I am going to copy my post from another thread (The scale of what we do - diabetes by the numbers) because someone suggested it would be better to be seen in a new topic. I hope Sam19 and others will copy their replies also. Maybe there is a better way to handle this?
One thing that I don’t ever see discussed here is the difference between men and women when it comes to living with diabetes. Since both you and I have Type 1, Jen, I Googled “Men versus Women Type 1 diabetes.” There is article after article about how women with T1 diabetes have higher mortality and rates of complications than men. They don’t necessarily know all of the reasons but suggest everything from more hormonal issues, poorer medical care especially when it comes to cardiovascular care, smaller vascular systems that are damaged more by high blood sugars, more autoimmune issues than men, and more psychological issues such as eating disorders and tendency to care for others before ourselves.
There is no doubt that many of the ultra-control topics are TuD are dominated by men. Do they have an easier time than we do in achieving flat lines or is it purely coincidental more reflecting the membership mix of TuD at this time? Or do men just like to talk about flat lines more???
I can’t compare my T1D history to yours because I didn’t have BG meters for many of my “high-hormone years” including my two pregnancies and then didn’t have the Internet for many years after that. It never dawned on me that my BG control varied throughout the month based on hormones, but I would have learned about that from other women on the Internet.
At age 64 I definitely have an easier time with blood sugars than when I was younger. Some of that has to be related to hormones. For me a lot of the difference is that like Terry I have more time to focus on diabetes and to live in a routine that allows scheduled walks every day.
We all work with the diabetes that we were dealt. All we can do is keep working at it and get up tomorrow and try again.
I want to thank Laddie for posting this as a separate topic. I replied in the other thread that until she posted the above comment, I was not aware of this difference between the genders with T1D. I consider myself fairly well read on the topic of diabetes but this important topic escaped my diabetes radar. My ignorance in part probably stems from my male bias.
Ovr the years, in various threads here but mostly threads dealing with glycemic data measure, I did notice that men were over-represented in the comments. I attributed this to the basic differences in the hormonal lives between genders. I had no idea that many scientific studies have documented significant clinical outcome differences between men and women T1Ds with respect to cardio vascular disease and mortality.
My interest in T1D and cardio vascular disease comes from watching my father die from stroke complications and more recently seeing my older brother experience a stroke.
I wasn’t aware of the differences, either. Of course, I was aware of the issue of hormonal cycles making control more difficult for many women (something that is well known but not really ever studied or dealt with in detail in terms of management). But I wasn’t aware that there were actual long-term differences in outcomes for women with Type 1 diabetes as compared to men.
This is very interesting to me. What are your thoughts, @Laddie? I have some thoughts of my own but want to tread lightly and not get into a gender type debate so would like to hear out some other people’s ideas first.
Open question to the ladies on the forum—
Why do you think (based on the info you just provided) women are more susceptible to morbid complications of diabetes than men. Open session please comment.
I’d also be interested to see some macro data like what are mens average a1c levels as compared to women’s across the board-- the question being— are men better controlling diabetes in general and thus suffering less complications (and if so-- why, and how/ can that possibly be improved?). – or are all things being equal women just experiencing more complications because of their physiology. I truly think this is a topic worth exploring.
I also didn’t realize there was a difference but in the general population women live longer than men. As my grandfather discovered after my grandmother passed away. He was the most popular person in the senior community they lived in. Men were very few around the community. My very unprofessional opinion is that if we as women are living longer than men, the likelihood of us having more complications or problems will rise. The joys of living longer may mean more problems.
And as to hormones, both sexes have those major issues and problems through those tough teen years but us women have many years later of blood sugar issues due to hormones and monthly cycle. And the medical research still can’t come to a decision on hormone therapy or not.
I am hoping I can live a long and healthy live. And prove the medical professions back when I was diagnosed wrong.
(Was told I wouldn’t live past 30!)
I did the same search as @Laddie, and the handful of articles I read said that there isn’t just a higher incidence of complications, but that women with Type 1 actually die sooner (have a shorter life expectancy) than men with Type 1. It also mentioned that cardiovascular complications in women tend to be more fatal than cardiovascular complications in men. One article noted that both of these trends are the opposite of what’s seen in people without diabetes (usually women live longer and men have more fatal outcomes of cardiovascular disease).
I’m a woman in early menopause. Ugh. I was diagnosed a few years ago at age 49. Since my dx with an A1C of 13.3 and complications upon diagnosis, I have kept my A1Cs in the mid fives. I don’t know if I flat line - I don’t have (nor desire) a pump or cgm. But my lows are mild and I don’t have wild bg swings.
