Dr. Rajesh Manghnani

Diabetes - How Does It Affect Women?

Diabetes is a public health concern that is rapidly rising in numbers across the world due to higher stress levels and the industrialization of most economies all across the world. Although medication and early diagnosis have been able to stop diabetes-related problems and reduce deaths occurring from it, it still remains a problem as it severely reduces the quality of life.

Diabetes poses some unique risks for women as compared to men. There are some problems areas created by diabetes which are common in both men and women and there are certain problems which are very unique to women. Let’s look at some of the facts and figures as mentioned below-

INCIDENCE OF DIABETES –

Women are prone to diabetes as much as men are in most populations. Although specifically in India, according to a study conducted in 2014, about 7.1% of the population gets affected in total. However, in certain populations, it has been seen that the incidence of diabetes among women tends to be higher than men.

RACE AS A FACTOR -

Some races tend to be even more predisposed to diabetes than others such as Pacific islanders, some people of South American descent such as Mexicans, South Asians and people of African descent. Some of the risk factors for this could be –

1. Diet

2. A culture of no exercising among some groups

3. Prevalence and preference for a sedentary lifestyle

4. Industrialized societies and urbanization which lead to poor eating habits

5. Higher percentage of body fat

6. Hereditary factors

PCOS AND DIABETES –  

PCOS is a disorder that disrupts a woman’s endocrine system and increases her levels of androgens, or male hormones.

This disruption can cause irregular menstruation, excessive hair growth, acne, and obesity. It can also impact a woman’s ability to have a child. It’s often diagnosed when small pockets of fluid appear in a woman’s ovaries during an ultrasound.

While the cause of PCOS remains unknown, it’s believed that insulin resistance, which leads to high levels of insulin, as well as low-grade inflammation and hereditary factors, may all play a role.

How does PCOS relate to Diabetes?

Insulin resistance can create an adverse reaction involving the immune system and help bring about type-2 diabetes.

Type-2 diabetes is a condition in which the cells of the body become resistant to insulin, an inadequate amount of insulin is made, or both.

While type-2 diabetes is typically preventable or manageable through exercise and a proper diet, research shows that PCOS is a strong independent risk factor for developing diabetes. In fact, women who experience PCOS in young adulthood are at an elevated risk for diabetes and potentially fatal heart problems later in life.

It is advisable that you take steps to control insulin levels in any case.

IMPACT OF DIABETES ON SEX LIFE -

Sex is good for diabetes. It's good for your heart and blood flow, helps you sleep, and boosts your mood.

If you have diabetes and have had painful sex or trouble getting aroused, though, sex may not seem too sexy. About 35% of women with diabetes seem to have sexual issues. That doesn't mean you have to live with them. There's help to get your sex life going again.

Sexual Challenges For Women :

1. Vaginal Dryness. This is the biggest sexual complaint in women with diabetes. Vaginal dryness is, this  twice as likely if you have diabetes. If you are in menopause or postmenopause, less estrogen may be the cause. If you aren't, damage to the nerves that lubricate your vagina may be. Vaginal dryness can become a painful cycle. If sex hurts because of it, you may tense up during sex, causing more pain, or avoid sex altogether.
2. Vaginal Infections. Urinary tract infections (UTIs) may make sex painful. Yeast infections can also cause pain during sex, as well as vaginal dryness. If you have poorly controlled diabetes, you're more likely to have yeast and other vaginal infections.The burning and pain can make sex very uncomfortable -- and when there is chronic infection, there is chronic discomfort that can cause a woman to avoid sex for long periods of time.

Avoiding sex may only make the problem worse.

DIABETES AND PREGNANCY -

Diabetes can affect a person without warning and sometimes may even occur without any family history. For a woman of childbearing age, this is stressful as the desire to become a mother and the thought of bringing harm to the child. Although the risks associated with pregnancy in a diabetic woman can’t be ignored, the number of misconceptions is huge and adds to the stress. However, the situation is not as bad as it is made out. A diabetic woman can get pregnant and deliver healthy babies. You just need to take certain precautions to become a mother.

How Diabetes Affects Pregnancy?

The most commonly seen complications of diabetes are those that affect the kidney, eyes and the nervous system. These are also known as diabetic-nephropathy, retinopathy and neuropathy respectively. After delivery the symptoms might disappear; however, treatment may be required. Ensure that you inform your doctor about any changes in your body as they can be symptoms of a condition. Common conditions seen among mothers are:

1. Urinary tract infection leading to fever.

2. High blood pressure leading to fluid build-up.

3. Swelling in limbs and face.

4. Protein excretion in urine.

5. Carpal tunnel syndrome leading to numbness & tingling in hands.

6. Build-up of ketone bodies.

7. Risk of premature delivery or requirement of c-section.

If undetected for long, there could be worsening of eye problems, nerve damage and severe kidney disorder. Medication may be provided, including suggestion for having complete bed rest, early admission to the hospital or early delivery.

Unchecked diabetes can also put the baby at risks such as:

1. High blood sugar levels leading to fat accumulation in shoulders and trunk.

2. Low blood sugar level after birth.

3. Stillbirth.

4. Jaundice.

5. Risk of getting obese or diabetic later in life.

6. Macrosomia (having a large baby)

7. Birth defects (not usually a risk for women with gestational diabetes)

8. Respiratory distress syndrome (difficulty breathing)

Target blood glucose goals before getting pregnant:

1. Pre-meal (before eating): 60-119 mg/dl

2. 1 hour after meals: 100-149 mg/dl

Can Diabetic Women have Normal Pregnancy?

