Women are just as sus­cep­ti­ble

The Star Malaysia - - Fit For Life -

KUALA LUMPUR: There is an as­sump­tion that women are less sus­cep­ti­ble to di­a­betes than men.

This is wrong, said as­so­ciate pro­fes­sor and con­sul­tant en­docri­nol­o­gist Dr Alexan­der Tan, who is also Univer­siti Malaya Med­i­cal Cen­tre head of the Di­a­betes Care Unit.

“Due to such an as­sump­tion, women may get di­ag­nosed later and have a longer pe­riod of un­de­tected high glu­cose, which in turn can lead to more com­pli­ca­tions,” he said.

Some stud­ies have even shown that heart dis­ease in women with di­a­betes is more deadly than in men, he said.

Dr Tan also pointed out that the National Health and Mor­bid­ity Sur­vey (NHMS) 2015 showed that the preva­lence of di­a­betes in Malaysia was slightly higher in adult fe­males (18.3%) than males (16.7%).

NHMS also es­ti­mated that about 10% of Malaysians un­der age 45 have di­a­betes, with one in 20 Malaysians (5.5%) in the 18- to 20-year age group hav­ing di­a­betes.

He said it is es­pe­cially wor­ry­ing to see an in­creas­ing num­ber of young peo­ple with di­a­betes.

“And it is wor­ry­ing that many women who are of child-bear­ing age (less than 45 years old) al­ready have di­a­betes,” he said.

In gen­eral, Dr Tan said the preva­lence of di­a­betes in preg­nancy (ei­ther type 2 or ges­ta­tional di­a­betes) is es­ti­mated to be be­tween one in 10 and one in seven preg­nan­cies or 10% to 15% of preg­nan­cies.

“This has an im­pact not just on the woman, but also on the foe­tus as well. It’s two lives af­fected.

“High blood glu­cose lev­els dur­ing a woman’s preg­nancy can re­sult in a higher risk of mis­car­riage, de­for­mi­ties and dif­fi­cul­ties dur­ing labour due to in­creased foetal size, which can harm both the baby and the mother,” he said.

He said that there is also a hy­poth­e­sis that “foetal pro­gram­ming”, which oc­curs while a baby is in the uterus, may af­fect their me­tab­o­lism as they grow up – they tend to be more obese and be­come di­a­betic as they grow up.

Dr Tan ex­plained that there are gen­er­ally two sce­nar­ios of a woman hav­ing di­a­betes dur­ing preg­nancy – the woman has di­a­betes prior to preg­nancy and then be­comes preg­nant (usu­ally called “type 2 di­a­betes in preg­nancy”) or she de­vel­ops di­a­betes dur­ing preg­nancy (ges­ta­tional di­a­betes).

Type 1 di­a­betes in preg­nancy does oc­cur but it is rare and it is the hard­est to man­age, he said.

For type 1 di­a­betes, in­sulin is a must whether the woman is preg­nant or not as they could die with­out it, while for type 2, some pa­tients can do with­out in­sulin but need med­i­ca­tion.

For women with ges­ta­tional di­a­betes, it is mainly diet con­trol, but some­times in­sulin is needed, he said.

“Most cases of ges­ta­tional di­a­betes tend to have a nor­mal glu­cose level af­ter preg­nancy.

“How­ever, a woman who has a his­tory of ges­ta­tional di­a­betes will have a higher risk of de­vel­op­ing type 2 di­a­betes later on in life and should there­fore be reg­u­larly mon­i­tored for this,” he said.

Women with di­a­betes also have a higher risk of vagi­nal thrush (yeast in­fec­tion) and uri­nary tract in­fec­tion.

Di­a­betes is also linked with poly­cys­tic ovar­ian syn­drome in women, he said.

There­fore, he said there is a need to push for equal ac­cess to screen­ing, di­ag­no­sis and treat­ment – ex­act- ly what this year’s International Di­a­betes Fed­er­a­tion’s World Di­a­betes Day cam­paign is high­light­ing, he said.

Dr Tan said that if a woman is known to have di­a­betes be­fore be­com­ing preg­nant, she will need to con­sult with her doc­tor to en­sure that her med­i­ca­tions are suit­able for preg­nancy and her glu­cose level is well con­trolled be­fore try­ing to con­ceive (HbA1c less than 6.5%).

“A preg­nant woman with di­a­betes needs to go for reg­u­lar fol­low-ups with her gy­nae­col­o­gist and physi­cian to mon­i­tor her glu­cose (both at home and at clinic) and to en­sure the foe­tus is de­vel­op­ing nor­mally.

“She should also re­ceive ad­vice on main­tain­ing a healthy diet for preg­nancy, which in­cludes know­ing how to man­age car­bo­hy­drate in­take and avoid­ing ex­ces­sive weight gain dur­ing preg­nancy. In some cases she may need to start on in­sulin.

“With di­a­betes in preg­nancy, you have a lim­ited amount of time to get things right to avoid poor out­comes,” he em­pha­sised.

Asked if there were women who did not know they had di­a­betes un­til they were screened dur­ing preg­nancy, he said that there were quite a num­ber.

“There are many younger peo­ple with di­a­betes who don’t know they have di­a­betes un­til they go for a rou­tine check-up,” he said.

Dr Tan said that most preg­nant women un­dergo screen­ing for di­a­betes at 24 to 28 weeks but some get tested ear­lier if they are at high risk (such as strong fam­ily his­tory and obe­sity).

With proper care, mon­i­tor­ing, ed­u­ca­tion, med­i­ca­tions and the right at­ti­tude to­wards look­ing af­ter one­self and the baby in the womb, a woman can avoid the ter­ri­ble com­pli­ca­tions of di­a­betes, he said.

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