Women with diabetes have more to manage. Stay on track by checking your blood sugar often, eating healthy food, and being active so you can be your healthiest and feel your best.

How is diabetes different for women than it is for men? Diabetes increases the risk of heart disease (the most common diabetes complication) by about four times in women but only about two times in men, and women have worse outcomes after a heart attack. Women are also at higher risk of other diabetes-related complications such as blindness, kidney disease, and depression.

Not only is diabetes different for women, it’s different among women—African American, Hispanic/Latina, American Indian/Alaska Native, and Asian/Pacific Islander women are more likely to have diabetes than white women.

How you manage diabetes may need to change over time depending on what’s happening in your life. Here’s what to expect and what you can do to stay on track.

Diabetes is a disease caused by high levels of blood sugar (glucose) in your body. This can happen when your body does not make insulin or does not use insulin correctly.

Insulin is a hormone made in the pancreas, an organ near your stomach. Insulin helps the glucose from food get into your body's cells for energy. If your body does not make enough insulin, or your body does not use the insulin correctly, the glucose stays and builds up in your blood.

Over time, this extra glucose can lead to prediabetes or diabetes. Diabetes puts you at risk for other serious and life-threatening health problems, such as heart disease, stroke, blindness, and kidney damage.

The three main types of diabetes are:

• Type 1 diabetes. Type 1 diabetes is an autoimmune disease, meaning the body's immune (defense) system attacks and destroys the cells in the pancreas that make insulin. If you have type 1 diabetes, your body does not make insulin, so you must take insulin every day.
• Type 2 diabetes. This is the most common type of diabetes. You can get type 2 diabetes at any age, even during childhood. With type 2 diabetes, your body does not make enough insulin or is not able to use its own insulin correctly. When this happens, blood glucose levels rise.
• Gestational diabetes. Gestational diabetes is a type of diabetes that happens only during pregnancy. Gestational diabetes can cause health problems for the baby and the mother if not controlled. Although gestational diabetes goes away after your baby is born, having diabetes during pregnancy raises your risk for type 2 diabetes later on.

Diabetes affects women and men in almost equal numbers. However, diabetes affects women differently than men.

Compared with men with diabetes, women with diabetes have:

• A higher risk for heart disease. Heart disease is the most common complication of diabetes.
• Lower survival rates and a poorer quality of life after heart attack
• A higher risk for blindness
• A higher risk for depression. Depression, which affects twice as many women as men, also raises the risk for diabetes in women.

Yes. The longer you have type 2 diabetes, the higher your risk for developing serious medical problems from diabetes. Also, if you smoke and have diabetes, you are even more likely to develop serious medical problems from diabetes, compared with people who have diabetes and do not smoke.

The extra glucose in the blood that leads to diabetes can damage your nerves and blood vessels. Nerve damage from diabetes can lead to pain or a permanent loss of feeling in your hands, feet, and other parts of your body.

Blood vessel damage from diabetes can also lead to:

• Heart disease
• Stroke
• Blindness
• Kidney failure
• Leg or foot amputation
• Hearing loss

Women with diabetes are also at higher risk for:

• Problems getting pregnant
• Problems during pregnancy, including possible health problems for you and your baby
• Repeated urinary and vaginal infections

A risk factor is something that puts you at a higher risk for a disease compared to the average person.

Risk factors for type 1 diabetes in women and girls include:

• Age: It often develops in childhood.
• Family health history: Having a parent or brother or sister with type 1 diabetes
• Certain viral infections or illnesses, such as coxsackie virus B (a common cause of hand, foot, and mouth disease), rotavirus (also called stomach flu), and mumps
• Where you live: It is more common in people who live in colder climates.

Risk factors for type 2 diabetes in women and girls include:

• Overweight or obesity: Body mass index (BMI) of 25 or higher for adults. Find out your BMI. Children and teens weighing above the 85th percentile based on their BMI are at risk for type 2 diabetes. Find BMI charts for children and teens.
• Older age: 45 or older. After menopause, women are at higher risk for weight gain, especially more weight around the waist, which raises the risk for type 2 diabetes.
• Family health history: Having a mother, father, brother, or sister with diabetes
• Race/ethnicity: Family background of African-American, American Indian/Alaska Native, Hispanic, Asian-American, and Native Hawaiian/Pacific Islander
• Having a baby that weighed 9 pounds or more at birth
• Having diabetes during pregnancy (gestational diabetes)
• High blood pressure: Taking medicine for high blood pressure or having a blood pressure of 140/90 mmHg or higher. (Both numbers are important. If one or both numbers are usually high, you have high blood pressure.)
• High cholesterol: HDL cholesterol of 35 mg/dL or lower and triglycerides of 250 mg/dL or higher
• Lack of physical activity: Women who are active less than three times a week
• Having polycystic ovary syndrome (PCOS)
• Personal history of heart disease or stroke

If you have any of these risk factors, talk to your doctor about ways to lower your risk for diabetes. You can also take the Diabetes Risk Test and talk about the results with your doctor.

