Insulin Therapy and Your Life

09/01/2010

 If your doctor just started you on insulin therapy, you’ve likely had diabetes for a while and you know the importance of following a healthy diet, exercising regularly and monitoring your blood sugar levels. Nothing changes in terms of these requirements now that you’re on insulin. Hopefully, you’ll find it easier to keep fasting blood sugar levels in your target range and to reach an A1C of less than 7 percent.

You may be wondering about the effect of insulin on other aspects of your life. Here’s what we know:

Your sex life. You may have noticed changes in your libido and sexual life since your diagnosis of diabetes. High blood sugar can reduce vaginal lubrication, leading to dryness and pain during intercourse. It can also increase the risk of vaginal infections, which can make sex more painful. Long-term damage to small blood vessels can occur when diabetes isn’t well controlled, resulting in decreased arousal. Since insulin should provide better control of your blood sugar, with fewer episodes of high blood sugar levels (hyperglycemia), you may see these symptoms improve.

Pregnancy. Having diabetes during pregnancy can increase the risk of miscarriage, early labor and delivery, as well as preeclampsia and congenital defects in the baby. However, the best thing you can do to prevent these issues is to control your blood sugar levels before and during your pregnancy. In fact, all guidelines regarding pregnancy and diabetes recommend starting insulin therapy before getting pregnant so women can achieve target blood sugar (glucose) levels before conceiving. Taking insulin during your pregnancy is perfectly safe. One study that reviewed 10 years of pregnancy outcomes in women with type 2 diabetes found those taking insulin during pregnancy had significantly lower rates of complications. If you use oral medications for blood sugar control, talk to your health care provider about whether they are approved for use during pregnancy.

Menopause. Once you are menopausal, your body’s production of insulin drops even further, increasing insulin resistance. The fact that you’re already taking insulin is a good thing, but be sure to monitor your blood sugar for changes in your insulin requirements after menopause. As for hormone therapy, the decision is up to you and your health care professional. Replacement estrogen and/or progesterone therapy is recommended only for short-term use to address symptoms such as hot flashes and vaginal dryness in perimenopausal and postmenopausal women, but not for long-term use. The same recommendations apply if you have diabetes. An analysis of 107 studies found that hormone therapy reduces insulin resistance and fasting blood sugar levels in women with type 2 diabetes. However, if you have any significant risk factors for heart disease, talk with your doctor about whether hormone therapy is right for you and about other steps you can take to reduce your risks.

Other medications. People with diabetes often need other medications, such as a statin to control cholesterol and blood pressure-lowering drugs. Some drugs can increase your response to insulin; others can reduce it. Those that may increase the blood sugar-lowering effects of insulin include ACE inhibitors, fibrates, certain antidepressants, most oral anti-diabetes medications, some anti-arrhythmia drugs, certain pain relievers, hormones and antibiotics. Drugs that can reduce the blood sugar-lowering effects of insulin include certain steroids, niacin, diuretics, albuterol, certain hormone medications like thyroid hormones and estrogen and progesterones in oral contraceptives, as well as some psychiatric medications such as olanzapine and clozapine. Beta blockers, clonidine and lithium can make you more susceptible to hypoglycemia, while pentamidine can cause hypoglycemia, sometimes followed by hyperglycemia. Remind every health care professional who prescribes any drug for you that you take insulin, and ask if the drug will affect your blood sugar levels. Taking insulin for your diabetes doesn’t have to change your life. In fact, given the evidence regarding the benefits of insulin therapy in diabetes, it will help you have a longer, healthier life.

This content was developed with the support of sanofi aventis. For more information on the health topics mentioned in this article visit the HealthyWomen.org areas below.

Diabetes Health Center : http://www.healthywomen.org/healthcenter/diabetes Healthy Living Center : http://www.healthywomen.org/ages-and-stages/healthy-living Midlife & Beyond: http://www.healthywomen.org/ages-and-stages/midlife-and-beyond Pregnancy Center : http://www.healthywomen.org/healthcenter/pregnancy Menopause Center: http://www.healthywomen.org/healthcenter/menopause References American Diabetes Association. Standards of me dical care in diabetes–2010. Diabetes Care. 2010;33(Suppl 1):S11-61. Ekpebegh CO , Coetzee EJ, Merwe Lvd, et al. A 10-year retrospective analysis of pregnancy outco me in pregestational Type 2 diabetes: comparison of insulin and oral glucose-lowering agents. Diabetic Medicine. 2007;24(3):253-258. Giraldi A, Kristensen E. Sexual dysfunction in women with diabetes mellitus. J Sex Res. 2010;47(2):199-211. Lantus [product information]. Bridgewater , NJ : Sanofi Aventis; 2007. Mahmud M, Mazza D. Preconception care of women with diabetes: a review of current guideline recommendations. BMC Womens Health. 2010;10:5. Wedisinghe L, Perera M. Diabetes and the menopause. Maturitas. 2009;63(3):200-203.