Most women look to this moment with equal parts fear, dread, and excitement. While many women with diabetes have a vaginal birth without complications, the chances of having a cesarean section or having labor induced before your due date are increased. That's partly because women with diabetes are more likely than others to have large babies, in which case vaginal delivery can damage the baby's collarbone or shoulders. It's also because diabetes and obesity increase a woman's risk for high blood pressure and a condition called preeclampsia (see box). These conditions often require early delivery to prevent harm to the mother and baby. The upside is somewhat more control of the circumstances around labor and delivery; the downside is that induction often leads to more intense, painful contractions that come faster, plus an increased chance of having a cesarean section.

Planning Pregnancy and Reducing the risks for you and your baby-

Starting a family requires a bit more planning when you're a mother-to-be with diabetes. But you can take some simple steps to make sure your pregnancy and your baby are safe and healthy.

1. Start with a checkup: The first step in preparing for pregnancy is to talk to your health care provider. He or she might recommend:

   • Changing medications.

   • Treatment for certain conditions.

   • Consulting with specialists.

2. Focus on Blood Sugar Control: Controlling your blood sugar level is the best way to prevent diabetes complications. When you're preparing for pregnancy, blood sugar control is more important than ever. Your health care provider might want you to reach a specific haemoglobin A1C level — a reflection of your blood sugar level for the past two to three months — before pregnancy.

3. Keep up a Healthy Diet: Your diabetes diet probably includes plenty of fruits, vegetables and whole grains. You can eat the same foods while you're preparing for pregnancy. If you're having trouble keeping your blood sugar level in your target range or you want to lose excess pounds before pregnancy, consult a registered dietitian. He or she can help you customize your diabetes meal plan to meet your pre-pregnancy needs.

4. Get Active: Physical activity is another important part of your diabetes treatment plan. During your preconception appointment, get your doctor's OK to exercise. Then choose activities you enjoy, such as walking, swimming or stationary biking, and make them part of your daily routine.

5. Manage Stress: When you are preparing for pregnancy, try to keep stress under control. Too much stress can interfere with your blood sugar level and make it harder to take good care of yourself — and your baby.

GESTATIONAL DIABETES –

Gestational diabetes is diagnosed during pregnancy when your body cannot cope with the extra demand for insulin production resulting in high blood glucose levels. Gestational diabetes is managed by monitoring blood glucose levels, adopting a healthy eating plan and performing regular physical activity. Effective management of gestational diabetes will reduce the risk of complications during pregnancy and the birth of your baby.

Your gynaecologist and dietician can help you with blood glucose monitoring, healthy eating and physical activity.

There are three basic components in effectively managing gestational diabetes:

1. Monitoring blood glucose levels

2. Adopting a healthy eating pattern

3. Physical activity.

Gestational diabetes can often initially be managed with healthy eating and regular physical activity. However, for some women with gestational diabetes, insulin injections will be necessary for the rest of the pregnancy. Approximately 10 – 20% of women will need insulin; however, once the baby is born insulin is no longer needed. This is safe for both the mother and the baby.

After the baby is born, gestational diabetes usually disappears. A special blood glucose test (Oral Glucose Tolerance Test - OGTT) is performed six weeks after delivery to ensure that blood glucose levels have returned to normal. However, women who have had gestational diabetes have an increased risk of developing type 2 diabetes later in life and should be tested for diabetes at least every 2 – 3 years.

Can gestational diabetes affect my baby?

If gestational diabetes is not well looked after (blood glucose levels remain high) it may result in problems such as a large baby, miscarriage and stillbirth. A large baby can create the risk of injury at delivery, caesarean delivery, forceps delivery and a need for the baby to be looked after in special care until the glucose level stabilises after delivery.

Erectile Dysfunction is a disorder in males that refers the incapability to ‘get’ or ‘maintain’ an erection for intercourse. Many people refer to this condition as impotence. Some of the common symptoms are:
1. Difficulty in achieving an erection.
2. Inability to perform in bed as the person ejaculates way before orgasm and is not able to maintain an erection.

Causes of erectile dysfunction usually include:
1. Stress
2. Relationship Issues
3. Obesity
4. Fatigue
5. Performance anxiety
6. Excessive consumption of alcohol
7. Diabetes
8. Enlarged prostate gland

Homeopathy offers a number of treatments for the symptoms of erectile dysfunction. It is a popular system of medicine that follows a holistic approach without any side effect. Homeopathy targets the underlying causes that lead to sexual incapacities in men and addresses the problem from its root.

1. Nux Vomica: Prescription of Nux Vomica is done by homeopathic specialists for treating mild cases of erectile dysfunction. Nux Vomica can help in providing a boost to your sex life by addressing sexual dysfunctions that are caused due to work pressure and lack of rest.
2. Caladium: Addiction can play a major role in hampering your sex life. In most cases, bad habits often cause sexual weakness in men. Consumption of tobacco should be counteracted with the intake of Caladium so the issue of erectile dysfunction is addressed. This medication is helpful for people who are easily aroused, even after oral sex or foreplay. Caladium is also known for treating apparent impotency caused due to acute psychological stress.
3. Selenium: Patients who need Selenium are usually unable to fulfil their sexual desires due to slow or weak erections. Fatigue is commonly experienced after sex. Some symptoms addressed by Selenium include passage of seminal fluid that is involuntary which occurs during urination and sleep.
4. Lycopodium: Being a widely popular homeopathic medication, Lycopodium can be used to address erectile dysfunction in young adults that results from frequent masturbation. Lycopodium can be used to address issues of erectile dysfunction that results from indiscriminate sexual activities.