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Diabetes 1 &

2
CAITLYN CRAIG

WHAT IS DIABETES?

The pancreas makes insulin, a substance that


helps the body store energy from food. Diabetes
mellitus interferes with the body's ability to store
energy from food. Type 1 diabetes mellitus (also
called juvenile diabetes) occurs when the
pancreas stops making insulin. Type 2 diabetes
mellitus (also called adult-onset diabetes) occurs
when the body makes plenty of insulin but
cannot use it normally. In both types, the result
is high blood sugar levels. Over time, high blood
sugar levels can lead to blindness, kidney failure,
nerve damage, and heart disease.

A short video that


explains diabetes and
how it works in the
body:
https
://www.youtube.com/w
atch?v=jHRfDTqPzj4

Gender Specific Symptoms


Symptoms unique to men include:
Reduced strength from loss of
muscle mass
Recurrent episodes of thrush
around the genitals
Itching of or around the penis
Erectile dysfunction

Symptoms unique to women


include:
Vaginal and oral yeast
infections and vaginal
thrush
Urinary infections
Female sexual dysfunction
Polycystic ovary syndrome

Its important to keep in mind that


many people with type 2 diabetes
have no noticeable symptoms.

Type 1 diabetes is unique among


autoimmune diseases in not
having a clear female
predisposition
A family history of diabetes
confers a higher risk for women
compared to men
Adults with diabetes are more
likely to have a mother with
diabetes than a father
The likelihood for an affected
maternal grandmother is
likewise increased

Risk Factors

Mortality Differences
Diabetic men live an average of 7.5 years less than
nondiabetic men
Diabetic women live an average of 8.2 years less
than women without the disease
Inequality revealed in 2007 study:
Between 1971 and 2000 the death rate for men with
diabetes fell
The death did not decline for diabetic women

Reasons for Gender Disparities


Women often receive less aggressive treatment for
cardiovascular risk factors and conditions related to
diabetes.
The complications of diabetes in women are more difficult
to diagnose.
Women often have different kinds of heart disease than
men.
Hormones and inflammation respond differently in women.

Gender Prevalence

In the first half of the last century the


prevalence of type 2 diabetes was higher
among women than among men, but this trend
has shifted, so more men than women are now
diagnosed with type 2 diabetes . This change in
the gender distribution of type 2 diabetes is
mainly caused by a more sedentary lifestyle
particularly among men, resulting in increased
obesity.

Gender Prevalence
Recent data has shown that men develop diabetes at a lower
degree of obesity than women.

Obesity is one of the main risk factors for type 2 diabetes, and
especially the abdominal visceral fat is associated with increased
type 2 diabetes risk. Body fat distribution differs by sex and in
general men have more abdominal fat.

Men are in general more insulin resistant than women, which can
be explained by their higher proportion of visceral and hepatic fat
compartments associated with insulin resistance.

Gender Prevalence

Type 1 diabetes has a known gender dimorphism. More boys than


girls develop type 1 diabetes, suggesting that the female hormones
protect against type 1 diabetes.
Type 2 diabetes also has a sex dimorphism in the human population,
and after menopause and the loss of estrogen production, more
Even
thethan
prediabetes
syndromes
women
men have
diabetes. differ by sex. For example,
impaired fasting glucose is mostly observed in men, whereas
impaired glucose tolerance is observed more in women. Thus, most
of these differences are believed to be the consequence of the
effect of male and female hormones after puberty

Heart Disease in Diabetics

Heart Disease in Diabetics


The risk for heart disease for diabetic women is 6 times higher and for
diabetic men is 2-3 times higher
Diabetic women are more likely to:
Have poor blood glucose control
Be obese
Have high blood pressure
Have high unhealthy cholesterol levels

Heart disease is more deadly for diabetic women than diabetic men
Approximately 50% higher risk

Heart attacks are more often fatal for diabetic women than diabetic
men

Heart Disease in Diabetics

Women with diabetes have been found to achieve recommended


target blood glucose, blood pressure, and LDL-cholesterol less
often than men
Adherence to treatment guidelines is significantly lower for
diabetic women than men with pre-existing cardiovascular disease
Diabetic women who survive their first acute myocardial infarction
are more likely to have recurrent cardiovascular events than
nondiabetic women, whereas the risk for diabetic and nondiabetic
men is similar

Urological Problems
More than half of men and women with diabetes
have bladder dysfunction because of damage to
nerves that control bladder function. Bladder
dysfunction can have a profound effect on a
person's quality of life.
Urologic problems that affect men and women with
diabetes include bladder problems and urinary tract
infections.