I think, from seeing lots of posts in the DOC, women put everyone else before themselves. “I have three kids…”, my job takes too much…", “I don’t have the xxxx to exercise…” Do we also not recognize the signs of a heart attack - which are entirely different than the signs for men. Heart disease is the highest cause of death for both sexes - recently turned higher for women than men. Our outcomes after heart attacks are also worse. Is high blood pressure worse for women? Glucose more damaging?
Now I’m sure to get into trouble here. After the eighth grade, girls stop being good at math at a higher rate than boys. Lots of reasons why, but it’s just the way it is. I do math in my head constantly with this T1D stuff. If you aren’t comfortable with math, it’s much harder.
There are a lot of cultural differences with boys and girls, women and men. Women have been the caretakers.
Most research is on T2D. Are they conflating the results? It wouldn’t surprise me.
Could it be that drug trials are done on men and not women? To eliminate the “hormonal changes” they just use men for trials. It came to light when Ambien became a problem for women. Turns out the clinical trials used men and the effects and dosage are different. The FDA has new rules now, but it’s not been very long. Maybe many pharmaceuticals work better/different for men/women.
New study shows metformin may reduce heart disease in T1D. Are more men taking it? Is it different for women?
I don’t expect to live as long as my mother does. She’s 86 and doing well.
I can see hormones definitely affecting women more, and perhaps making blood glucose levels more difficult to achieve. I think at least in the past women and heart disease was often overlooked. Women tend to present in a totally different manner from men when having a heart attack and many times women were simply misdiagnosed. Hopefully that has changed with more awareness of women presenting differently. I think a lot of how well someone manages their illness has to do with one how much a person is willing to own their illness and take responsibility for it, and also just how good of access individuals have to multiple providers and selections in providers. In my area I have a numerous endocrinologist I can choose from if I am unsatisfied with my care. Also insurance…do you have a PPO where you can choose in or out of network provider…or do you have an HMO and have to stay within the network. Just my thoughts on the subject.
Also many women have children and also while diabetic increasing chances of complications depending on how well one is in control during pregnancy. And yes as women do typically live longer than men…that also predisposes us to a longer time of developing complications.
Then again is it just random luck of the draw. There is absolutely no family history of diabetes in my family…yet I got type 1…but there is a strong family history of heart disease, but even with diabetes for 30 plus years, and a lot of those years not in the best of control, I show absolutely no signs of heart disease or high blood pressure. Will that always be the case…who knows, time will tell. Or is it just randomness. In my family people either die young…or live to be really old. I figure I have a 50/50 shot at it diabetic or not.
I wonder whether this could be at least partially due to cultural and societal patterns. Sounds foolish, I know, but wait. Back in the day, men were far more subject to cardiovascular episodes than women. No one was thinking about it the right way, so it wasn’t clear why. Then women began to enter the work force in greater numbers in more responsible positions with greater power (and stress), and the difference began to narrow. Just wondering whether there could be some (heretofore unrecognized) factor like that adding fuel to whatever it is that’s going on.
In my lifetime, since the '70’s, women transformed the socially acceptable roles they could pursue. I say, brava! Unfortunately as they took on career ambitions and workplace responsibilities they often did that in addition to their primary responsibilities at home.
What I’m about to say may get my “man card” pulled, but it’s what I’ve seen first-hand. We men did not always equitably share the household tasks of childcare, cleaning, and cooking. It’s been a large adjustment for men and many of us have tried to take on more family and household responsibilities, but it’s been less than ideal. I offer as one example, the woman in the family is often responsible for all things medical. It’s often the woman who makes all the medical appointments. I think this is changing but it takes a few generations for the bulk of the change to occur.
So I agree, women have taken on more responsibilities outside the family and that may very well contribute to increased stress and more susceptibility to heart disease.
Yes, that’s the sort of thing I’m thinking of. I wonder whether those changing roles and responsibilities, and the stress they engender, could be a factor in the mix. Just a theory, that’s all.
That argument about career and family assumes that a majority of women go off and have families. Is this the case? I’m only wondering because I’m in my mid-30s and, while a few of my friends have kids, I’d say a majority do not, and many are not even married (myself included). Maybe this is a more recent change, but I think the assumption that women are always raising families is not the case anymore.
I would make a guess that hormones, and the fact that they have not been addressed at all in terms of how to manage diabetes with them (while everything else—food, exercise, illness, is addressed by CDEs and many books) may play a large role. But, most likely, it’s not any one factor but a combination of several.
I think that @Sam19’s point about whether women with Type 1 actually have worse control, or whether they have the same control and are just more suseptible to complications, is one that could make a big difference. If they are achieving the same control and are more suseptible to complications, maybe targets for men and women need to be changed, similar to how targets for pregnant women are already different from everyone else.
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.
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.)
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…
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.
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.
