There is an epidemic of diabetes in the United States. More than 34 million Americans have diabetes, according to the American Diabetes Association.
Recently, the U.S. Preventative Services Task Force lowered the recommended age to start screening for diabetes from 40 to 35. This is to help catch diabetes sooner in more people before the disease causes additional health complications.
While anyone can develop diabetes, there are some ways it affects women and people who were assigned female at birth that you may not have heard of before.
There are two types of diabetes: Type 1, where the body doesn’t produce any insulin, and Type 2, where the body produces some insulin but doesn’t respond to it.
Insulin is a hormone that regulates how your body uses or stores blood sugar, which is your body’s primary energy source.
How does diabetes affect women differently?
There are some universal aspects of diabetes, such as the fact that managing it is a lifelong commitment and that dealing with a chronic disease can take a toll on mental health.
But there are also some aspects of having diabetes that are unique to women and people assigned female at birth.
It’s also important to note that, just as diabetes may affect different genders in different ways, it also affects people of different races and ethnicities in different ways. Due to healthcare inequities, Native American, Hispanic, Black and Asian women are more likely to develop Type 2 diabetes than white women.
Here are some ways both kinds of diabetes affects women of all races differently.
Increased yeast infections and UTIs
Women and people with vaginas who have diabetes are likely to get more urinary tract infections (UTIs) and vaginal yeast infections, says Dr. Subbulaxmi Trikudanathan, medical director of the UW Medicine Diabetes Institute.
This is because elevated blood sugars can interfere with the immune system’s ability to function, causing immunosuppression, while high glucose levels can promote yeast growth.
Symptoms of UTIs include blood in the urine, a burning feeling while peeing, and having to pee more often and with urgency; symptoms of a vaginal yeast infection include burning, itching, a change in vaginal discharge color or consistency, and redness of the labia and vulva.
Blood sugar changes during the menstrual cycle
Diabetes can also affect someone’s menstrual cycle — or, rather, the other way around. Someone’s blood sugar patterns may change at different points in their cycle, which affects how someone manages their diabetes.
“Studies and a lot of patients notice blood sugars tend to rise in the luteal phase, the last two weeks prior to periods. Insulin sensitivity goes down and they have more insulin resistance because of rising progesterone,” Trikudanathan says.
Increased heart attack risk
“If you look at statistics, women with diabetes are more likely to have a heart attack at a younger age, have a lower survival rate when they have one, and have a poorer quality of life and lower life expectancy,” Trikudanathan says.
There are several factors that contribute to this, she says. Due to the ways heart disease can present differently in women, many women may not know they have an underlying heart problem until an event like a heart attack occurs.
Women’s symptoms may be dismissed or not taken as seriously by doctors, or their symptoms may present in a way that doesn’t seem like traditional heart attack symptoms. And from a biological standpoint, women going through menopause experience a drop in estrogen levels, and since estrogen has a slightly protective effect on heart health, less estrogen means a slightly higher risk for heart problems.
After controversy about the cardiovascular safety of Type 2 diabetes medications such as rosiglitazone, the FDA created a mandate in 2008 that resolved this, Trikudanathan says.
“All new diabetes medications in the last decade have had to go through rigorous trials, which has given us a wealth of info to know which medications are superior in reducing cardiovascular events,” she says.
Increased risk for eating disorders
Eating disorders overall are more common in women, whether they have diabetes or not. But there’s a particular type of eating disorder called diabulimia that impacts up to 40% of young women with diabetes and is most common in women with Type 1.
Diabulimia involves purposefully injecting less insulin or injecting it less frequently in order to promote weight loss. It is dangerous because it can lead to the same complications that untreated diabetes can.
Trikudanathan notes that people with Type 2 diabetes are often at risk for binge eating disorder.
Risk of gestational diabetes
Women and people assigned female at birth who don’t have diabetes can develop it during pregnancy, which is called gestational diabetes.
While gestational diabetes usually goes away after the baby is born, it can indicate a higher risk for developing diabetes later on or with another pregnancy.
