WOMEN & DIABETESWOMEN & DIABETES

Linda Patrick RN, PhD ( c )Linda Patrick RN, PhD ( c )

Faculty of NursingFaculty of Nursing

University of WindsorUniversity of Windsor

WHAT IS DIABETES?WHAT IS DIABETES?

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

TYPE 2 DIABETESTYPE 2 DIABETES

• ““OCCURS WHEN THE PANCREAS OCCURS WHEN THE PANCREAS DOES NOT PRODUCE ENOUGH DOES NOT PRODUCE ENOUGH INSULIN OR WHEN THE BODY DOES INSULIN OR WHEN THE BODY DOES NOT EFFECTIVELY USE THE INSULIN NOT EFFECTIVELY USE THE INSULIN THAT IS PRODUCED” THAT IS PRODUCED” (CDA, 2000)(CDA, 2000)

• THE OTHER TWO TYPES OF DIABETES ARE THE OTHER TWO TYPES OF DIABETES ARE TYPE 1 (10% OF THE POPULATION) & TYPE 1 (10% OF THE POPULATION) & GESTATIONAL DIABETES (GLUCOSE GESTATIONAL DIABETES (GLUCOSE INTOLERANCE FIRST DETECTED DURING INTOLERANCE FIRST DETECTED DURING PREGNANCY)PREGNANCY)

A GROWING PROBLEMA GROWING PROBLEM

• IT IS ESTIMATED THAT OVER 2 IT IS ESTIMATED THAT OVER 2 MILLION CANADIANS HAVE MILLION CANADIANS HAVE DIABETESDIABETES

• 90% HAVE TYPE 2 DIABETES90% HAVE TYPE 2 DIABETES

• ABORIGINAL PEOPLES, LATIN-ABORIGINAL PEOPLES, LATIN-AMERICANS, AFRICANS, ASIANS AND AMERICANS, AFRICANS, ASIANS AND PEOPLE OF HISPANIC DESCENT HAVE PEOPLE OF HISPANIC DESCENT HAVE HIGHER INCIDENCEHIGHER INCIDENCE

WARNING SIGNS OF WARNING SIGNS OF DIABETESDIABETES

• INCREASED THIRSTINCREASED THIRST• INCREASED HUNGER INCREASED HUNGER • FREQUENT VOIDINGFREQUENT VOIDING• FEELING TIREDFEELING TIRED• BLURRED VISIONBLURRED VISION• FREQUENT OR RECURRING FREQUENT OR RECURRING

INFECTIONSINFECTIONS• THE METABOLIC SYNDROME…HIGH THE METABOLIC SYNDROME…HIGH

BP, HIGH CHOLESTEROL, HIGH BP, HIGH CHOLESTEROL, HIGH BLOOD SUGARS OR………BLOOD SUGARS OR………

NO NO SYMPTOMS SYMPTOMS

AT ALL……AT ALL……

DIABETES CAN BE DIABETES CAN BE SILENTSILENT

• DIABETES CAN REMAIN UNDETECTED DIABETES CAN REMAIN UNDETECTED FOR YEARS (MAYBE AS MANY AS ½ OF FOR YEARS (MAYBE AS MANY AS ½ OF CASES)CASES)

• Some individuals with type 2 Some individuals with type 2 diabetes exhibit few or no classic diabetes exhibit few or no classic symptomssymptoms

• The long-term consequences or The long-term consequences or damage from having prolonged damage from having prolonged elevated blood glucose levels can be elevated blood glucose levels can be significant even before a diagnosis significant even before a diagnosis is made is made

TYPE 2 DIABETESTYPE 2 DIABETES

• LIFE ALTERING & OFTEN LIFE LIFE ALTERING & OFTEN LIFE DIMINISHINGDIMINISHING

• WIDE RANGE OF COMPLICATIONSWIDE RANGE OF COMPLICATIONS• MAJOR CAUSE OF CADMAJOR CAUSE OF CAD• NEW CASES OF ADULT ONSET NEW CASES OF ADULT ONSET

BLINDNESSBLINDNESS• KIDNEY DISEASEKIDNEY DISEASE• SEXUAL DYSFUNCTIONSEXUAL DYSFUNCTION• NEUROPATHIES (NERVE DAMAGE), NEUROPATHIES (NERVE DAMAGE),

CIRCULATORY PROBLEMS (BLOOD CIRCULATORY PROBLEMS (BLOOD VESSEL DAMAGE) …MASSIVE VESSEL DAMAGE) …MASSIVE INFECTIONS, AMPUTATIONSINFECTIONS, AMPUTATIONS

A MAJOR HEALTH A MAJOR HEALTH CONCERNCONCERN

• ABORIGINAL PEOPLE ARE ABORIGINAL PEOPLE ARE THREE TO FIVE TIMES MORE THREE TO FIVE TIMES MORE LIKELY TO HAVE OR DEVELOP LIKELY TO HAVE OR DEVELOP DIABETES THAN ANY OTHER DIABETES THAN ANY OTHER GROUP AND TWO THIRDS OF GROUP AND TWO THIRDS OF ABORIGINAL PEOPLE WITH ABORIGINAL PEOPLE WITH DIABETES ARE WOMEN WITH DIABETES ARE WOMEN WITH TYPE 2 DIABETESTYPE 2 DIABETES

