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Women and Diabetes |
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Welcome to the Women and Diabetes page. This page includes some background information on diabetes, special situations that women may encounter in their lives that may affect their diabetes care, and resources for further exploration of the various aspects of diabetes care. Being in control and in the best of health cannot be over-emphasized! I have had Type 1 insulin-dependent diabetes for 8 years, and this topic is of great interest to me. Approximately 8% of the female population in the United States has diabetes, according to the Joslin Diabetes Center at Harvard University. What is Type 1 Diabetes?
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Diabetes Overview Diabetes occurs when the body is no longer able to effectively use a hormone called insulin. This happens because the islet (or beta) cells in the pancreas which produce insulin are destroyed by the body's own immune system (see Type 1); or have become inadequate (due to age, for example) to effectively meet the body's needs (see Type 2). Insulin is needed for the body to use glucose (sugar), and glucose is fuel for the body's cells. If body cells cannot absorb glucose, then glucose levels will rise. Prolonged high blood sugar levels can cause damage to vital organs and tissues in the body. Insulin is a very important and necessary hormone in the body, and is often taken for granted. So how does a diabetic get insulin? If the patient is a Type 2 diabetic, they may be eligible to take a pill that stimulates the pancreas/islet cells to produce more insulin. However, the most common method of delivery is manual injection, and this is a mandatory requirement for those with Type 1 diabetes (Note: the pill will not work for those with Type 1 because the islet cells have been completely destroyed, and therefore the pill has nothing to act upon). Patients must determine how much insulin to take based on their blood glucose readings. Since this is not the most pleasurable thing to do (I do it twice daily--imagine!!), researchers have been trying to develop less painful methods of insulin delivery. The most recent groundbreaking development has been the insulin pump. In order to cure diabetes entirely, researchers are looking at the possibility of programming stem cells to develop into islet cells which will in turn be surgically placed inside a patient's body. The main obstacle to this has been rejection--kind of like what happened to the diabetic patient in the first place: the immune system mistakenly saw the islet cells as foreign. As I mentioned above, insulin doses are determined by blood glucose monitoring. This is done by using a blood glucose testing meter, which is about the size of a wallet. The patient is required to prick their finger to get a small drop of blood. The blood is placed on a strip that is inserted into the meter. Doesn't it seem that diabetics are poked and prodded enough? It is true, but essential. Blood glucose monitoring is extremely important to the overall control of the diabetes. Blood glucose levels that are poorly managed can potentially damage body organs and tissues, leading to serious complications such as blindness, kidney failure, and amputations of the limbs, among others. Keeping blood glucose levels in check can significantly reduce the chances of developing complications, and increase the quality of one's life. Diabetics can live as long as non-diabetics do, provided that proper management is adhered to at all times. Research is also being done on minimizing the pricking and inconvenience of blood glucose testing. Click here.
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(http://www.diabeticexpress.com) Insulin bottles |
(http://www.diabeticexpress.com) A blood glucose testing meter
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Type 1 Diabetes (5-10% of all cases) occurs in children and some adults. The islet cells in the pancreas (which produce insulin) are destroyed. It is not known what causes this to occur, but autoimmune, genetic, and environmental factors may play a role. Patients must take insulin injections manually.
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Type 2 Diabetes (90-95% of all cases) occurs in adults, most commonly in the elderly. In this type of diabetes, the islet cells still produce insulin, but not enough to be effectively used by the body. Patients may take insulin pills which stimulate the pancreas to produce more insulin; or in some cases the pill is not effective enough, so the patient may have to take manual injections. The main cause of Type 2 diabetes is lack of exercise and obesity. Extra weight means that the islet cells must work harder to produce enough insulin, and this may have damaging effects. Maintaining a healthy weight can make insulin use by the body more efficient and can decrease your chances of developing diabetes. Age also plays a role in developing Type 2 diabetes, in that the activity of islet cells may not be as effective as they used to be.
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Gestational Diabetes occurs in 3-5% of all pregnancies, and disappears when the pregnancy is over. Women are expected to gain weight while they are pregnant, and this is likely the main cause of this "temporary" diabetes. Women who have had gestational diabetes are at greater risk of developing Type 2 diabetes later in life. What are the effects on a mother who develops gestational diabetes? How is her infant affected? For more information, click here.