Type 1 diabetes usually develops in children and young adults, but it can happen at any age. It is more common in non-Hispanic whites and non-Hispanic blacks than in Hispanic populations. About 5% of people with diabetes have type 1 diabetes. If you have a parent or sibling with the disease you may be more likely to develop type 1 diabetes.

Type 2 diabetes is more common in adults, especially in people who are 45 and older, have a family history of diabetes, or have overweight or obesity. About 90–95% of people with diabetes have type 2 diabetes. Type 2 diabetes is becoming more common in children and teens, which may be because more of them have overweight and obesity.

Yes. It is more common for certain racial and ethnic groups to have diabetes. This affects women who are:

• American Indian/Alaska Native. American Indian/Alaska Native women have the highest rate of diabetes among all racial and ethnic groups in the United States. It is more than twice as common for American Indian/Alaska Native women to be diagnosed with diabetes compared to white women. But rates of diabetes are different in different regions of the United States. Rates are lowest in Alaska Native people and highest in people who are American Indian and live in certain areas of the Southwest.
• Black. Diabetes is almost twice as common in non-Hispanic black women compared to non-Hispanic white women.
• Hispanic. It is more common for Hispanic women than non-Hispanic white women to be diagnosed with diabetes. Among Hispanic women in the United States, it may be more or less common for women of different heritage groups to be diagnosed with diabetes. For example, Mexican-American women have almost twice the rate of diabetes diagnosis compared to white women. But Cuban-American women have a lower rate compared to white women.
• Asian. Diabetes is the fifth-leading cause of death for Asian or Pacific Islander women in the United States. However, it may be more or less common for women of different Asian heritage groups to be diagnosed with diabetes. One in every 33 Chinese-American women is diagnosed with diabetes compared to 1 in every 10 Asian Indian women. It is also more common for Asian women to develop gestational diabetes compared to white women.

Type 1 diabetes symptoms are usually more severe and may develop suddenly.

Type 2 diabetes may not cause any signs or symptoms at first. Symptoms can develop slowly over time. You may not notice them right away.

Common signs and symptoms of type 1 and type 2 diabetes include:

• Feeling more tired than usual
• Extreme thirst
• Urinating more than usual
• Blurry vision
• Feeling hungrier than usual
• Losing weight without trying
• Sores that are slow to heal
• Dry, itchy skin
• Tingling in the hands or feet
• More infections, such as urinary tract infections and vaginal yeast infections, than usual

Maybe. You should be tested for diabetes if you are between 40 and 70 years old and are overweight or obese. Your doctor may recommend testing earlier than age 40 if you also have other risk factors for diabetes. Also, talk to your doctor about diabetes testing if you have signs or symptoms of diabetes. Your doctor will use a blood test to see if you have diabetes.

If the testing shows that your blood sugar levels are high, you can begin making healthy changes to your eating habits and getting more physical activity to help prevent diabetes.

It’s important to use birth control if you don’t want to become pregnant or if you want to wait until your blood sugar levels are in your target range, since high blood sugar can cause problems during pregnancy for you and your baby. There are many types of birth control methods, including intrauterine devices (IUDs), implants, injections, pills, patches, vaginal rings, and barrier methods like condoms and diaphragms. Choosing the right option for you will depend on whether you have any other medical conditions, current medicines you take, and other factors.

What You Can Do: Talk with your doctor about all your birth control options and risks. Continue checking your blood sugar, track the results, and let your doctor know if your levels go up.

If you know you want to have a baby, planning ahead is really important. Diabetes can make it harder to get pregnant, and high blood sugar can increase your risk for:

• Preeclampsia (high blood pressure)
• Delivery by cesarean section (C-section)
• Miscarriage or stillbirth

A baby’s organs form during the first 2 months of pregnancy, and high blood sugar during that time can cause birth defects. High blood sugar during pregnancy can also increase the chance that your baby could:

• Be born too early
• Weigh too much (making delivery harder)
• Have breathing problems or low blood sugar right after birth

What You Can Do: Work with your health care team to get your blood sugar levels in your target range and establish good habits such as eating healthy and being active. Your blood sugar levels can change quickly, so check them often and adjust your food, activity, and medicine as needed with guidance from your doctor.