FINANCIAL COSTSFINANCIAL COSTS• AVERAGE INDIVIDUAL HAS HEALTH COSTS AVERAGE INDIVIDUAL HAS HEALTH COSTS

THAT ARE 2 TO 5 TIMES HIGHER THAN A THAT ARE 2 TO 5 TIMES HIGHER THAN A

PERSON WITHOUT DIABETESPERSON WITHOUT DIABETES (CDA, 2000)(CDA, 2000)

• MEDICATIONS, SUPPLIESMEDICATIONS, SUPPLIES (FOR A LIFETIME)(FOR A LIFETIME)

• MORE FREQUENT VISITS TO HEALTH MORE FREQUENT VISITS TO HEALTH CARE PROVIDERSCARE PROVIDERS

• MORE LIKELY TO REQUIRE PLACEMENT MORE LIKELY TO REQUIRE PLACEMENT IN LONGTERM CARE FACILITY AS A IN LONGTERM CARE FACILITY AS A SENIORSENIOR

• A PUBLIC HEALTH PROBLEM WITH A COST A PUBLIC HEALTH PROBLEM WITH A COST OF 9 BILLION A YEAR IN CANADAOF 9 BILLION A YEAR IN CANADA

EMOTIONAL COSTSEMOTIONAL COSTS

IMMEASURABLEIMMEASURABLE

DIABETES MAY HAVE A GREATER IMPACT DIABETES MAY HAVE A GREATER IMPACT ON QUALITY OF LIFE THAN OTHER ON QUALITY OF LIFE THAN OTHER

CHRONIC DISEASES DUE TO THE FACT CHRONIC DISEASES DUE TO THE FACT THAT DIABETES MANAGEMENT IS AN THAT DIABETES MANAGEMENT IS AN

INTEGRAL COMPONENT OF DAILY INTEGRAL COMPONENT OF DAILY LIVING REQUIRING EXTENSIVE LIVING REQUIRING EXTENSIVE

EDUCATION AND LIFESTYLE CHANGES EDUCATION AND LIFESTYLE CHANGES (BOOTH, 2001)(BOOTH, 2001)

DIABETES & WOMENDIABETES & WOMEN

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

•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”

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

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

RISK FACTORSRISK FACTORS

• AGEAGE• OBESITYOBESITY• ETHNICITYETHNICITY• LEVEL OF ACTIVITYLEVEL OF ACTIVITY• H/O GESTATIONAL DIABETESH/O GESTATIONAL DIABETES• BIRTH WEIGHTBIRTH WEIGHT• IF YOUR MOTHER HAD IF YOUR MOTHER HAD

GESTATIONAL DIABETESGESTATIONAL DIABETES• ALSO SMOKING AND CERTAIN ALSO SMOKING AND CERTAIN

DRUGSDRUGS

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

SPECIAL ISSUES FOR SPECIAL ISSUES FOR WOMEN WITH DIABETESWOMEN WITH DIABETES

WIDESPREAD DISEASE IN MIDDLE AGED AND OLDER WIDESPREAD DISEASE IN MIDDLE AGED AND OLDER WOMENWOMEN..

• AREAS OF HEALTH CONCERN: CARDIOVASCULAR DISEASE, AREAS OF HEALTH CONCERN: CARDIOVASCULAR DISEASE, MENTAL HEALTH ISSUES, INFECTION, CONTRACEPTION AND MENTAL HEALTH ISSUES, INFECTION, CONTRACEPTION AND FERTILITY. FERTILITY.

• WOMEN ARE MORE AT RISK FOR CORONARY HEART DISEASEWOMEN ARE MORE AT RISK FOR CORONARY HEART DISEASE

• DECREASED LIFE EXPECTANCY (MORE THAN MEN)DECREASED LIFE EXPECTANCY (MORE THAN MEN)

• This may be due to the yet unexplained loss of cardio This may be due to the yet unexplained loss of cardio protection in women with diabetes (Eko, 1999). protection in women with diabetes (Eko, 1999). Postmenopausal women who have a combination of risk Postmenopausal women who have a combination of risk factors that include diabetes and being overweight are at factors that include diabetes and being overweight are at particularly high risk for morbidity and mortality from CHDparticularly high risk for morbidity and mortality from CHD

THE BURDEN OF THE BURDEN OF DIABETESDIABETES

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

• One study found that women with One study found that women with chronic conditions who self-report poor chronic conditions who self-report poor adjustment have fewer social and adjustment have fewer social and psychological resources to draw upon to psychological resources to draw upon to help them cope with their chronic illness help them cope with their chronic illness (Watt, Roberts, Browne, & Gafni,1994)(Watt, Roberts, Browne, & Gafni,1994)

• The process of balancing multiple, The process of balancing multiple, competing demands by women in competing demands by women in families where a chronic illness existed families where a chronic illness existed in another family member was difficult…in another family member was difficult…imagine when the person with the imagine when the person with the chronic illness is the woman!chronic illness is the woman!

IN THE WORDS OF IN THE WORDS OF WOMEN WITH TYPE 2 WOMEN WITH TYPE 2

DIABETES….DIABETES….• ““I knew that whether they said it or I knew that whether they said it or

not at some level they were not at some level they were interpreting they (interpreting they (other peopleother people), they ), they were saying or I perceived them as were saying or I perceived them as saying, “you know, if only you ... would saying, “you know, if only you ... would control your eating, you wouldn’t have control your eating, you wouldn’t have this condition.... and how irresponsible this condition.... and how irresponsible that a woman your age, that, you that a woman your age, that, you know, you’ve let yourself go to the know, you’ve let yourself go to the point that you’ve developed diabetes”.point that you’ve developed diabetes”.

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