If diabetes were a gender issue, then women should fight for gender equality. Why? Because women are at a losing end when it comes to diabetes and its many complications compared to men. For one, diabetes causes more complications in women than in men, some of which are unique to women. Being diabetic makes a woman prone to complications in pregnancy, reproduction, and the heart. Uncontrolled blood sugars in diabetic women may also cause increased yeast infections, bladder infections, vaginal dryness, and inability to reach orgasm during sexual intercourse.

Today, diabetes remains as one of the most serious health challenges facing women all over the world. Data from the American Diabetes Association (ADA) show that approximately 8.9 percent or 9.1 million of all women in the United States have diabetes, one-third of which are unaware that they have it. In the Philippines, the latest National Nutrition and Health Survey (NNHeS) done in 2003 reveals that 5=: percent of Filipino women aged 20 to 70 have diabetes. According to Ms. Felicidad Velandria of the Food and Nutrition Research Institute (FNRI) and one of the lead investigators of the study, this means that 5 out of every 100 adult women in the country have diabetes. The criteria used in the survey for defining diabetes was a fasting blood sugar (FBS) level of more than 125 mg/ dL and a previous history or diagnosis of diabetes.

Although NNHeS states that no significant gender difference was found in terms of the prevalence of diabetes among men and women, it can still be noted that the prevalence of diabetes in men is lower at 4.1 percent compared to 5 percent in women. The highest prevalence of diabetes in women was in the group aged 50 to 59, suggesting an increase in the incidence of diabetes with age. However, complications of diabetes affect women not only in old age but through different life stages. From adolescence to adulthood through old age, diabetes . impacts women slightly differently than it does men. Complications of diabetes are among the top 10 causes of deaths among women, with heart disease as the number one cause of death among women with diabetes.

Heart complications
Cardiovascular disease, as a complication of diabetes, is said to be more serious among women than men. Data from the ADA show that deaths from heart disease in women with diabetes have increased 23 percent over the past 30 years. Most women with diabetes have type 2 diabetes, which increases their risk for heart disease. Studies have shown that women with diabetes have more than three times the risk of developing heart disease than women without diabetes. The risk of developing heart disease is also greater in women than men.

“There is a 3- to 4-fold increase in cardiovascular complications in women compared to men,” says Dr. Esperanza Cabral, immediate past president of the Philippine Society of Hypertension and a past president of the Philippine Heart Association. According to Dr. Cabral, there are underlying pathophysiological mechanisms in women that makes them at greater risk of developing heart disease than men. Researchers say that when women develop diabetes, it is often accompanied by more adverse changes that increase their chances of developing heart disease. These changes include an adverse rise in blood pressure, a decrease in the level of HDL cholesterol (good cholesterol), and increases in abdominal fat predominantly because of obesity and an inactive lifestyle. Although the same changes also occur in men with diabetes, experts say that these changes are not to the same extent as in women.

To prevent heart complications, Dr. Cabral recommends an aggressive treatment of risk factors. She advises diabetic women to keep their diabetes under control by being aware of their ideal body weight and making significant lifestyle changes like quitting smoking, limiting alcohol intake, adhering to proper diet and exercising regularly.

Complications in pregnancy
Aside from the heart complications, diabetes also carries risk to a woman and her unborn baby during pregnancy. One of the most serious complications of diabetes in pregnancy is gestational diabetes mellitus (GDM). Women who do not currently have diabetes, run the risk of getting gestational diabetes or diabetes in pregnancy. GDM develops in two to five percent of all pregnancies. Although inconvenient and risky, GDM often disappears after pregnancy. However, it also puts women at an increased risk for developing type 2 diabetes later in life.

There are several factors that may contribute to the development of GDM. Research shows that pregnant women who are overweight or obese are at an increased risk of developing gestational diabetes. Other risk factors for GDM include: family history of diabetes, over age 25 at time of pregnancy, previous pregnancy with gestational diabetes, and smoking. “There is still no direct cause-and -effect for gestational diabetes,” says Dr. Rogelio Mendiola, an obstetriciangynecologist -and vice-president of the Philippine Obstetrical and Gynecological Society (POGS). However, one probable cause is that pregnant women need more insulin in the body than normal because of the increased production of hormones. This increase in hormone production in pregnancy may lead to insulin resistance, one of the factors that causes diabetes, explains Dr. Mendiola.

Gestational diabetes usually occurs during the fourth to sixth month of pregnancy, says Dr. Mendiola. He adds that most of the time, the patients are not aware that they have GDM until the doctor discovers that there is a fast increase in the growth of the fetus, which is one major complication of GDM. “Definitely, diabetes will not only affect the mother but also the fetus,” he says. He further explains that on the part of the fetus, there are lots of complications that may arise because of diabetes like congenital anomalies and other defects that usually affect the heart of the fetus.

Delivering big babies that weigh eight pounds or more is another complication of diabetes, says Dr. Mendiola. Big babies upon delivery do not necessarily mean that the baby is healthy, but it can be due to diabetes complications. These babies also run the risk of developing diabetes, especially if they grow to be obese children. “If the woman is initially diabetic there should be counseling, and treatment of this patient should be team management. Not only will the obstetrician take care of the woman’s pregnancy and the fetus, but there will also be an endocrinologist or a diabetologist. And in most cases a nutritionist is also needed,” he added.

For women with diabetes, experts recommend excellent blood glucose control before conception and throughout pregnancy to ensure the health of both the baby and the mother. To control a diabetic woman’s blood sugar during pregnancy, Dr. Mendiola says that diet control and exercise in addition to other treatments for blood sugar control would be best. According to Dr. Mendiola, one of the main causes of increased blood sugar or uncontrolled intake is poor diet. He therefore suggests that patients should practice selective dieting, which means that they have to avoid foods that will increase or aggravate their blood sugar. He also recommends regular exercise for pregnant diabetic women or for those suffering from gestational diabetes. “The best exercise is 15 to 30 minutes brisk walking which should be done regularly, about 3 to 4 times a week.”

Treatment and prevention
Good blood sugar control and proper monitoring by a team of healthcare professionals are the best treatment options to prevent the various complications associated with diabetes. Being educated about the disease is also important. A lot of complications associated with diabetes can be prevented if women are educated about their disease. Being well-informed can help women better control their blood glucose level, as well as their blood pressure and cholesterol levels.

Necessary lifestyle changes should also be in place. Smokers should stop smoking, and overweight women with diabetes should develop a regular exercise regimen coupled with proper diet to achieve their ideal weight. For non-diabetic pregnant women, getting checked for gestational diabetes between the 24`h and 28`h weeks of pregnancy is recommended to prevent possible complications to the mother and the fetus. This is especially true for women aged 25 years and above, those who have a family history of diabetes (diabetes in first-degree relative), and women who are overweight or obese.

Prevention is indeed better than cure, as the old saying goes. So if you’re a woman and you want to prevent the development of diabetes and to avoid its complications, make the necessary steps and do the necessary changes in your life that could make a difference in keeping you healthy, alive and continually empowered.

Related terms:

• "diabetes complications" and "gender difference"
• dr rogelio mendiola
• facing the challenges of NNHeS
• how does a filipino woman avoid becoming diabetic
• number of mothers who died because of gestational diabetes
• why are women still suffering from gdm
• why women are prone to diabetes

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