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Diabetes Battle of the Sexes

Men are from Mars and women are from Venus. Does this hold true even in diabetes? According to the Centers for Disease Control and Prevention, which regularly collects data for the U.S. Department of Health and Human Services, at 50 years is the age when both men and women commonly get their incident diabetes. But that’s about all the similarity men and women have with diabetes.

Higher morbidities in men
Recent data show that, while the incidence of diabetes has increased in both men and women, there has been a higher rate of increase in men. It also disproportionately affects the elderly more; almost 25 percent of the population 60 years and older had diabetes in 2007. Men appear to get more complications like renal failure, lower extremity amputation, and retinopathy as well. Cardiovascular disease appears to be two times higher in men than for women. However, data from the Atherosclerosis Risk in Communities Study showed that, compared to their respective sex group without diabetes, incidence of coronary heart disease was 2.52 times higher for men with diabetes and 3.45 times higher for women with diabetes.

More differences between men and women
While men seem to have higher morbidities, women seem to be missing out on well-documented reductions in mortality rates (death due to diabetes) in the general U.S. adult population in the past 25 years. In an article published in Annals of Internal Medicine in 2007, Dr. Gregg and his colleagues reported that among women with diabetes, neither all-cause nor cardiovascular disease mortality declined between 1971-1986 and 1988-2000. Sex differences in the pathophysiology of coronary heart disease have been proposed, including a greater tendency for women to have microvascular coronary heart disease and left ventricular hypertrophy, differences in inflammatory and hormonal responses to risk factors, more complicated patterns of symptoms, and less accurate diagnoses of coronary heart disease. Whether these factors differentially influence mortality rates among women with diabetes is still not clear.

Men also reported higher quality of life, especially regarding diet issues, and more overall treatment satisfaction, according to a study reported in Diabetes Spectrum titled, “Men and Diabetes: Psychosocial and Behavioral Issues”. “Simply put, we found that men seemed to have an easier time living with diabetes than did women,” the article concluded. I don’t know if this applies to Filipino patients, but I have observed that most men coming in to my clinic usually have their partners taking care of the medicines, food, and their follow-up checks. This is not true with women; they usually take care of their own medical problems.

The menstrual cycle and diabetes
Fluctuations in hormone levels occur through the menstrual cycle and these fluctuations can affect blood sugar control. Generally, when estrogen levels are high, the body may be resistant to its own insulin or injected insulin. Many women find their blood sugar to be high 3-5 days before, during, or after their periods.

The only way to manage blood sugar is to test and record blood sugar four or more times a day to look for your own pattern. This allows you to adjust your insulin doses and carbohydrate intake both before and during this time to better control your blood sugar.

Food cravings during premenstrual symptoms are triggered by an increase in progesterone and can make it more difficult to control the blood sugar. The craving is usually for chocolate or anything sweet. You may give in to your cravings by trying sugar-free and fat-free versions; examples are fat-free yogurt and sugar-free gums. Also, increase your exercise to compensate, or ask your physician to adjust your oral medications or insulin.

Polycystic ovary syndrome
Another problem women have to contend with is a disease called polycystic ovary syndrome (PCOS). This affects 6-10 percent of women, as stated in various health websites and is part of the insulin resistance syndrome. Women typically experience two or more of these symptoms: obesity, acne, infertility, irregular menstrual cycles, and ovarian cysts.

Similar to insulin resistance and type 2 diabetes, PCOS improves with weight loss, exercise and healthier eating habits, and insulin-sensitizing medications. Metformin is useful because it turns off production of glucose by the liver, improves insulin sensitivity, helps in weight loss, and eventually helps enable pregnancy. When a diabetic woman does get pregnant, there is risk to the baby and a consultation must immediately be made with an obstetrician and an endocrinologist.

Erectile dysfunction and men Men who have diabetes are prone to get erectile dysfunction from microvascular disease and from autonomic (nerve) dysfunction. Men are not quick to admit this problem, so it is important for healthcare providers to ask for the history, especially for chronically diabetic men. Medications like sildenafil are now available in appropriate settings.

No matter how many similarities or differences, the universal bottom line here is that both men and women should control their glucose to avoid the complications of diabetes. As the Finnish study has suggested, patients with diabetes, regardless of sex, are considered as coronary equivalents (people at very high risk for heart disease).

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