The Female Diabetes Danger Zone

Diabetes is a major heart hazard no matter who you are.
But if you’re a woman dealing with this disorder, the news gets worse:
While death rates for men with diabetes have dropped over recent years,
those for women have remained disturbingly unchanged. Learn why abnormally
high blood-sugar levels present more of a peril to women—and how proper
nutrition and lifestyle can help reduce your risk.

February 2008

By Lisa James

Failing kidneys, damaged nerves, amputated limbs, dimmed vision—perhaps no other disorder takes more of a toll on the human body than diabetes. But the deadliest consequence of uncontrolled glucose, or blood sugar, is how it harms the heart. Cardiovascular disease and stroke account for roughly 65% of all deaths among people with diabetes, rates that are two to four times higher than those among nondiabetic adults.

Women’s lives are especially threatened. Last June, the Centers for Disease Control (CDC) announced that while the death rate for the nearly 11 million men with diabetes dropped by 43% from 1971 to 2000, the rate for the nearly 10 million afflicted women was stagnant.

Scientists do not yet understand all the reasons why, but they are looking at several possibilities. “One factor might be less of an improvement in cardiovascular risk factors among diabetic women,” says Edward Gregg, PhD, the CDC epidemiologist who led the mortality study (Annals of Internal Medicine 8/7/07). “Rates of smoking, high blood pressure and high cholesterol have come down among men. These risk factors have come down somewhat among women, but the improvements, among diabetic women at least, have not been as great.” Women may not be treated as aggressively for both diabetes and heart disease as men, and Gregg says it’s even possible that “the process by which diabetes affects heart disease is different between the sexes.”

In response to this threat, the CDC and three other public health organizations have developed the National Public Health Initiative on Diabetes and Women’s Health. The idea, says Gregg, is “to identify the main opportunities to reduce risk for women.”

Hidden Danger

Part of the problem is that type 2 diabetes, the most common form, does much of its deadly work quietly over a number of years. It generally begins as insulin resistance, in which the body’s ability to use insulin, the substance that transports glucose from the bloodstream into the cells to be burned for energy, is impaired. The pancreas, a gland located behind the stomach, tries to produce more and more insulin to meet the ever-rising demand. Eventually, the pancreas wears out and loses its abil­ity to produce any insulin at all. Lifestyle—excess calories and stress, minimal exercise and relaxation—plays a major role in this process. A family history of diabetes is another factor, with seven new genetic links discovered just within the past year, but the balance between genetics and lifestyle has not yet been quantified.

Diabetes in the Bedroom

Of all the complications that can bedevil a woman with diabetes, one of the least discussed, and most distressing, is how this disorder can short-circuit her love life.

“When a woman comes to the doctor, she often doesn’t mention these problems,” says Wendy Arthur, MD. And diabetes-related sexual issues are often compounded by those that can accompany the aging process itself. “Most midlife women tend to have a decrease in sexual sensitivity, and that can lead to delayed or difficult orgasms,” Arthur says.

A pair of Certified Diabetes Educators (CDEs), Janis Roszler and Donna Rice, address this issue in Sex and Diabetes: For Him and For Her (American Diabetes Association). They advise getting a grip on blood-sugar levels. This will help fight fatigue (a major bedtime bummer in itself) and especially those low-glucose crashes that can cause romance to fizzle. They recommend probiotics and cranberry to forestall bladder infections, and, if needed, a good water-based lubricant for optimal comfort. Roszler and Rice also suggest going slow: “If your sexual activity is rushed, your body may not have time to become aroused.”

Supplemental help is available, and one of the best-known intimacy aids is the amino acid L-arginine. Roszler and Rice cite a University of Hawaii study in which an arginine-based formulation increased a woman’s desire, sensation and overall sexual satisfaction; another study showed similar improvements among women in different stages of menopause (Journal of Sex & Marital Therapy 10-12/06). Among herbal remedies, ginkgo encourages better genital blood flow while both damiana and muira puama have long histories of use in revving stalled sex drives. But keep in mind that communication is the ultimate aphrodisiac. “The more you connect outside of the bedroom,” say Roszler and Rice, “the easier it will be to connect in the bedroom.”