Urological Problems
Common bladder problems in men and women with diabetes include the
following:
Overactive bladder - Damaged nerves may send signals to the bladder at the
wrong time, causing its muscles to squeeze without warning. The symptoms of
overactive bladder include
urinary frequency-urination eight or more times a day or two or more times
a night
urinary urgency-the sudden, strong need to urinate immediately
urge incontinence-leakage of urine that follows a sudden, strong urge to
urinate
Poor control of sphincter muscles - Sphincter muscles surround the urethrathe tube that carries urine from the bladder to the outside of the body-and keep it
closed to hold urine in the bladder. If the nerves to the sphincter muscles are
damaged, the muscles may become loose and allow leakage or stay tight when a

Estimates of the prevalence of erectile


dysfunction in men with diabetes vary
widely, ranging from 20 to 75 percent.
Men who have diabetes are two to three
times more likely to have erectile
dysfunction than men who do not have
diabetes.
Among men with erectile dysfunction, those
with diabetes may experience the problem
as much as 10 to 15 years earlier than men
without diabetes.
Research suggests that erectile dysfunction
may be an early marker of diabetes,
particularly in men ages 45 and younger.
Poor blood glucose control and the resulting
nerve damage can cause retrograde
ejaculation

Sexual
Dysfunction
In Diabetic Men

Sex hormone-binding globulin


(SHBG) and total testosterone
are higher in male children
and young adults with
diabetes
In adult men with wellcontrolled type 1 diabetes,
SHGB was significantly higher
with lower free testosterone
concentrations , suggesting a
tendency towards
hypogonadism among adult
men with type 1 diabetes
Diabetic men with erectile

Sexual
Dysfunction
In Diabetic Men

Although research about sexual


problems in women with diabetes is
limited, one study found 27 percent
of women with type 1 diabetes
experienced sexual dysfunction.
Another study found 18 percent of
women with type 1 diabetes and 42
percent of women with type 2
diabetes experienced sexual
dysfunction.
Sexual problems may include
decreased vaginal lubrication, resulting
in vaginal dryness
uncomfortable or painful sexual
intercourse
decreased or no desire for sexual

Sexual
Dysfunction
In Diabetic Women

Reproduction Problems
Decreased sexual function and sexual distress has been noted during luteal
phase of women with type 1 diabetes
During the follicular phase lower basal estrogenic tone and androgen
production has been observed
Diabetic women are more likely to suffer from oligomennorrhea or
secondary amenorrhea
Diabetic women are more likely to have polycystic ovary syndrome, a
condition known to be associated with reduced fertility

Reproduction Problems
Changing medications. If you take oral diabetes medication, you
might need to switch to insulin or make other changes to your
diabetes treatment plan before you conceive. In addition, some
medications including certain drugs to treat high blood
pressure aren't recommended during pregnancy.
Treatment for certain conditions. If you have high blood pressure
or signs of heart, eye, nerve or kidney disease or other
diabetes complications that could be aggravated by pregnancy
preparing for pregnancy might include treatment before
conception.
Consulting with specialists. Your health care provider might
suggest scheduling preconception appointments with an
obstetrician who specializes in high-risk pregnancies, a diabetes
educator, a registered dietitian or other specialists.

