With 199 million women worldwide currently living with diabetes, it is no surprise that the theme for this year’s World Diabetes Day is Women and Diabetes – our right to a healthy future. One of the primary reasons the 2017 campaign is focusing on women is that women and girls are key agents in the adoption of healthy lifestyles to improve the health and wellbeing of future generations.
Diabetes is a largely self-managed condition. Your healthcare professionals can offer guidance, but ultimately you decide what advice you will take and what you will reject. We hope that the following frequently asked questions will empower you with knowledge and insight. Remember, the more we learn – the more informed our decisions can be.
Q: I had gestational diabetes. How soon after having the baby should I get my blood glucose rechecked?
A: Like more than 60% of women with gestational diabetes, your blood glucose levels will probably return to normal in the weeks after your baby is born. However, you are still at a higher risk of developing type 2 diabetes (up to a 60% chance in the next 10 to 20 years). Alternatively, you may remain with ‘intermediate hyperglycaemia’ (otherwise known as ‘prediabetes’, a form of ‘dysglycaemia’ where blood glucose levels are not high enough for diagnosis of type 2 diabetes, but neither are normal). This represents a high-risk state for future diabetes and cardiovascular disease. Thus, you should have a fasting blood glucose test (and an oral glucose tolerance test, if required by the results of that test) performed at 6 weeks after delivery. This will help to determine your future risks and guide any lifestyle or medical treatments needed to give you the best chance of a long and healthy life with your new baby.
Q: Can women with diabetes breastfeed their babies?
A: Yes! Breast milk provides the best nutrition for babies and breastfeeding is recommended for all mothers with either pre-existing diabetes or gestational diabetes. In addition, the breastfeeding experience allows you as a new mother, and your new baby, to experience the closest physical and emotional bonding possible. A Lactation Consultant is the best person to help you to achieve success. Unless you have another physical or emotional problem apart from having diabetes, that prevents breastfeeding, and you and your health care team decide on balance of risk not to continue, breastfeeding is a worthwhile goal to work at!.
Q: Will menopause affect my diabetes?
A: Menopause is the natural time in a woman’s life when monthly periods cease and she is no longer able to bear children – this usually occurs around the age of 50, but may occur earlier in women with diabetes. From a diabetes point of view, a decline in the levels of the hormone oestrogen during menopause makes the cells of the body less sensitive to insulin. This may lead to higher and less predictable blood glucose levels and make it harder to keep your diabetes well controlled. As with the menstrual cycle, this potential effect on blood glucose is variable. Thus, regular blood glucose testing and sharing of the results with your diabetes team is needed to determine the effects and needed response (if any). Healthy lifestyle choices, such as eating healthy foods and exercising regularly, are the cornerstone of your diabetes treatment plan and can also help you feel your best during and after menopause.
Q: Can your menstrual cycle affect your blood glucose levels?
A: Any change in physiology that affects your sensitivity to insulin can change your blood glucose levels. The menstrual cycle and menopause are hormone-driven events that are distinct in their life-cycle presentation and in their effects on the physiology of women.The menstrual cycle is made up of the regular, natural and recurrent changes, in women, which include ovulation (ovaries) and menstruation (uterus). It is governed by hormonal changes that result in specific anatomic and physiological processes that make pregnancy possible. In a few small studies in women with diabetes, continuous glucose monitoring has shown an increase in the frequency of hyperglycaemia (high blood glucose) during the ‘luteal’ phase (the period between ovulation and the beginning of menstruation), probably due to the effects of high levels of progesterone during this phase. This means that in women with diabetes, the menstrual cycle should be taken into consideration, especially when fine-tuning insulin therapy. However, this cyclical effect on blood glucose varies widely with each person – some women even experience hypoglycaemia (low blood glucose) and some no effect at all. As a result, regular blood glucose testing, and examination of the results together with your diabetes team, remains the only way to know how / if your monthly cycle affects your diabetes control and if needed, how to respond insightfully to any effects.
Q: Can diabetes be inherited?
