Women with Diabetes Need Accessible Women’s Health Care
Editor’s Note: This article explores the lack of readily available information and research related to women’s health care—the umbrella term for healthcare that encompasses female sexual and reproductive health. Beyond Type 1 recognizes that, while cisgender women’s healthcare is vastly under-researched, particularly at its intersection with diabetes care, transgender and non-binary healthcare is even less studied, which leads to poor physical and mental health outcomes. For information on providing culturally sensitive care to LGBTQ+ individuals, read our coverage here. For more information on expanding inclusivity in women’s health care, read this coverage from the Colorado School of Public Health.
For a woman with diabetes, regular and affordable access to women’s health care—the umbrella term for healthcare that encompasses female sexual and reproductive health—is critical. Every part of diabetes can be affected by other health concerns—including gynecological, pregnancy and breast cancer. And every other part of a woman’s overall health can potentially affect her diabetes care and safety.
Here, we’ll first take a closer look at some of the most common health concerns a woman with diabetes may experience, then dig into some of the underlying systemic issues in women’s health care.
Common Health Concerns
These are a few of the health concerns you might experience as a woman with diabetes.
Most women—with or without diabetes—will experience a few yeast infections throughout their lifetime. Women with any type of diabetes are at a higher risk of developing yeast infections because excess sugar in your urine actually feeds the growth of yeast.
Without adequate healthcare, a seemingly harmless yeast infection can become extremely painful—and a long term recurring issue.
While yeast is part of a healthy vagina, too much yeast results in very uncomfortable and potentially painful symptoms.
If your blood sugar levels are persistently high for even just a few days, it can trigger an overgrowth of yeast. While improving your blood sugars quickly can help slow down the growth, you’ll likely still need an over-the-counter treatment from the pharmacy.
If your blood sugars are chronically over 11.11 mmol/L200 mg/dL for weeks, months, or years, yeast infections could be a recurring issue that’s hard to clear up. Poor circulation can also reduce your body’s ability to fight infection, in general.
Working with your healthcare team to bring your blood sugars down to a safer range is a critical part of treating and preventing yeast infections.
It’s also important to not confuse symptoms of a potential sexually transmitted infection with a yeast infection. Do not hesitate to contact your healthcare team if you’re experiencing vaginal symptoms of any kind. If you’re experiencing frequent or treatment-resistant yeast infections, reach out to your healthcare team immediately.
Vaginal Lubrication & Sexual Pleasure
Women with diabetes are more likely to struggle with dryness and pain during sex—and more likely to struggle with achieving an orgasm. However, working with your healthcare team to manage healthy blood sugar levels can largely prevent these issues!
There are two pea-sized glands near the opening of your vagina that produce lubricating fluids. Without this lubrication, your vagina will struggle with persistent dryness, making sex very uncomfortable. While using a lubricant can help, it’s never a perfect fix.
These glands include both nerves and blood vessels. Just like the nerves and blood vessels throughout your fingers, eyes, toes and kidneys, the nerves and blood vessels in your vagina can be damaged by chronically high blood sugar levels.
The same can be said for sexual pleasure. Your clitoris is made up of nerves and blood vessels, too. When high blood sugars damage these nerves and blood vessels, you may feel less pleasure and have more difficulty achieving an orgasm.
But this can be largely prevented by working with your healthcare team to bring your blood sugar levels into a safer, healthier range.
Pregnancy—with or without diabetes—is full of unknowns and inevitably stressful on a woman’s body. When you add the complexities of type 1 diabetes to pregnancy, research has found that it increases a woman’s risk of experiencing a variety of serious complications.
Some of these complications include:
- Hypertension (pre-eclampsia)
- Obstructed labor
- Postpartum hemorrhage (excessive, severe bleeding)
- Nephropathy (kidney disease—onset or pre-existing)
- Retinopathy (onset or pre-existing)
- Stillbirths (death of a fetus or newborn)
- Premature delivery
- Congenital anomalies
- Neonatal hypoglycemia (low blood sugar in newborns)
- Fetal macrosomia (large baby at birth)
While tight blood sugar management can reduce your risk of these complications, it’s never a guarantee. Many women who report tight blood sugar management during pregnancy have experienced these complications.
In fact, a woman with diabetes needs accessible healthcare long before she actually becomes pregnant. The more you can plan and prepare for pregnancy with support from your healthcare team, the more you can reduce the risk of these complications. Your body’s health for the sake of pregnancy actually starts long before you’re pregnant.
“During the first eight weeks of pregnancy, a baby’s organs, such as the brain, heart, kidney and lungs begin to form. High blood sugar levels in the mother can affect this early stage development, increasing a baby’s risk of birth defects,” explains Jamillah Hoy-Rosas, MPH, RDN, CDCES, vice president of clinical operations at One Drop.
