Gender differences in Type 1 Diabetes

Jen I agree, I see a lot of women now in their 30’s with no interest in getting married or having children. Or women waiting till they are in their 30’s before even thinking about getting married or having children. I see in a lot of women today enjoying having their careers, flexibility to travel, go where they want, do what they want and not have anyone to answer to for it. But I do see this being a more recent change especially in the 20/30 year olds.

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Lots of strong possibilities above, which I won’t repeat, but one possible contributor I see missing:

Hormonal contraceptives (ie birth control pills) have been demonstrated to increase the risk of microalbiminaria in non-diabetic women and also to produce effects opposite those of the ACE inhibitors and ARBs typically used to treat/delay kidney disease in diabetics (they activate RAAS signaling).

But we really don’t know whether they increase the risk of kidney and heart disease in diabetes… it just seems likely that they might.

There have been only a very few very poorly designed studies on the effect of hormonal contraceptives on the diabetic kidney. It kills me that there isn’t more info available for me to base my own contraceptive decisions on… And that doctors don’t share (or often know) the possible risks.

The existing studies fall in 2 categories:
1.
Most studies showed no increased risk of kidney disease due to the pill, but didn’t follow patients long enough to actually detect much risk at all. (It’s kind of like saying that smoking as a teenager is safe b/c doesn’t increase the risk of lung cancer before age 20.)
2.
One study showed nearly a 10-fold increased risk in patients on the pill, but the no-pill group averaged about 15 years older at T1D diagnosis… which to me indicates that their lower risk could be due to not having D as a teenager or having LADA rather than T1. (There were also very few patients in the study.)

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Just my wild and uneducated opinion, but I suspect someday they may look back and realize many health problems might be linked to hormonal BC… Both in women who take them and in their offspring.

Granted, I acknowledge that there’s no known evidence of such at this point…

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I’d be willing to bet it has something to do with cardiology. Women aren’t screened like men typically are. Women aren’t as educated about heart disease/attack symptoms as men are, and women’s symptoms are so much more varied and at times quite subtle.

Women are also more susceptible to autoimmune disease, as mentioned above, and the conglomerate of autoimmune diseases (as they tend to cluster) could amplify the damage being done by diabetes, or even hide that damage. I have pernicious anemia, which keeps my body from absorbing certain nutrients, Sjogren’s Syndrome which causes extreme dry eyes and mouth, multiple sclerosis which can and does mess everything in the central nervous system up, as well as type 1 diabetes.

So for example, I didn’t think anything of sudden blurry vision because of the Sjogren’s and MS, when in fact it was the onset of type 1.

Smaller blood vessels and body parts, such as nerves, also makes sense to me.

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Diabetes is fickle at the best of times for both genders and I think there may be socio-economic factors at play in some cases for women’s poorer glucose control. But I believe that diabetes challenges women more mostly because of the ebb and flow of their fertility. It is common for girls and women with diabetes to report a great deal of struggle with insulin resistance related to the female cycle. If you add up the weeks affected by this, over the years, you end up with a significant amount of time possibly spent outside of safe blood sugar range. Women who choose to counter this with synthetic hormones, sign up for another set of unknown risks, cardiovascular and organ-related, already discussed above. I also wonder if women generally are more carb-oriented in their diets and have to undergo a more drastic shift when switching to LCHF.

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Plus there is a group of women diagnosed T1 AFTER menopause.

In my case nearly 6 years after . . .

And yet, still, the Joslin statistic that nearly 3/4 of this group will die of CVD.

Study doesn’t say at what age they die of CVD. Just that it is highly likely to be due to of CVD complications.

So is there also a lack of hormonal fluctuation as a factor here?

I have no idea. BUT I am looking forward to being 95 and in the minority of my demographic !

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I’m currently in the throes of menopause and have developed type 1. It’s pretty strange.

hugs @Spooky that really sounds difficult. hopefully things will smooth out for you soon.

I believe there’s a difference. I struggle with hormonal changes affecting my BG levels all the time now, not to mention for about 2 weeks around my periods, they’re completely unpredictable.