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"Diabetic females have normal fertility and can become pregnant as readily as non-diabetics." (Goodman, 83) The quote above would have been considered radical if it were made 30 or more years ago. History has not always been the kindest to young diabetic women who wanted to get married and have families. Many misconceptions, misunderstandings and unnecessary fears have denied diabetic women from living normal lives like non-diabetic women. There was a time when diabetic women were advised not to become pregnant, largely due to lack of knowledge and understanding in the medical field in this area. Before the discovery of insulin in 1920, pregnancy was almost unheard of in young diabetic women because they often did not live long enough to conceive. The life span of any diabetic before 1920 was not more than a few weeks. After insulin was discovered and its purpose identified, people began living longer, and now to an age they were able to conceive. However, doctors were still studying insulin and trying to understand how it worked. The first insulins were not perfect either, and have become most effective only recently. Diabetic mothers had difficulty managing their blood glucose levels when the first insulin came out, which made them more susceptible to a number of complications. Their diets were not very good either. Surviving a pregnancy was considered a miracle. Among infants born to those mothers who survived, there was an increased mortality rate, large size and weight, and organ enlargement which led to congenital deformities. Of course, these problems raised much fear and anxiety in the medical world and to those affected with diabetes. Doctors often discouraged their young diabetic female patients from getting pregnant, and instilled in them much fear of the potential consequences if they did get pregnant. Take a look at a couple of these stories (Goodman, 80-82): A 17 year old girl felt that no man would marry her because she had an "incurable disease." She dropped her dreams of marriage and family and decided to devote her life to a career instead. A 24 year old schoolteacher declined a marriage proposal from her boyfriend. "I wouldn't want to fail him as a wife, and I've heard its almost impossible for diabetic women to become pregnant. Would it be fair for me to marry him?" At the Eighth Congress of the International Diabetes Federation meeting in 1973, an associate professor of medicine at the University of Colorado by the name of Dr. Paul Beck stated that, "Women with severe diabetes should be strongly advised to avoid pregnancy." He also commented on the complications of diabetes and instilled fear about it adding into the gene pool. This raised much fear (though in reality, the occurrence of a child inheriting diabetes from a parent is small) . Take this story (Goodman, 81-82): A minister and his wife, upon finding out that their daughter had diabetes, made her break off her wedding engagement. "We know that diabetes is hereditary, so we are responsible for our daughter's having it. That's terrible enough. We certainly don't want her doing the same thing to more kids. Marriage and children are out of the question," said the minister. These heartbreaking stories would not last for long, except in those with ignorance. At the Joslin Diabetes Clinic, Dr. Priscilla White kept a number of diabetic mothers under her supervision. She gave them special care and treatment, including administration of estrogen and progesterone, and studied the progress of the mothers. Doctors Black and Miller did further studies, and found that improvement in diabetes care that mothers got significantly increased the survival rates of their newborn babies. Greater consistency in blood glucose testing techniques, more concern about diet, careful scheduling of insulin injections, and proper exercise were discovered to be the essential components to a successful diabetic pregnancy (Goodman, 85-86)
(http://www.cdc.gov/diabetes/pubs/images/womanbab.gif) Diabetic mothers-to-be have a lot to think about before they decide to get pregnant. Planning must start well in advance. Women should go and get a thorough evaluation from their physician before becoming pregnant. Maintaining acceptable blood glucose levels is of the utmost importance. This reduces the chances of miscarriage and serious defects in the infant as it begins to develop. A careful and balanced meal plan is also essential for mother and baby, and this must also be determined. Click on the links below to read more about the expectations and questions that arise at each stage of pregnancy.
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Nicole Johnson, Miss America 1999 Zippora Karz, ballerina Mary Tyler Moore, actress |
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Related Web Sites
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References
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| Created by: Laura Brumbaugh on 04/24/02 | |
| Biology
Department Beverly J. Brown, Ph.D. |
Nazareth College |