Just because male diabetic death rates have dropped doesn’t mean that men with diabetes are off the hook. In both sexes, the presence of excess blood sugar translates into shorter lifespans and fewer years free of heart disease compared with people whose glucose levels are in the safe range. High levels of glucose and insulin have also been linked with a greater risk of colon polyp recurrence (Gastroenterology 11/07).

All this combines to make diabetes the sixth leading cause of death—and even that relatively high rank doesn’t really capture the whole story. “It may be a heart or brain complication that ultimately kills the person,” Gregg explains, “and when the death certificate is being filled out, the fact that diabetes was an initiator years before is often overlooked.”

What’s more, the glucose level that defines diabetes has gone down over the past 20 years, so the number of diagnosed cases has gone up. By current standards, a glucose level below 100 mg/dl is normal, the prediabetic range is 100 to 125 mg/dl and anything over 126 is considered outright diabetes.

Underlying Factors

Diabetes is closely linked to metabolic syndrome, which includes being overweight and having higher-than-normal levels of blood fat, pressure and sugar. What scientists now know is that excess weight carried in the abdomen (as opposed to the hips and thighs) is particularly hazardous to health. “There’s a real simple thing we should all be doing, and that’s measuring our waist,” says Wendy Arthur, MD, director of Comple­mentary and Holistic Health for Clayton College of Natural Health in Birmingham, Alabama. Anything much over 35 inches for a woman and 40 inches for a man signals peril.

Inflammation is another danger: Arthur gives the example of someone with diabetes who works out but dies suddenly of heart disease. “The conventional way of looking at things is that they must have had high lipids,” or blood fats, she says. “Now we’ve learned that it’s chronic, low-grade inflammation that’s clogging their arteries.” She believes hard exercise like running can create inflammation and suggests low-impact pursuits such as swimming.

Women have issues of their own. For one thing, diabetes risk factors such as increased inflammation appear earlier in women, even before their glucose levels start to rise. Women are also less likely to change poor health habits, such as eating fatty foods and not exercising. In 11 years of clinical practice, Arthur found that her diabetes patients, especially women, “did not want to make lifestyle changes.” And women who develop blood-sugar problems during pregnancy (gestational diabetes) are more likely to develop type 2 diabetes later in life.

Bad News

Whether you’re a man or a woman, being told that you have diabetes is a jolt. Donna Kay, diabetes lecturer and author of The Complete Diabetes Lifestyle (Big Think Media, www.completediabeteslifestyle.com), heard those words in the summer of 2003. “The first couple of weeks were spent in disbelief because I had no family history of diabetes,” she recalls. “Then it was really, ‘Holy Moses, it’s the rest of my life we’re talking about.’”

Diabetes may not have been in Kay’s genes, but it did lurk within her approach to living. “Before I was diagnosed I spent 15 years doing marketing in high tech,” she says. “I was living the high life—high stress, high cholesterol and fat intake, a lot of travel and a sedentary lifestyle.” Always on the heavy side, Kay was initially delighted to lose weight despite ravenous hunger. But she was also constantly tired and thirsty. “In the back of my mind,” she says, “an alarm bell was ringing.” That’s when a blood test pegged her blood sugar level at 370.

After the shock wore off, Kay learned how to cope physically and emotionally. She believes both are important: “The best support you can have is a positive and hopeful attitude.” Kay even discovered a silver lining in her own diabetes cloud. “I found a calling,” she says. “I’ve changed careers—writing, public speaking. I want to be a peer educator for other people with diabetes.” Arthur agrees that being with other people who are working their way through the same challenge is invaluable to someone who has been newly diagnosed. She says research has “found that treatment works best if the lifestyle changes are addressed in a group setting. People get more out of it by hearing the questions of others.”

Kay also stresses the need to accept your situation—pretending that you don’t have a blood-sugar issue just because you aren’t suffering its complications right now will only set you up for big problems later on. And while finding a good professional healthcare team is critical to staying healthy despite diabetes, she also recommends “not being afraid to be your own best healthcare advocate. Be assertive in terms of what’s in your best interest.”

Living a Low-Glucose Life

The good news about finding a new way to live after a diabetes diagnosis is that you don’t have to do it all at once. “If you can figure out small changes you can make,” Kay says, “that can add up to a big difference over your lifetime.”