“Those who have had a history of gestational diabetes have a 50% higher risk of developing diabetes,” says Trikudanathan.
Women who have Type 1 or Type 2 diabetes and want to get pregnant must deal with additional planning and monitoring, too, since diabetes can put them at a higher risk for complications.
Additional menopause symptoms
Just as diabetes can interact with someone’s menstrual cycle, so too can it interact with someone’s body when their menstrual cycle is changing and ending.
Common menopause symptoms such as hot flashes and night sweats can affect someone’s overall health and health behaviors, which in turn can affect their diabetes.
“These things can cause changes in patterns of eating and other mood changes, which can affect how the blood sugars behave,” Trikudanathan explains.
Social impacts on diabetes management
Trikudanathan says that many of her female patients struggle to prioritize self-care, which is important for people with diabetes in managing their disease and any mental health impacts of it.
This struggle is often due to societal expectations that women face, such as pressure to do most of the caregiving for children and elders and to do more housework and chores.
For people of all genders, managing diabetes can be like a full-time job; so for women who are faced with more responsibilities, managing the disease can be even more challenging.
How do I know if I’m at risk for diabetes?
Doctors are still learning about what causes Type 1 diabetes, though having a family history of the disease, having certain genes, or contracting different viruses can put someone at greater risk for it.
There are a few conditions that put women and people assigned female at birth at risk for developing Type 2 diabetes. These include having a history of gestational diabetes or having a condition called polycystic ovary syndrome (PCOS).
Across all genders, other risk factors for developing Type 2 include having a family history of the disease, being overweight, not getting much physical activity and being over age 45.
If you have any risk factors or have noticed any diabetes symptoms, it’s important to talk with a doctor and get screened.
“Sometimes people are fearful because they have a loved one who has complications of diabetes, and they are fearful that’s the path they’ll go down, too. I challenge people to advocate for their own health; knowledge is their first step. With lifestyle modifications and medications, your risk for developing complications can be very little,” says Dr. Nicole Ehrhardt, an assistant professor of medicine in the UW School of Medicine Division of Metabolism, Endocrinology and Nutrition.
Screening is simple and usually involves taking a blood sample to measure your blood sugar levels. If you have symptoms of diabetes, doctors will also take them into account.
If you are diagnosed with diabetes, treatment is usually multi-pronged and includes lifestyle changes as well as medication.
Why it’s important to catch diabetes early
Early diagnosis is important for both types of diabetes.
“You don’t want to wait until you have symptoms of uncontrolled diabetes,” says Ehrhardt.
That’s because those symptoms can lead to permanent health problems that significantly impact someone’s quality of life.
The most common symptoms of uncontrolled diabetes include increased thirst, dry mouth, needing to pee more often, being very hungry and tired, tingling or numbness in the hands and feet, and blurry vision. If left untreated, diabetes can lead to eye disease and blindness, kidney disease, heart disease and limb amputations.
The good news?
“We know from long-term studies that by managing the disease with an A1C goal of 7 or less does prevent long-term complications in both Type 1 and Type 2,” Ehrhardt says.
How to prevent Type 2 diabetes
Whether you want to prevent yourself from developing prediabetes or Type 2 diabetes, or you already have one of those conditions and want to prevent them from worsening, there are a few gold standard rules to follow.
First, losing weight — even small amounts — can help lessen symptoms or even resolve the disease. Losing 15% or more of bodyweight can be more effective than any other treatment, according to recent research.
Lifestyle changes like exercising more and eating more fruits and vegetables are extremely important; in fact, they can be enough to prevent someone with prediabetes from going on to develop diabetes, Ehrhardt says.
“They can be even more effective than using medication early on,” she says.
The changes don’t have to be life-altering to be effective. Simply adding a walk to your daily routine, adding extra fiber to your diet and avoiding sugary beverages can make a big difference.
“You don’t always have to make the best choices, but if you set up small, everyday changes you’re more likely to be successful. No matter where you are, you can make small changes in the environment you’re in,” Ehrhardt says.