WOMEN & DIABETES

1. WOMEN & DIABETES Linda Patrick RN, PhD ( c ) Faculty of Nursing University of Windsor

2. WHAT IS DIABETES? • “A GROUP OF METABOLIC DISEASES CHARACTERIZED BY HYPERGLYCEMIA RESULTING FROM DEFECTS IN INSULIN SECRETION, INSULIN ACTION, OR BOTH”(ADA, 2003, S5)

3. TYPE 2 DIABETES • “OCCURS WHEN THE PANCREAS DOES NOT PRODUCE ENOUGH INSULIN OR WHEN THE BODY DOES NOT EFFECTIVELY USE THE INSULIN THAT IS PRODUCED” (CDA, 2000) • THE OTHER TWO TYPES OF DIABETES ARE TYPE 1 (10% OF THE POPULATION) & GESTATIONAL DIABETES (GLUCOSE INTOLERANCE FIRST DETECTED DURING PREGNANCY)

4. A GROWING PROBLEM • IT IS ESTIMATED THAT OVER 2 MILLION CANADIANS HAVE DIABETES • 90% HAVE TYPE 2 DIABETES • ABORIGINAL PEOPLES, LATIN-AMERICANS, AFRICANS, ASIANS AND PEOPLE OF HISPANIC DESCENT HAVE HIGHER INCIDENCE

5. WARNING SIGNS OF DIABETES • INCREASED THIRST • INCREASED HUNGER • FREQUENT VOIDING • FEELING TIRED • BLURRED VISION • FREQUENT OR RECURRING INFECTIONS • THE METABOLIC SYNDROME…HIGH BP, HIGH CHOLESTEROL, HIGH BLOOD SUGARS OR………

6. NO SYMPTOMS AT ALL……

7. DIABETES CAN BE SILENT • DIABETES CAN REMAIN UNDETECTED FOR YEARS (MAYBE AS MANY AS ½ OF CASES) • Some individuals with type 2 diabetes exhibit few or no classic symptoms • The long-term consequences or damage from having prolonged elevated blood glucose levels can be significant even before a diagnosis is made

8. TYPE 2 DIABETES • LIFE ALTERING & OFTEN LIFE DIMINISHING • WIDE RANGE OF COMPLICATIONS • MAJOR CAUSE OF CAD • NEW CASES OF ADULT ONSET BLINDNESS • KIDNEY DISEASE • SEXUAL DYSFUNCTION • NEUROPATHIES (NERVE DAMAGE), CIRCULATORY PROBLEMS (BLOOD VESSEL DAMAGE) …MASSIVE INFECTIONS, AMPUTATIONS

9. A MAJOR HEALTH CONCERN • ABORIGINAL PEOPLE ARE THREE TO FIVE TIMES MORE LIKELY TO HAVE OR DEVELOP DIABETES THAN ANY OTHER GROUP AND TWO THIRDS OF ABORIGINAL PEOPLE WITH DIABETES ARE WOMEN WITH TYPE 2 DIABETES

10. FINANCIAL COSTS • AVERAGE INDIVIDUAL HAS HEALTH COSTS THAT ARE 2 TO 5 TIMES HIGHER THAN A PERSON WITHOUT DIABETES(CDA, 2000) • MEDICATIONS, SUPPLIES(FOR A LIFETIME) • MORE FREQUENT VISITS TO HEALTH CARE PROVIDERS • MORE LIKELY TO REQUIRE PLACEMENT IN LONGTERM CARE FACILITY AS A SENIOR • A PUBLIC HEALTH PROBLEM WITH A COST OF 9 BILLION A YEAR IN CANADA

11. EMOTIONAL COSTS IMMEASURABLE DIABETES MAY HAVE A GREATER IMPACT ON QUALITY OF LIFE THAN OTHER CHRONIC DISEASES DUE TO THE FACT THAT DIABETES MANAGEMENT IS AN INTEGRAL COMPONENT OF DAILY LIVING REQUIRING EXTENSIVE EDUCATION AND LIFESTYLE CHANGES (BOOTH, 2001)

12. DIABETES & WOMEN • Type 2 diabetes is the most prevalent form of the disease and all women comprise the largest group affected(Campaigne & Wishner, 2000).

13. Gestational diabetes mellitus (diabetes during pregnancy) occurs in 2% to 7% of all pregnancies • The occurrence may vary according to racial and ethnic groups and the incidence of obesity in a society • Most women experience a return to normal glucose tolerance in the postpartum period or the first six weeks following delivery ……. • which has led to gestational diabetes mellitus (GDM) being referred to as “a temporary condition that occurs during pregnancy”

14. A history of GDM is a significant risk factor for the future development of predominantly type 2 diabetes for women and their offspring(American Diabetes Association, 2001; Dornhorst & Rossi, 1998; Meltzer et al., 1998)

15. “Half of the women diagnosed with GDM will develop diabetes in the next 15 to 20 years” (Pacaud & Dunbar, 2001, p. 1)

16. RISK FACTORS • AGE • OBESITY • ETHNICITY • LEVEL OF ACTIVITY • H/O GESTATIONAL DIABETES • BIRTH WEIGHT • IF YOUR MOTHER HAD GESTATIONAL DIABETES • ALSO SMOKING AND CERTAIN DRUGS

17. Type 2 diabetes is more prevalent in woman than men, making prevention and early detection of particular importance

18. SPECIAL ISSUES FOR WOMEN WITH DIABETES WIDESPREAD DISEASE IN MIDDLE AGED AND OLDER WOMEN. • AREAS OF HEALTH CONCERN: CARDIOVASCULAR DISEASE, MENTAL HEALTH ISSUES, INFECTION, CONTRACEPTION AND FERTILITY. • WOMEN ARE MORE AT RISK FOR CORONARY HEART DISEASE • DECREASED LIFE EXPECTANCY (MORE THAN MEN) • This may be due to the yet unexplained loss of cardio protection in women with diabetes (Eko, 1999). Postmenopausal women who have a combination of risk factors that include diabetes and being overweight are at particularly high risk for morbidity and mortality from CHD

19. THE BURDEN OF DIABETES • Women coping with a chronic illness often experience an additional burden relating to traditional gender roles in the home (Robinson, 1998). As caregivers, women often push their own needs into the background losing touch with themselves creating an unresolved stockpile of illness problems (Kleinman, 1998).

20. One study found that women with chronic conditions who self-report poor adjustment have fewer social and psychological resources to draw upon to help them cope with their chronic illness (Watt, Roberts, Browne, & Gafni,1994) • The process of balancing multiple, competing demands by women in families where a chronic illness existed in another family member was difficult…imagine when the person with the chronic illness is the woman!

21. IN THE WORDS OF WOMEN WITH TYPE 2 DIABETES…. • “I knew that whether they said it or not at some level they were interpreting they (other people), they were saying or I perceived them as saying, “you know, if only you ... would control your eating, you wouldn’t have this condition.... and how irresponsible that a woman your age, that, you know, you’ve let yourself go to the point that you’ve developed diabetes”.

22. “I didn’t think that it (gestational diabetes) meant that eventually I would get diabetes. I may have changed my lifestyle if I’d known that….maybe I wouldn’t have allowed myself to get as heavy as I did and maybe I would have exercised more…you know, I think I would have been more cautious”