Breast Cancer
Breast cancer is the most common malignancy in women and the second leading cause of cancer death (exceeded by lung cancer in 1985). Breast cancer is three times more common than all gynecologic malignancies put together. The incidence of breast cancer has been increasing steadily from an incidence of 1:20 in 1960 to 1:7 women today.
About 212,920 women in the United States will be found to have invasive breast cancer in 2006. About 40,970 women will die from the disease this year. Right now there are slightly over 2 million women living in the United States who have been treated for breast cancer. The chance of a woman having invasive breast cancer some time during her life is about 1 in 8. The chance of dying from breast cancer is about 1 in 33. Breast cancer death rates are going down. This decline is probably the result of finding the cancer earlier and improved treatment.
Complications
Having diabetes increases your risk for many serious complications. Some complications of diabetes include: heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy).
Coronary Heart Disease in Women with Diabetes
One of three women will die of heart disease compared to one of nine women dying of breast cancer. Forty percent of heart attacks result in death. Diabetes is a powerful risk factor for heart disease in women. Heart disease is the leading cause of death in women with diabetes. Women with diabetes are twice as likely to have a second heart attack and 4 times more likely to have heart failure than women without diabetes.
Many women with type 2 diabetes already have heart disease when they are diagnosed or have many of the risk factors such as high lipids levels, high blood pressure, abdominal obesity, and abnormalities in blood vessel function. Women with type 1 diabetes can develop heart disease when they are young. Women with diabetes are not only at greater risk for heart disease, but also experience more adverse outcomes.
What you can do to protect yourself
- Don’t Smoke
- Control your blood pressure
- Maintain a healthy weight
- Exercise regularly
- Eat a low-fat diet
- Take care of diabetes
- Be aware of chest pain
- Know your family history
Eating Disorders
Research suggests that eating disorders are probably more common among women with diabetes than women who do not have diabetes. Bulimia is the most common eating disorder in women with type 1 diabetes. Among women with type 2 diabetes, binge eating is more common.
Because both diabetes and eating disorders involve attention to body states, weight management, and control of food, some people develop a pattern in which they use the disease to justify or camouflage the disorder. Because the complications of diabetes and eating disorders can be serious, even fatal, responsible, healthy behavior is essential.
Eating disorders are illnesses with a biological basis modified and influenced by emotional and cultural factors. The stigma associated with eating disorders has long kept individuals suffering in silence, inhibited funding for crucial research and created barriers to treatment. Because of insufficient information, the public and professionals fail to recognize the dangerous consequences of eating disorders. While eating disorders are serious, potentially life threatening illnesses, there is help available and recovery is possible.
Types of Eating Disorders
Anorexia (or anorexia nervosa) is an eating disorder centered around an obsessive fear of weight gain. Anorexia involves self-starvation and excessive weight loss. Although anorexia is a psychological disorder, the physical consequences are serious and sometimes life-threatening.
Bulimia is characterized by recurrent binge eating (the rapid controlled consumption of large amounts of food). Purging may occur with self-induced vomiting, laxatives, diuretics, insulin omission or reduction, fasting, severe diets, or vigorous exercise.
Binge Eating Disorder (also known as Compulsive Overeating) is characterized primarily by periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full. While there is no purging, there may be sporadic fasts or repetitive diets and often feelings of shame or self-hatred after a binge.
Eating Disorders Not Otherwise Specified (EDNOS)
A range of other disordered eating patterns doesn’t fit the other specific types. These conditions are still serious, and intervention and attention are necessary.
EDNOS, or other types of eating disorders, may include:
- Eating problems or disordered eating with some, but not all, of the characteristics of an eating disorder; for example, people who severely restrict food intake, but who do not meet the full criteria for anorexia nervosa.
- Chewing food and spitting it out (without swallowing).
- Bingeing and purging irregularly, such as at times of increased stress.
Eating Disorders and Pregnancy
Women with eating disorders have higher rates of miscarriage than do healthy, normal women. Also, your baby might be born prematurely, meaning that it would not weigh as much, or be as well developed, as babies who are born full term. Women with anorexia nervosa are underweight and may not gain enough weight during pregnancy. They risk having a baby with abnormally low birth weight and related health problems. Women with bulimia nervosa who continue to purge may suffer dehydration, chemical imbalances or even cardiac irregularities. Pregnancy heightens these health risks. Women who are overweight due to binge eating are at greater risk of developing high blood pressure, gestational diabetes and overgrown babies. Low birth weight babies are at risk of many medical problems, some of them life threatening.
Your teeth and bones might become weak and fragile because the baby’s need for calcium takes priority over yours. If you don’t replenish calcium with dairy products and other sources, you could find yourself with stress fractures and broken bones in later years. Once calcium is gone from your bones, it is difficult, if not impossible, to replace it.
Gastroparesis and Diabetes
Gastroparesis is a disorder affecting people with both type 1 and type 2 diabetes, where the stomach takes too long to empty its contents. It happens when nerves to the stomach are damaged or stop working. The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.
Gastroparesis can make diabetes worse by making it more difficult to manage blood glucose. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise.
The most important treatment goal for diabetes-related gastroparesis is to manage your blood glucose levels as well as possible. Treatments include insulin, oral medications, changes in what and when you eat, and in severe cases, feeding tubes and intravenous feeding.
Mental Health
Anxiety
Anxiety disorders are serious medical illnesses that affect approximately 40 million American adults. These disorders fill people’s lives with overwhelming anxiety and fear. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.
Types of Anxiety
Generalized Anxiety Disorder (GAD)
is much more than the normal anxiety people experience day to day. It’s chronic and fills one’s day with exaggerated worry and tension, even though there is little or nothing to provoke it.