Additionally, Hoy-Rosas says that high blood sugar levels can complicate the birthing process.
“If blood sugars are too high throughout the later stages of pregnancy, it increases the risk of preeclampsia and of babies being born too large for their gestational age, making deliveries more complicated,” Hoy-Rosas says.
High blood sugar levels in the mother can also lead the baby to be larger than normal at birth—referred to as “fetal macrosomia”—explains Nichole Butler, MD, gynecologist at Women’s Health Center at Weiss Memorial Hospital.
Persistently high blood sugars and insulin resistance beyond what’s expected in pregnancy can contribute to a baby essentially gaining too much weight during the last trimester, explains Butler. High blood sugars also increase your baby’s risk of experiencing low blood sugars after birth when they are no longer getting that excess sugar through the umbilical cord.
As a result of all of these complications, women with diabetes have a higher likelihood of delivering via cesarean section.
Working with your healthcare team to improve your blood sugar levels and adopt healthy lifestyle habits during pregnancy is a critical part of reducing your baby’s risk of fetal macrosomia.
- Learn more: Pregnancy with Type 1 Diabetes
Examining Systemic Issues
Health care for women—especially BIPOC women and non-binary people assigned female at birth—continues to suffer from systemic issues of racism and bias throughout the United States.
Inequities In Maternal Mortality
The rate of women dying during pregnancy and childbirth has been rising with alarming statistics. About 700 women die every year in the United States—more than any other comparable country—and most of these deaths are preventable.
The incidence of maternal mortality among pregnant women with type 1 diabetes is 0.5 percent, a percentage that is five to 20 times higher than the general obstetric population.
For women of color—and their babies—the rates of death are worse.
“Maternal and infant mortality rates remain high in low-income and minority communities, as many Black and Indigenous women face racial, economic and environmental disparities and healthcare professionals deal with a shortage of resources to serve these communities,” explains a recent report on an analysis of maternal mortality.
For Black and brown women, the maternal health crisis is even more pronounced, according to Hoy-Rosas. Black women are three to four times more likely than white women to die from a pregnancy-related cause.
American Indian and Alaska Native women are 2.5 times more likely to die from pregnancy-related causes.
These inequities are largely fueled by systemic racism and bias in the healthcare setting.
Impactful change can happen in medical training. Here are just a few resources identifying and working to make a difference in this crisis:
- Diagnosing and Treating System Racism
- AMA Adopts Guidelines that Confront Systemic Racism in Medicine
- Addressing Health Inequities in Type 1 Diabetes
- Ways to Eradicate Systemic Racism in Healthcare
Increasing Access To Women’s Health Care
Too often, people with diabetes do not have access to the most basic healthcare—a primary care provider. While every person with diabetes should have the opportunity to meet with an endocrinologist, the need for routine appointments with a primary care provider is imperative.
Systemic barriers need to be broken down, explains Hoy-Rosas. This includes access to affordable health insurance, timely care and consistent appointments with a primary care provider.
“Oftentimes, people are accessing care at urgent care centers or at emergency rooms,” Hoy-Rosas says. “And those are not stable long-term relationships that you have with a provider who knows you, your particular issues and some of the challenges you may be facing.”
Some of the deaths among pregnant people with diabetes are related to hypoglycemia and ketoacidosis—both manageable if treated promptly with adequate access to insulin, emergency glucagon, emergency healthcare and ongoing diabetes education and support.
A long-term patient provider relationship can also foster patient participation in decision making, provider referral to gynecologists and endocrinologists, and better management of medical conditions to prevent other diabetes complications.
“Our country is in an epidemic of maternal health care crisis,” says Hoy-Rosas.
“The United States has the highest rate of maternal morbidity and mortality as compared to other industrialized nations. And so it is important that we prioritize health care for women with diabetes throughout the entirety of their lifespan, particularly in those reproductive years, so that we can reverse the tide of the maternal health crisis that’s going on right now.”
- Learn more: Emergency Glucagon
- Learn more: Managing Diabetes Without Health Insurance
- Learn more: Getting Insulin
- Learn more: Connect with Women at Diabetes Sisters
The bottom line
Too many women, non-binary people assigned female at birth, and those across the gender spectrum are being vastly underserved by our current healthcare system and health care research. This leads to preventable poor health outcomes and must change.
Peer support can make a massive difference in health outcomes and overall well-being for everyone living with diabetes. To find other people who have experienced or are going through similar experiences, join us on our Beyond Type 1 and Beyond Type 2 community platforms.