Pregnancy and Diabetes


Birth Defects
The organs of the baby form during the first two months of
pregnancy, often before a woman knows that she is pregnant. Blood
sugar that is not in control can affect those organs while they are
being formed and cause serious birth defects in the developing baby,
such as those of the brain, spine, and heart.
An Extra Large Baby
Diabetes that is not well controlled causes the babys blood sugar to
be high. The baby is "overfed" and grows extra large. Besides
causing discomfort to the woman during the last few months of
pregnancy, an extra large baby can lead to problems during delivery
for both the mother and the baby. The mother might need a C-

Macrosomia- Big Baby


Syndrome

Pregnancy and Diabetes


High Blood Pressure (Preeclampsia)
When a pregnant woman has high blood pressure, protein in her urine,
and often swelling in fingers and toes that doesnt go away, she might
have preeclampsia. It is a serious problem that needs to be watched
closely and managed by her doctor. High blood pressure can cause
harm to both the woman and her unborn baby. It might lead to the
baby being born early and also could cause seizures or a stroke (a
blood clot or a bleed in the brain that can lead to brain damage) in the
woman during labor and delivery. Women with type 1 or type 2
diabetes have high blood pressure more often than women without
diabetes.

Pregnancy and Diabetes


Low Blood Sugar (Hypoglycemia)
People with diabetes who take insulin or other diabetes medications
can develop blood sugar that is too low. Low blood sugar can be very
serious, and even fatal, if not treated quickly. Seriously low blood
sugar can be avoided if women watch their blood sugar closely and
treat low blood sugar early.
If a womans diabetes was not well controlled during pregnancy, her
baby can very quickly develop low blood sugar after birth. The
babys blood sugar must be watched for several hours after delivery.

Pregnancy and Diabetes


Early (Preterm) Birth
Being born too early can result in problems for the baby, such as
breathing problems, heart problems, bleeding into the brain,
intestinal problems, and vision problems. Women with type 1 or
type 2 diabetes are more likely to deliver early than women without
diabetes.

Miscarriage or Stillbirth
A miscarriage is a loss of the pregnancy before 20 weeks.
Stillbirth means that after 20 weeks, the baby dies in the womb.
Miscarriages and stillbirths can happen for many reasons. A
woman who has diabetes that is not well controlled has a higher

Microvascular Complications
Diabetes is the most common cause of kidney failure,
accounting for nearly 44 percent of new cases
Nearly 180,000 people are living with kidney failure as a
result of diabetes
Diabetic, Caucasian men are at a greater risk for the
development and progression of renal disease than their
female counterparts
Diabetic, Black women are at a greater risk than diabetic,
black men

Microvascular Complications
In nondiabetic populations , men have been shown to
have a higher risk of renal disease than women
Female sex is associated with a more rapid progression of
diabetic renal disease in both premenopausal non-White
women and postmenopausal women
The probable loss of female protection against
development and progression of renal disease in diabetic
has been linked to the direct effects of sex hormones that
are altered by diabetes

Each year, over half of all amputations in


the United States are caused by diabetes
mellitus and subsequent complications, with
most being lower-extremity amputations
Damage to the foots sensory nerves,
diabetic neuropathy, contributes to foot
deformities and/or ulcers that increase the
chance of lower-extremity amputations
(LEA) unless treated
Among people with diabetes, LEA rates were
highest among men, individuals who are
non-Hispanic Black and the elderly
Trends by Sex : In 2003, the age-adjusted
LEA rate among men (5.8 per 1,000 persons
with diabetes) was approximately twice the
rate among women (2.9 per 1000 persons
with diabetes)

Amputations

Crude and Age-Adjusted Hospital Discharge Rates for Nontraumatic Lower


Extremity Amputation per 1,000 Diabetic Population, United States, 1988
2009, CDC

Bibliography
Schenck-Gustafsson, K. (2012). Handbook of clinical gender medicine. Basel: Karger.
Perreault, L., Ma, Y., Dagogo-Jack, S., Horton, E., Marrero, D., Crandall, J., & Barrett-Connor, E.
(2008). Sex Differences in Diabetes Risk and the Effect of Intensive Lifestyle Modification in the
Diabetes Prevention Program. Diabetes Care, 31(7), 1416-1421. Retrieved February 25, 2016.
Frch, Kristine. Gender and T2DM [internet]. 2014 Aug 13; Diapedia 3104972816 rev. no. 10.
Available from: http://dx.doi.org/10.14496/dia.3104972816.10
National Data. (2015, April 27). Retrieved February 25, 2016, from
http://www.cdc.gov/diabetes/data/national.html