© 2010 HealthyWomen All rights reserved. Reprinted with permission from HealthyWomen. 1-877-986-9472 (toll-free). On the Web at: http://www.HealthyWomen.org.


Women and Heart Disease Across the Lifespan Part 1 (Young Women)

05/26/2010
This is the first of a three part series titled “Women and Heart Disease across the Lifespan.”  On this show we will concentrate on heart conditions that are more likely to affect young women. We will discuss the following conditions: palpitations, tachycardia, pericarditis, conditions that may occur during pregnancy, and premature heart disease.


Pregnancy Problems Can Increase Heart Disease/Stroke Risk

09/30/2009

Young women who develop diabetes during pregnancy (called gestational diabetes) are more likely to develop diabetes and heart disease as they get older compared to women without gestational diabetes (study published Diabetes Care 2008).

Women who develop high blood pressure during pregnancy are more likely to develop coronary artery disease than women who maintained a normal blood pressure during pregnancy. Women with high blood pressure during pregnancy also develop significant narrowings in coronary arteries at an earlier age, about 3 years earlier (Journal Hypertension April 2009).

Women who experience pre-eclampsia during pregnancy are more likely to have a heart attack, stroke and develop blood clots later in life (American Journal of Obstetrics and Gynecology 2009).

Women with a family history of premature heart disease are at an increased risk. All of these pregnancy problems that occur in younger women need to be recognized as predictors of future heart problems. Unfortunately many gynecologists, primary care physicians and cardiologists are unaware of the increased risk in these women. That is why the public needs to remain informed! Learn you risk factors for heart problems. 80% of heart attacks and strokes are preventable.

“Take Charge: A Woman’s Guide to a Healthier Heart” discusses how women can help control their cholesterol and other risk factors to prevent a heart attack, stroke and diabetes. “Take Charge: A Man’s Roadmap to a Healthier Heart” is due to be released Fall 2009. For more info visit www.heart-strong.com


High Blood Pressure During Pregnancy Increases Heart Risk

05/18/2009

prenant woman 

     Many women develop high blood pressure during pregnancy but after delivery their blood pressure normalizes.  Previous research has shown that these women are at a higher risk to develop high blood pressure when they get older (especially after menopause).  A new research study conducted by Chielan researchers published in the journal Hypertension (April 2009) reports that women who develop high blood pressure during pregnancy are also at a greater risk to develop significant coronary artery disease.  This study followed 217 women who underwent a heart catheterization approximately 30 years after their last pregnancy.  Women who had experienced high blood pressure during at least one of their pregnancies were more likely to have significant narrowings in their coronary arteries than women who had normal blood pressures during pregnancy.  Also women with high blood pressure during one of their pregnancies developed coronary artery disease about 3 years earlier.

     So any woman who experiences high blood pressure during pregnancy, even if their blood pressure normalizes after delivery should be closely monitored for future heart disease.  All heart disease risk factors should be evaluated in any woman who develops high blood pressure during pregnancy.

 “Take Charge: A Woman’s Guide to a Healthier Heart” was published this year and discusses how women can identify their risk factors and control their likelihood of developing future heart disease.  For more info please visit www.heart-strong.com


Migraines during pregnancy increase heart attack and stroke risk

03/26/2009

pregnant1

Migraine headaches have previously been shown to be a risk factor for heart disease and stroke in women, especially migraines with an aura or visual changes.  A study published in the British Medical Journal (March 2009) found that migraines during pregnancy can be lethal.  Over 33,000 pregnant women diagnosed with migraines were studied.  Women over 35 years of age were more likely to experience migraines during pregnancy.  Women who had migraines during pregnancy were 15 times more likely to have a stroke and twice as likely to develop heart disease.  All women need to know their risk factors in order to prevent a heart attack and stroke.

“Take Charge: A Woman’s Guide to a Healthier Heart” discusses risk factors for heart disease and stroke in women and provides tips on how to decrease your risk and live a healthier life. This book is available at www.heart-strong.com for only $10