One of the biggest challenges for most people with type 2 diabetes involves dietary adjustments. And while many obsess about losing weight, Kay has a better idea. “I worried about keeping my blood sugar under control,” she says. “Once I worked on this problem I stopped worrying about my weight and guess what, the weight came off.” It’s important to realize that no matter how many pounds you lose, your diabetes will likely not just go away for good. What’s more, you can’t lose sight of other heart disease risk factors, including high cholesterol and high blood pressure.

Fortunately, healthy eating can cover a lot of cardiovascular ground. According to a study in the October 2007 Journal of the American College of Nutrition, the Mediterranean diet—heavy on the veggies, whole grains and olive oil, light on the meat and sweets—has helped lower both glucose and cholesterol levels among people with prediabetes. (Whole foods have loads of fiber, which may help reduce obesity and prevent diabetes.)

Kay suggests concentrating on simple steps you can implement right away, like having a green salad before dinner every night and eating more fish (a rich source of heart-healthy omega-3 fatty acids). She also recommends keeping a food diary and, yes, counting calories. “I always have to fight the urge to eat more than my body truly needs,” she admits. “Exercise comes more naturally to me than saying no to that second helping.”

Speaking of exercise, you and the couch have to stop going steady. “Go for a walk with your kids,” says Kay. “If you don’t have kids, get a dog.” If you’re already experiencing foot problems, Arthur recommends “chair dancing. It’s excellent—you sit in a chair and there are workout routines set to different pieces of music” (see www.chairdancing.com). Arthur says that exercise is one area where men have an edge: “If a man comes in early in the course of his diabetes he will have normal muscle mass, and so he has an ability to lose that belly fat faster.”

One way a woman can even her odds is by using supplements that support a trimmer body shape. For instance, people who carry fat in their abdomens have been found to have less vitamin C than other folks (AJCN 12/05). Kelp, a brown seaweed, contains a substance called fucoxanthin that appears to target abdominal obesity. Both the fatty acid CLA and the mineral calcium have been shown to promote fat burning, while the herb garcinia (G. cambogia) helps inhibit fat formation and stifle appetite.

Another gender-based diabetes difference lies in how the sexes react to stress. “Stress is something that’s very real and very negative for diabetes,” says Kay. “If women tend to carry more stress around then men, then it doesn’t surprise me that women don’t control diabetes as well.” In addition to such practices as meditation or yoga, herbal stress busters (which are known collectively as adaptogens) include the ginsengs, Korean (Panax ginseng) and American (P. quinquefolius), along with the Siberian native rhodiola (R. rosea). In addition, the B vitamins aren’t known as the “stress vitamins” for nothing.

A number of natural remedies help deal with diabetes directly. “The most helpful would be gymnema [G. sylvestre, also known as gurmar] because it decreases the desire for sugars and reduces blood sugar,” says Arthur, “and stevia [a natural sweetener] because it actually has been found to reduce blood sugar and it’s safe to cook with.” She says that cinnamon paired with blueberries makes a great oatmeal topper. Cinnamon is available in supplemental form; other supplements used by practitioners include:

*Banaba—An Indian herb, Lagerstroemia speciosa; contains corosolic acid, a substance that helps move glucose into cells.
*Chromium—A trace mineral that fights insulin resistance.
*Fenugreek—An Indian spice that helps reduce glucose levels.
*Magnesium—Diets high in this essential mineral have been linked to reduced incidence of diabetes.
*Vitamins D and E—The former may drop diabetes risk by 33% when taken with its partner, calcium; the latter may reduce the risk of death from heart disease among some diabetics.

It’s hard to keep your glucose in check if you don’t gauge your levels daily. “At a minimum, you should measure your fasting blood sugar and take another blood-sugar measurement at least once again during the day,” Kay advises. (Invest in a good glucose monitor, and learn how to use it properly.)

Have your practitioner regularly measure your HbA1c, which shows how blood-sugar levels behave over time.

Diabetes will change the way you live—or at least it should, if you want to avoid complications—but it’s far from a death sentence. “Diabetes is very manageable,” says Kay. “And if you manage it correctly you have a better chance of living a long, healthy life.”

Diabetes Resources:
American Diabetes Association:
800-DIABETES, www.diabetes.org
Diabetes Exercise & Sports Association: 800-898-4322, www.diabetes-exercise.org
D Life: www.dlife.com
National Diabetes Education Program: 301-496-3583, www.ndep.nih.gov

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