Panic Attacks and Panic Disorder
People with panic disorder have feelings of terror that strike suddenly and repeatedly with no warning. They can’t predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next one will strike.
Phobias
Social phobia, also called social anxiety disorder, involves overwhelming anxiety and excessive self-consciousness in everyday social situations. People with social phobia have a persistent, intense, and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is a debilitating condition that can develop following a terrifying event. Often, people with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to.
Obsessive Compulsive Disorder (OCD)
Obsessive-compulsive disorder, or OCD, involves anxious thoughts or rituals you feel you can’t control.
Depression
The rate of depression in people with diabetes is much higher than in the general population. Women experience depression about twice as often as men. The risk of depression increases in women with diabetes. Many hormonal factors may contribute to the increased rate of depression in women — particularly such factors as menstrual cycle changes, pregnancy, miscarriage, postpartum period, pre-menopause, and menopause. Many women also face additional stresses such as responsibilities both at work and home, single parenthood, and caring for children and for aging parents.
Previous studies have shown individuals who are insulin-resistant may have higher serotonin concentrations and may be more prone to depression and even suicide. Women with diabetes may be more likely to suffer depression because of the clinical diagnosis.
Types of Depression
Major depression is characterized by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities.
Dysthymia, a less severe type of depression, involves long-term, chronic symptoms that are not disabling, but keep one from functioning well or feeling good.
Bipolar disorder (also known as manic-depressive illness) is not nearly as prevalent as other forms of depression.
Seasonal affective disorder (SAD) is a major depression that occurs in the winter when the amount of sunlight is limited.
Postpartum depression occurs within four weeks of childbirth. Most new mothers suffer from some form of the “baby blues.”
Psychotic depression is a rare form of depression characterized by delusions or hallucinations, such as believing you are someone you are not and hearing voices.
Osteoporosis
Osteoporosis is a disease in which bones become fragile and more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine, and wrist.
In the U.S., 10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis. Of the 10 million Americans estimated to have osteoporosis, eight million are women and two million are men. Women can lose up to 20 percent of their bone mass in the five to seven years following menopause, making them more susceptible to osteoporosis.
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) is the most common cause of female infertility. In women with PCOS, immature follicles bunch together to form large cysts or lumps. The eggs mature within the bunched follicles, but the follicles don’t break open and release them. As a result, women with PCOS often don’t have menstrual periods, or they have periods only on occasion.
No one knows the exact cause of PCOS, but studies are looking at whether it is caused by genetics. Also, because many women with PCOS also have diabetes, studies are examining the relationship between PCOS and the body’s ability to produce insulin.
Because there is no cure for PCOS, it needs to be managed to prevent further problems. There are many medications to control the symptoms of PCOS. Management focuses on each woman’s main concerns, such as infertility, acne or obesity. Long term, the most important aspect of treatment is managing cardiovascular risks such as obesity, high blood cholesterol, diabetes and high blood pressure.
Researchers are looking at how male hormone levels change as women with PCOS grow older. They think that as women reach menopause, ovarian function changes and the menstrual cycle may become more normal. But even with falling male hormone levels, excessive hair growth continues, and male pattern baldness or thinning hair gets worse after menopause.
Pregnancy
Gestational Diabetes
Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes. Gestational diabetes affects about 4% of all pregnant women — about 135,000 cases of gestational diabetes in the United States each year.
Diabetes and Pregnancy
The key to a healthy pregnancy for a woman with diabetes is keeping blood glucose (sugar) in the target range — both before she is pregnant and during her pregnancy. To do this, you need a diabetes treatment plan that keeps meals, exercise, and insulin in balance. This plan will change as you change with pregnancy.
Women’s Sexual Health
Sex is an important part of life and relationships. But diabetes can affect a woman’s sex life. Some women with diabetes have less interest in sex because of depression or levels can make some women feel tired all the time. Problems with having sex aren’t a normal part of getting older and don’t happen to all women who have diabetes.
Menopause
Menopause and the years leading up to it when your body gradually produces less estrogen and progesterone (perimenopause) may present unique challenges if you have diabetes. How these hormonal changes affect blood glucose may vary depending on the individual. Many women, however, notice that their blood glucose levels are more variable (increasing and decreasing) and less predictable than before. The hormonal changes as well as swings in your blood glucose levels can contribute to menopausal symptoms such as mood changes, fatigue and hot flashes.
Menopause and diabetes produce similar symptoms. You may mistake menopausal symptoms such as hot flashes, moodiness and short-term memory loss for symptoms of low blood glucose. If you incorrectly assume these symptoms are a result of low blood glucose, you may consume unnecessary calories in an effort to raise your blood glucose, and inadvertently cause a surge in blood glucose.
Because of your diabetes, however, you may experience stronger and more frequent episodes of low blood glucose, especially at night. This can further compromise sleep already interrupted by menopause-associated hot flashes and night sweats. Such sleep deprivation can cause fluctuations in blood glucose that make control more difficult.
Hormone Replacement Therapy (HRT) and Diabetes
Women with diabetes are at an increased risk for heart disease. The estrogen hormone which is lost at menopause is a powerful factor in preventing heart disease. Women with diabetes develop a greatly increased risk of developing heart disease after menopause. HRT can help reduce this risk.
HRT replaces the estrogen and progestin once produced by your body. HRT is sometimes used to treat women who experience serious or very unpleasant effects of menopause. In all women, there are risks and benefits. Women with diabetes are no exception.
Benefits: reduces risk of heart disease and reduces risk of osteoporosis, lipid effects, blood vessel effects
Risks: increases risk of breast cancer
