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I have a friend and colleague whose name is Lois Jovanovic. Lois is an endocrinologist. She treats lots of people who have diabetes, and she has had diabetes herself for many years. Lois tells her patients that diabetes chooses only beautiful, talented, intelligent women. Lois is certainly such a person, and many other women with diabetes I’ve met are, too.
Unfortunately, the disease “chooses” women for special diabetes-related physical and emotional burdens, as well. Throughout their lives, women with diabetes face more of these challenges than men do.
For example, among teens who have diabetes, more girls than boys are overweight. Given the greater pressure on women to be thin, it’s not surprising that more young women than young men try to control their weight in ways that compromise blood sugar control. One of the scariest ways is to reduce insulin doses dramatically. This is called “insulin purging,” because many of the calories consumed are purged or urinated away. Insulin purging is about ten times more common in women than men. It does control weight, but it also contributes to chronically high blood sugars. One of my patients called it “a very controlled high,” because as high as her blood sugars were, she was controlling things to keep them there. Unfortunately, controlled or not, women who run high to control their weight also run an increased risk of developing diabetes complications.
What helps? It’s really tough to accept the fact that efforts to keep blood sugars as close to normal as possible often lead to problems controlling weight. How each woman balances these considerations is for her to decide. It can help to be realistic about what you expect your body to look like. Few people over the age of 14 look like the models we see in the magazines. And those fit, glamorous, aging movie stars we see spend lots of time and money looking that way. Looking and feeling good can be a reality for all of us, and the key is maintaining a healthy, balanced lifestyle, including good eating, regular activity and emotional and spiritual pleasures. With these in your life, you may not look like a movie star, but you will feel like a million.
Only women experience pregnancy and childbirth, and the process involves special challenges for women with diabetes. Children are so precious, it’s no surprise that most women work extra hard to keep their blood sugars as close to normal as possible when they are pregnant. These efforts dramatically reduce the risks of any diabetes-related pregnancy complications, and I’ve seen some amazing drops in HbA1c levels among women preparing for pregnancy. One woman went from 10 percent to under 6 percent in about six months, and then started trying to get pregnant. The majority of serious diabetes-related pregnancy problems occur before the seventh week after conception, so to protect themselves and their babies, women should have close-to-normal blood sugars before trying to get pregnant. Unfortunately, many young women with diabetes are especially vulnerable to unplanned pregnancies, so they are rarely able to lower their blood sugars levels in time to help much.
What helps? Women of childbearing age, especially young women, should take special care not to become pregnant without planning. Today women with diabetes can dramatically improve their chances for an uneventful pregnancy and a healthy baby if they keep their blood sugar levels close to normal throughout the pregnancy. The woman I just mentioned had her baby six weeks ago, and the look on her face when I saw her holding the baby after they got home from the hospital made it clear that all the effort was worth it.
Among people who don’t have diabetes, heart disease is much less common among women than among men. Among people with diabetes it’s a different story: women and men suffer from heart disease at similar rates. For a variety of reasons, women seem to lose their partial protection against heart disease when they have diabetes.
What helps? Women who have diabetes can reduce their risk of heart disease. Keeping blood sugar, blood pressure and blood lipid levels as close to normal as possible all help. And, those old standbys diet and exercise have a role here, since they can directly affect blood sugar, pressure and lipid levels. Nor should we forget smoking, since when it comes to risk for heart disease, smoking only adds fuel to the fire.
Finally, there are emotional issues. Research I’ve conducted at the Johns Hopkins Diabetes Center with my colleague Dr. Mark Peyrot suggests that women have a harder time than men living with diabetes. Specifically, we found that:
In addition to these areas in which women and men differed, we found many issues, including most areas of self-care, that the two genders experienced similarly. Still, the women in our study were clearly less comfortable living with diabetes than the men were. In fact, there wasn’t a single issue where women seemed to have an advantage.
Some of the differences we found could reflect general differences between men and women. For example, women in the general population are more likely to be depressed, and less likely to feel supported by their spouses than men are. Other differences may reflect the way gender and diabetes interact, as in the way eating issues, which tend to affect all women to a greater degree than men, interact with the unique demands of diabetes management. Still other differences could be the result of the fact that women are more comfortable expressing themselves. For instance, women may be more willing than men to say they don’t feel confident.
Women in our study also had higher HbA1c levels than the men did.
What helps? My research points to several things that could help make life easier for women with diabetes. First, actively involving family members in supporting diabetes management can make a big difference. This support can be practical (e.g., cooking a healthy meal), or emotional (e.g., applauding diabetes self-care efforts). Second, dealing more effectively with issues of eating and body image is important. This is a really tough one, but some of the suggestions I’ve offered in this and earlier columns might help. Third, getting help for ongoing emotional distress can be critical.
Life with diabetes can be really demanding, especially for women. If you get down and stay that way for a while, get help. You may need just a few sessions with a counselor (try to find one who knows something about diabetes), or you may need somewhat longer treatment if you are depressed or have other serious problems.
Getting timely, effective treatment for emotional distress is really important for two reasons.
1. It feels good to feel less hassled and overwhelmed.
2. Relieving distress helps you feel motivated to take the best possible care of your diabetes, and that will help you feel better today and in the years to come
Being a woman with diabetes presents special challenges, but with a little help you can meet those challenges.