A: The risk of developing diabetes is affected by whether your parents or siblings have diabetes. The likelihood of developing type 1 diabetes or type 2 diabetes differs accordingly:
Type 1 diabetes and genetics – average risks
– Mother with diabetes increases risk of diabetes by 2%
– Father with diabetes increases risk of diabetes by 8%
– Both parents with diabetes increases risk by 30%
– Brother or sister with diabetes increases risk by 10%
– Non-identical twin with diabetes increases risk by 15%
– Identical twin with diabetes increases risk by 40%
Type 2 diabetes and genetics – average risks
– If either mother or father has diabetes, risk of diabetes increases by 15%
– If both mother and father have diabetes, risk of diabetes increases by 75%
– If a non-identical twin has diabetes, risk of diabetes increases by 10%
– If an identical twin has diabetes, risk of diabetes increases by 90%
Q: Is it okay for women to drink alcohol, if so, how much?
A: According to the 2012 South African (SEMDSA) Guideline for the Management of Type 2 Diabetes, adults who choose to consume alcohol should do so in moderation – for women, one unit per day (1 tot [25 ml] of spirits, 1 glass [125 ml] of wine or 1 pint [340 ml] of beer), or less, is recommended.
Your body identifies alcohol as a toxin and the organ which detoxifies alcohol is the liver. The liver has many functions – these include the production of new glucose, as well as the release of stored glucose from glycogen (stored starch), in an effort to maintain blood glucose levels in the fasting and between-meal states (this happens in people without diabetes too)
Click here to read more insights on alcohol beverages and diabetes…
Q: How can I learn to accept my diabetes?
A: Diabetes is a chronic (lifelong) health condition that affects every life domain – physical, psychological, social, spiritual and financial. Every one of us is also unique – an individual. So the way we learn to live with diabetes is also unique – there’s no recipe. Diabetes provides a major inflexion point in one’s life that demands CHANGE. Initially, humans don’t cope with change very well. We tend to grieve for what’s lost and past. The pioneering psychiatrist and author, Elisabeth Kübler-Ross, proposed a theory of ‘five stages of grief’:
1. Denial – Often the first and very normal reaction. “You must be wrong!”
2. Anger – We realise that denial cannot continue and experience frustration, which may be directed at others or oneself. “Why me? It’s not fair! Whose fault is it?”
3. Bargaining – We hope that we can avoid the cause of our grief. “Please God, save me from this and I’ll…”
4. Depression – Reality bites…
5. Acceptance – “It’s going to be okay. I need to move on with my life”.
This theory is usually applied to the process of loss when someone near passes on. But, it actually applies, and is useful, when considering the effects of any major life change – like getting married, or divorced, or being diagnosed with diabetes. After diagnosis, and being faced with the daily realities of diabetes self-management and treatment, we can experience two or more of the ‘stages of grief’, in any order. The important thing to realise is that, in time, acceptance will come. We move on, often stronger and wiser, and more thankful for what we have.
How can this ‘resolution’ / acceptance process be facilitated?
– Find out as much as possible about your condition, the surety of the diagnosis and its treatment. If you know more, you’ll be fearful and anxious of less.
– Discuss and clarify ALL of your questions and concerns with your diabetes team. Nothing is taboo or too ‘silly’ or embarrassing to ask.
– Stay in contact! Walk with your diabetes team to stay healthy. They are not just an ‘emergency’ resource for when the wheels fall off!
– Live life to the max! Take a decision to be the healthiest and happiest version of you possible. Discuss with your team how you’ll achieve this.
– Get support! Tell your family and friends that you have diabetes. Teach them how to help you if you have a ‘hypo’ (low blood glucose). People with diabetes who have good social support live longer, and are healthier, than those who hide their condition from others.
– Take small steps. Set realistic, achievable goals for you – you’ll be more likely to experience, and build on, success.
– Focus more on the positives of having diabetes. Maybe you’re now eating healthier, exercising more, making better food and life choices. Maybe diabetes has exposed you to a leadership / advocacy role that you wouldn’t have encountered without it.
Please do not hesitate to contact us further;
Physical address: 81 Central Street, Houghton, 2198
Johannesburg, South Africa
Telephone: 011 712 6000
Facebook: CDE Your Partner in diabetes