WOMEN

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WOMEN DIABETES

• Linda Patrick RN, PhD ( c )
• Faculty of Nursing
• University of Windsor

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WHAT IS DIABETES?

• A GROUP OF METABOLIC DISEASES CHARACTERIZED BY
  HYPERGLYCEMIA RESULTING FROM DEFECTS IN INSULIN
  SECRETION, INSULIN ACTION, OR BOTH (ADA, 2003,
  S5)

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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)

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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

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WARNING SIGNS OF DIABETES

• INCREASED THIRST
• INCREASED HUNGER
• FREQUENT VOIDING
• FEELING TIRED
• BLURRED VISION
• FREQUENT OR RECURRING INFECTIONS
• THE METABOLIC SYNDROMEHIGH BP, HIGH CHOLESTEROL,
  HIGH BLOOD SUGARS OR

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• NO SYMPTOMS
• AT ALL

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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

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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

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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

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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

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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)

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DIABETES WOMEN

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

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• 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

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• 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)

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

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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

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

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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

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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).

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• 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
  difficultimagine when the person with the
  chronic illness is the woman!

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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 wouldnt have this condition.... and
  how irresponsible that a woman your age, that,
  you know, youve let yourself go to the point
  that youve developed diabetes.

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• I didnt think that it (gestational diabetes)
  meant that eventually I would get diabetes. I may
  have changed my lifestyle if Id known
  that.maybe I wouldnt have allowed myself to get
  as heavy as I did and maybe I would have
  exercised moreyou know, I think I would have
  been more cautious