I eat very low carb and still struggle, yet I keep seeing men eating the same way as me with flatlines everyday. It’s very frustrating as I see my numbers fluctuate even when fasting. I’ve had T1D for over 30 years now so that probably has something to do with it as well.

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I am approaching menopause, but not quite there yet. I have marked fluctuations in insulin requirements throughout the month. For the first 10-14 days, I can require 30-40% less basal, and often less bolus as well. But it’s not always so clear cut. Some months don’t require much change at all.
I hate taking oral contraceptive pills, and what they do to my levels, so I haven’t used a COCP since my late teens.

In terms of lifestyle, I think I lead a rather selfish, “male” life.
I am (mostly) single, no kids, and only need to work one week a month. The rest of the time I devote to music, martial arts and sewing for a charity. But if I look at my mum’s life at the same age, she was working full time and looking after her aging father, and I was at university (being expensive). She had zero time to herself. If she had T1D, I don’t imagine her control would have been brilliant (despite being a more self disciplined individual than either my father or me). She was barely hanging on!

My control is pretty good, because I have time. Most women my age (almost 44), are very time poor. Men are more likely to take time for themselves I think. Golf, other sports, which give physical health benefits, time in the shed or workshop, which gives mental health benefits… Those sorts of activities may not be possible for a wife and mother. Other people always take priority…

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Oh wow do I have a lot to say about this topic… YES, women’s bodies are different from men’s. You’d think that’d be obvious, but it was only three years ago that the NIH required male AND female lab subjects be tested. And apparently, women’s health is considered to be a “new” field. ?! Amazing.

It’s a battle to explain to every doctor I work with how I have been struggling with my blood sugar since I entered perimenopause - this is continuous. I had gestational diabetes with both of my pregnancies, and was diagnosed with Type 1 diabetes four years after the birth of my last child. At first, the fluctuations were around my menstrual cycles, which were normal for a while - in other words, insulin resistance about a week before my period. But since I’ve gotten deeper into “the beginning of the end” (of this long phase of fertility in my life), I’ve gone through more hypos and more highs than I care to have experienced, with absolutely no road map anywhere about how to deal with it. And my doctors offering the rather useless comments of - “you need to get tighter control.” By how - not eating at all?

My diet is low carb, I don’t have the typical vices, I exercise, I diligently test and take my insulin. Yes I am married and have two children, I work, and all that comes with that. I have no desire to orphan my kids nor step out of an increasingly interesting life. But the fact of the matter is that no one knows what to do about this phase of a woman’s life, which is like a roller coaster - in other words, hormones at this point are an overriding factor which I cannot control. HRT and birth control mess up my numbers, so that smoother ride is out with me. Worry from my doctors doesn’t exactly help my stress levels, especially because they cannot offer a stable and safe solution for these blind-siding and moving target fluctuations. At this point, during this period of my life, having elevated numbers some of the time is safer than taking too much insulin and having continual hypos. I try to take care of myself. But it’s a challenge when you know what it’s like living in your own body day to day, there is scant information about women in this period of their life (but of course a wealth of it regarding childbirth, because hey, procreating is important but who cares about the rest), and you keep getting offered information which is both irrelevant and unhelpful.

It goes to prove that there is so much in the world that remains unknown, and for every frustrating thing that an unstudied portion of the patient population has to endure, there is an opportunity to advocate for yourself and others in your situation. It’s not what someone who has a booked life and is trying to get through that wants to hear, but it’s the only way for both the sake of your health and others who come after you.

Signed,

Exhausted. But still standing. …

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The unique medical issues faced by women, and the professions’ all too common failure to recognize the differences, are quite real. Sadly, it’s just a piece of a larger mosaic as far as diabetes is concerned. “One size fits all” is an approach that doesn’t work here. As one of our members likes to say, “If you want to treat diabetes by the book, you’ll need a separate book for each diabetic.” Many doctors do get that. Unfortunately way too many still don’t.

