How diabetes affects women differently from men

Diabetes is a serious health threat in Singapore. It’s such a menace that, in 2016, the Ministry of Health declared war on diabetes, in order to educate the population on the risks of the disease and how the burden of its effects can be reduced. The stats are sobering – one in three Singaporeans has a lifetime risk of getting diabetes. In fact, by 2050, it’s estimated that one million of us will have this disease.

With a lot more awareness of diabetes in the media in Singapore over the last few years, most of us are probably paying more attention to what we eat and how we can reduce our risk. But did you know that diabetes affects women differently? There are also several factors that make us more susceptible to the disease.

Who is more susceptible – men or women?

Internationally, the estimated prevalence of diabetes is roughly equal between genders, with the figure slightly lower in females (10.2 per cent), compared to males (10.8 pre cent). Dr Lim Weiying, Senior Consultant, Endocrinology, Singapore General Hospital, says that females and males are significantly different in terms of extent of insulin resistance, body composition and energy balance.   The more body fat we have, the more likely the chance of developing insulin resistance, which in turn increases the risk of type 2 diabetes. This is especially so if the fat is within the abdominal area or around the liver. 

“For the same body mass index, males tend to have more lean mass, while females have more adipose tissue, commonly known as body fat,” she explains. “However, in terms of body fat, females tend to have more subcutaneous (under the skin) fat tissue in general, while males tend to have more visceral (intra-abdominal) fat tissue.”

While males tend to have more of the type of fat (visceral) that makes them more susceptible to diabetes, women have another advantage – we are more insulin sensitive, which means we require smaller amounts of insulin to lower blood glucose levels.

“Adiponectin, an insulin-sensitising hormone, is also significantly higher in females than males. All these differences result in a more insulin-sensitive condition in females than males,” Dr Lim adds.

On hormones and obesity

Hormones are another thing that sets the sexes apart. Testosterone and androstenedione in males are associated with reduced total and central adiposity and improved insulin sensitivity. Testosterone deficiency predisposes males to type 2 diabetes mellitus, says Dr Lim.

However, in females, these same male hormones are associated with significantly increased abdominal fat. Dr Lim gives the example of how, as seen in women with polycystic ovarian syndrome, excess testosterone is correlated with insulin resistance. Therefore, oestrogen deficiency and/or testosterone excess predisposes females to type 2 diabetes. 

Even though oestrogen, the female hormone, may have beneficial effects on insulin sensitivity, the stats on obesity in Singapore are worrying for women. Dr Lim cites the National Population Health Survey 2022, which rates the obesity level in Singapore at 11.6 per cent. And although more males (13.1 per cent) than females (10.2 per cent) are obese, the prevalence of abdominal obesity in females (43.8 per cent) is higher than in males (42.9 per cent). As mentioned earlier, abdominal obesity (visceral fat) is related to increased insulin resistance. 

The most common risk factors for diabetes 

The World Health Organization (WHO) defines diabetes as a chronic disease that occurs either when the pancreas does not produce enough insulin – a hormone that regulates blood glucose – or when the body cannot effectively use the insulin it produces. 

There are three main types of diabetes – type 1, type 2 and gestational diabetes. Type 1 diabetes is an autoimmune condition where your immune system destroys the cells in the pancreas which produce insulin. Outside of family history, the risk factor for this condition is less established than type 2 diabetes and gestational diabetes. 

Type 2 diabetes is the disease’s most common form. It develops due to insulin resistance and relative insulin deficiency. And gestational diabetes is a form of diabetes first diagnosed in the second to third trimester of pregnancy that tends to resolve postpartum. Women with a history of gestational diabetes have a higher risk of up to 50 per cent of progressing to type 2 diabetes in the subsequent five to 10 years. 

There are several risk factors for type 2 diabetes:

• Being diagnosed with pre-diabetes
• Being overweight
• Aged 45 and above 
• A family history of type 2 diabetes 
• History of gestational diabetes 

Pre-diabetes is when your blood glucose level readings are higher than normal, but not high enough to be diagnosed as type 2 diabetes. Once you’re diagnosed as being pre-diabetic, you should make the necessary lifestyle changes – such as exercising regularly and losing weight – to prevent it from developing into type 2 diabetes. It’s a reversible condition, so it’s important to get regular health screenings so you can take early action. 

Diabetes the “silent killer”

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“Symptoms of diabetes only occur in 50% of individuals, typically in those with significantly high glucose levels. Frequent urination and excessive thirst are common symptoms experienced,” says Dr Lim.

Other symptoms experienced by both genders are: 

• Weight loss. 
• Feeling tired and weak. 
• Feeling irritable or having other mood changes. 
• Having blurred vision. 
• Having slow-healing wounds. 
• Increased frequency of infections, such as gum, skin, penile and vaginal infections. 

Dr Lim reveals that women with diabetes may experience more frequent vaginal infections, especially fungal infections. Therefore, you could be predisposed to suffering from yeast infections and urinary tract infections (UTIs). She advises to seek medical attention if in doubt of any symptoms. 

Unfortunately, diabetic women also have an increased risk of heart disease – more than diabetic men. Women with diabetes have almost double the chance of developing heart disease compared with their male counterparts. 

Smart food swaps and more exercise

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It is, therefore, important to lower your diabetes risk as much as you can, so as to avoid further health issues. Dr Lim has the following tips: 

1. Lead a physically active lifestyle and exercise at least 150 minutes per week (approximately 30 minutes per day for five days).
2. Cut out or reduce intake of sugar-sweetened beverages.
3. Maintain a healthy weight. The normal body mass index (BMI) range for Asians would be 18.5- 22.9 kg/m2 [BMI = weight (kg)/ (height (m) x height (m))] 
4. Maintain a healthy diet according to the Health Promotion Board’s My Healthy Plate and avoid taking excessive carbohydrates.  
5. Go for regular health screening for diabetes mellitus especially when you’re above 40 years old.

Dr Lim points out that although there is no best food to reduce the risk of diabetes, there are certain guidelines you can follow to lower your risk. In addition to replacing sugary drinks with water, eat sensibly and have a well-balanced diet consisting of carbohydrates, proteins, fats and fibres. 

As for individuals with diabetes, choosing low glycaemic index carbohydrates – such as swapping white jasmine rice for Basmati rice – will be useful to reduce blood glucose level spikes after meals, she adds.

This article was originally published in Singapore Women's Weekly.