C. Ronald Kahn, MD - President / Director, Joslin Diabetes Center; Mary K Iacocca Professor of Medicine, Harvard Medical School. His discoveries in insulin signals/receptors revolutionized diabetes research.
What special health risks do diabetic women face?
C. Ronald Kahn, M.D.: There are special risks that women should be attentive to, I think that put them in a special category. Gestational diabetes, which is diabetes that appears sometimes during pregnancy, in a person who hasn't had diabetes, is really a form of type-two diabetes in most cases that is showing up due to the hormonal changes during pregnancy. It may go away after the pregnancy is over but it definitely needs to be paid attention to during the pregnancy.
C. Ronald Kahn, M.D.: And after the pregnancy, these women need to be monitored much more closely for the subsequent risk of type-two diabetes, because they are in a higher risk group. It's very important for women who've had gestational diabetes to know that they have this risk. But the risk can also be reduced by these life style changes that we've already talked about like keeping their weight down and more exercise.
C. Ronald Kahn, M.D.: Women obviously who have diabetes may also know that there are changes with their blood sugar control during both pregnancy and also with menstrual cycle. Hormones that are cycling, like estrogen, and progesterone, that change during pregnancy but also change with each menstrual cycle do have effects to changing someone's sensitivity and this occurs in normal women. It occurs in adolescent women, starting their periods, going through menarche. These are normal physiological changes. They can certainly be managed. People just need to be aware that they may see these differences and need to learn their own bodies. They need to learn how does their own body respond?
C. Ronald Kahn, M.D.: And of course as they go through menopause they may also see changes as these hormones decrease. None of these are making a huge change in their overall management, but they will make changes that a man may not see in the same way. Women normally have protection against vascular disease until the menopause. Very few women, for example, have a heart attack prior to menopause. It's only after menopause that they become at the same risk as men for coronary artery disease.
C. Ronald Kahn, M.D.: This isn't true for women with diabetes. Women with diabetes lose some of that protection, so they need to be more attentive than average women whether their cholesterol is high or low, whether their triglycerides are high or low, whether their HDL and LDL, the good cholesterol and the bad cholesterol are in the right range. And pay more attention to the treatment of that than women without diabetes, because they've lost some of the protection that women normally have. A normal woman might be able to get by with not such a great cholesterol in her normal reproductive period, but a woman with diabetes shouldn't take that chance.