Women and Diabetes
What Is Diabetes?
Diabetes is a disease that affects the body's ability to produce or respond to
insulin, a hormone that allows blood glucose (blood sugar) to enter the cells of
the body and be used for energy. Diabetes falls into two main categories: type
1, which usually occurs during childhood or adolescence, and type 2, the most
common form of the disease, usually occurring after age 45.
How Does It Affect Women?
Approximately 8.1 million or 8.2% of all women in the United States have
diabetes, however, about a third of them do not know it. With its complications
-- blindness, kidney disease, amputations, heart attack and stroke -- diabetes
is the seventh-leading cause of death (sixth-leading cause of death by disease)
in the United States. Women with diabetes have an increased risk of vaginal
infections and complications during pregnancy. For women who do not currently
have diabetes, pregnancy brings the risk of gestational diabetes. Gestational
diabetes develops in 2% to 5% of all pregnancies but disappears when a pregnancy
is over. Women who have had gestational diabetes are at an increased risk for
developing type 2 diabetes later in life.
Women and Diabetic Complications
The risk of diabetic ketoacidosis (DKA) is 50 percent higher
among women than men. DKA, often called diabetic coma, is a condition
brought on by poorly controlled diabetes and marked by high blood glucose
levels and ketones (by-products of fat metabolism in the blood). Although it
is accompanied by high blood glucose levels, DKA is not caused by high blood
sugar; it is caused by lack of insulin. Before insulin therapy was
available, DKA was the predominant cause of death from diabetes.
Women with diabetes are 7.6 times as likely to suffer
peripheral vascular disease (PVD) than non-diabetic women. PVD is a
disorder resulting in reduced flow of blood and oxygen to tissues in the
feet and legs. The principal symptom of PVD is intermittent claudication
(pain in the thigh, calf, or buttocks during exercise).
Intermittent claudication is associated with a three- to four-fold
increased risk of coronary heart disease, stroke, or cardiac failure in
women with diabetes.
Pregnancy and Diabetes
Pregnancy demands more insulin in the body than normal because of the
increased production of hormones that can lead to insulin resistance. For
women with diabetes, excellent blood glucose control before conception
and then throughout pregnancy is vital to the health of the baby and the
The rate of major congenital malformations in babies born to
women with preexisting diabetes varies from 0 to 5 percent among women who
receive preconception care to 10% among women who do not receive
Between 3 to 5 percent of pregnancies among women with diabetes
result in death of the newborn within 28 days. This compares to a rate of
1.5% for women who do not have diabetes.
Macrosomia, large birth weight, occurs 2 to 3 times more often
in diabetic pregnancies as in the general population. Because of the
increased risk of fetal macrosomia, women with diabetes are 3 to 4 times
more likely to have a cesarean section.
Women with diabetes are up to 5 times as likely to develop
toxemia (a disorder of unknown cause usually marked by hypertension,
protein in the urine, edema, headache, and visual disturbances) and
hydramnios (excessive amounts of amniotic fluid) as women without
Approximately 2 to 5 percent of all non-diabetic pregnant women
develop gestational diabetes, a form of diabetes that occurs only during
Approximately 40 percent of women with gestational diabetes who are
obese before pregnancy develop type 2 diabetes within 4 years. The
chance of developing diabetes during this same period is lower if the women
are less overweight.
Diabetes and Birth Control
Birth control pills can affect blood glucose levels and diabetes
The intrauterine device (IUD) may lead to infections. Because women with
diabetes are already at a higher risk of infection, most should not use the
What Is Needed?
In ideal circumstances, women with diabetes will have their disease under
good control and be monitored frequently by a health care team knowledgeable in
the care of diabetes.
Patient education is critical. People with diabetes, with the
help of their health care providers, can reduce their risk for complications
if they are educated about their disease, learn and practice the skills
necessary to better control their blood glucose levels as close as to the
normal range as is possible for them, and receive regular checkups from
their health care team.
Health care team education is vital. Because people with diabetes
have a multi-system chronic disease, they are best monitored and managed by
highly skilled health care professionals trained with the latest information
on diabetes to help ensure early detection and appropriate treatment of the
serious complications of the disease. A team approach to treating and
monitoring the complex facets of this systemic disease serves the best
interests of the patient.
Non-diabetic pregnant women should be checked for gestational
diabetes between the 24th and 28th weeks of pregnancy unless they are in the
low risk category. This category includes women who are less than 25 years
of age, have no family history of diabetes, have a normal body weight and
are not a member of an ethnic/racial group with high prevalence of diabetes
(i.e., Latina, African American, Native American, and Asian.)