor blood glucose levels. This may help with identifying patterns and adjusting your diabetes management plan if needed. CGMs have real-time glucose readings and alerts that detect and help you respond to glucose fluctuations more effectively.

• Collaborate with your healthcare team. Work with your endocrinologist and a diabetes educator (if you have access to one) to develop a specialized plan for managing your diabetes during menopause. 

• Adjust your insulin. Hormonal fluctuations may require adjustments to insulin dosages or changes in the timing of insulin administration. Again, work with your healthcare provider who can help establish the right insulin regimen for you.

• Eat a nutritious diet. Increasing your intake of fruit, vegetables, and whole grain cereals (while reducing consumption of processed foods and alcohol) may reduce menopause symptoms and fluctuations in blood sugar. There isn’t one recommended diet for diabetes and menopause, but incorporating foods rich in vitamins like folate will be beneficial.

• Take supplements. Magnesium and vitamin D support bone health and improve sleep quality. While it’s always best to get vitamins from food, supplements may also work for alleviating some symptoms as an alternative to HRT. Note that there are some supplements people with diabetes should avoid.

• Get exercise. Increasing physical activity, such as taking a walk after a meal, can improve insulin activity and carb absorption. Weight-bearing activities, such as dancing or low-impact aerobics, are known to be good for bone health. Find exercises that you enjoy, and if you can, invite family, friends, or other women experiencing menopause – it may improve mental health. Exercise also helps with balancing stress hormones and improving sleep, which can positively affect glucose levels.

• Stay educated and informed. Keep updated with the latest research and information about menopause and diabetes management. Attend educational programs, workshops, or support groups to stay informed and learn from others' experiences. There are many free events and informative podcasts available across social media channels and in real-life settings.

The bottom line

Going through menopause with diabetes can be challenging. Everybody experiences this phase of life differently, and there is no single guaranteed treatment effective for all women.

For some, connecting with others via online communities and forums is helpful. Plenty of support groups exist on all social media platforms. If you prefer real-life meet-ups, look for menopause support groups in your local community (in the U.K. we even have menopause cafes). If a support group doesn’t yet exist in your area, consider starting one – it might just be the single most useful therapy you encounter. 

https://diatribe.org/how-does-diabetes-affect-menopause