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I’ve read other accounts like yours in my years of participating at TuD. A common theme we all endure is the persistent sketchy grasp of diabetes in the general public. But then bumping into shades of that ignorance in medical practitioners always bothers me.

I consider myself lucky as a man to avoid all the hormone challenges women with diabetes must face over their lifespan. Good luck with your continued struggle. Do you know if it gets any easier post-menopause?

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It’s all so different for every woman, Terry4. So, I really don’t know what the post-menopause territory will look like for me. Mostly I guess, and I’ve heard diabetes described this way before, I have another “growing child” I have to keep an eye on in addition to my actual two. I guess my task is to try to keep up my energy level as best I can… sigh…

In my limited exposure to menopause, it appears to me that it varies just like everything else. For some, it’s an enormous PITA. For others it’s a minor annoyance. For some, it’s over in just a few years, for others it lasts a frustratingly long time. And for some (including my other half), little reminders continue to pop up much later, at random. She volunteers at the local retirement community and some of the residents think it hilariously funny that she still gets the odd occasional hot flash. So it’s like diabetes—everyone’s is individual.

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Hi Caprifoglio,
I experienced exactly what you describe here. Since no help was forthcoming from either my diabetes educator or my doctor, I had to sort it myself. In my pre and peri menopausal years, which in my case comprised about 15 years, I was driven by the deep unpredictable lows and highs to get a pump. What finally came to help was when I noticed that the sudden increase and decrease of my insulin requirements were triggered by ovulation (up) and just before period onset (down). I created four basal programs, each with essentially the same pattern through the 24 hours, but in 10% increments up and down. After a couple bad test, I’d switch to the next program up or down, till the numbers worked again. Hope this helps!

I’ve copied this from a discussion in 2012 with a father whose daughter was experienceing oncoming puberty and becoming unpredictable BG-wise.

Sudden, dramatic, night-time hypos unexplained - #19 by earthling This is the whole conversation.

Here’s the relevant part of my comment:

When I went on the pump I learned why MDI had never worked well for me - Because my basal rate varied so much in a 24 hour period as well as over the 4 week menstrual cycle.
My evening rate was highish -.550/hr. - through the supper hours; then dropping to .2 or .15 from 9pm-midnight; down further to .1 or even less, 12am-3am; then up to .4 from 3am-5:30am; .7, 5:30am-8am; and 1.0 8am-11-am; finally .4 from 11am-4:30pm.
In 24 hours my basal ranged ten fold, .1 to 1.0!

The other problem with some of us is that our basal rate as a whole rises or drops by x% during different parts of our cycle. After ovulation it climbs for 2 weeks then a steep drop as the period starts (down as much as 40% in my case) then slightly up and stable for two weeks prior to ovulation again.

This can be handled by creating multiple basal patterns for each part of the cycle. When 2 or 3 bad tests high or low happen she just switches to the next program.

I know both the beginning and end of menstruation is challenging for T1’s as whatever pattern we are used to changes dramatically and often for awhile. If that IS what is happening to your daughter it is frustrating, exhausting and worrisome… but most likely normal. Just keep trying. It will settle out eventually!

Best luck!

-Linda

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Oh wow this is amazing - I have an appointment with my new endo. next week, thanks so much for this feedback, Linda, going to discuss this with her! HUG

Hey, have you ever discussed this with your gynecologist? They probably have more expertise in the area of hormone fluctuations (note the many varieties of BCPs and menopausal drugs!) than your endo, and could be a valuable resource!

…and consider consulting a gynecologist–experts in hormone fluctuations.

I’ve been in consultation with a hormonal specialist for some years now. GYNs don’t know much about this in comparison. There’s really nothing I can do except ride it out safely with the supervision of an excellent endo. I met my new one on Wednesday and I’m happy to say, I think I can get through this with her - she’s very reassuring and we’re going to work together to make sure I’m as even-keeled as I can be during this period of my life. Outside of a system that monitors and works with women’s bodies, i.e. consideration of hormone fluctuations, and can be modified to work with everyone’s differences, there really is no solution. Maybe they’ll invent something one day, since they’re starting to consider that women are actually different from men now, for a change.

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