Gestational diabetes—high blood sugar during pregnancy—can develop in women who don’t already have diabetes. It affects 2% to 10% of pregnancies in the United States every year. Any woman can have gestational diabetes, but some are at higher risk, including those who are overweight or have obesity, are more than 25 years old, or have a family history of type 2 diabetes. Careful management is important to ensure a healthy pregnancy and healthy baby.

What You Can Do: If you’re diagnosed with gestational diabetes, your doctor will work with you to create a treatment plan to help keep your blood sugar in your target range by eating healthy food in the right amounts and being active most days of the week. You may need diabetes medicine or insulin shots to keep you and your baby healthy.

Gestational diabetes usually goes away after your baby is born. However, about 50% of women with gestational diabetes go on to develop type 2 diabetes. It’s important to get tested for diabetes 4 to 12 weeks after delivery and continue to get tested every 1 to 3 years to make sure your blood sugar levels are in a healthy range. Ask your doctor about participating in the CDC-led National Diabetes Prevention Program, which includes a lifestyle change program scientifically proven to prevent or delay type 2 diabetes in people at risk.

Changes in hormone levels right before and during your period can make blood sugar levels hard to predict. You may also have longer or heavier periods, and food cravings can make managing diabetes harder. You may notice a pattern over time, or you may find that every period is different.

What You Can Do: Check your blood sugar often and keep track of the results to see if there’s a pattern. If you use insulin, you might need to take more in the days before your period. Talk to your doctor about changing your dosage if needed. Being active on most days, eating healthy food in the right amounts, and getting enough sleep can all help too.

After menopause, your body makes less estrogen, which can cause unpredictable ups and downs in blood sugar. You may gain weight, which increases your need for insulin or other diabetes medicines. Hot flashes and night sweats may disrupt your sleep, making managing blood sugar harder. This is also a time when sexual problems can occur, such as vaginal dryness or nerve damage.

What You Can Do: Ask your doctor about ways you can manage menopause symptoms. If your blood sugar levels have changed, you may need to change the dosage of any diabetes medicines you’re taking. Heart disease risk goes up after menopause, so make heart-healthy choices that also help manage your diabetes, such as eating healthy food and being active.

What is diabetes?

Diabetes is a disorder of metabolism, a term that describes the way our bodies chemically change the foods we eat into growth and energy. After we digest food, glucose (sugar) enters the bloodstream, where it is used by the cells for energy. For glucose to get into the cells, insulin must be present.

Insulin is a hormone produced by the pancreas, an organ located behind the stomach. It is responsible for moving glucose from the bloodstream into the cells to provide energy needed for daily life. In people with diabetes, the body produces too little or no insulin or it does not respond properly to the insulin that is produced.

• In type 1 diabetes, the body produces little or no insulin. This form of the disease typically appears in children and young adults, but it can develop at any age.
• In type 2 diabetes, the body produces insulin but not enough, and the body does not respond properly to the insulin that is produced. This form of the disease is more common in people who are older, overweight, and inactive.

What is osteoporosis?

Osteoporosis is a condition in which the bones become less dense and more likely to fracture. Fractures from osteoporosis can result in pain and disability. In the United States, more than 53 million people either already have osteoporosis or are at high risk due to low bone mass.

Risk factors for developing osteoporosis include:

• Being thin or having a small frame.
• Having a family history of the disease.
• For women, being postmenopausal, having an early menopause, or not having menstrual periods (amenorrhea).
• Using certain medications, such as glucocorticoids.
• Not getting enough calcium.
• Not getting enough physical activity.
• Smoking.
• Drinking too much alcohol.

Osteoporosis is a disease that often can be prevented. If undetected, it can progress for many years without symptoms until a fracture occurs.

The diabetes–osteoporosis link

People with diabetes, particularly type 1 diabetes, often have poorer bone quality and an increased risk of fractures. Those with long-standing disease and poor blood sugar control, and who take insulin have the highest fracture risk.

The onset of type 1 diabetes typically occurs at a young age when bone mass is still increasing. It is possible that people with type 1 diabetes achieve lower peak bone mass, the maximum strength and density that bones reach. People usually reach their peak bone mass in their 20s. Low peak bone mass can increase one’s risk of developing osteoporosis later in life.

Some of the complications of diabetes, such as nerve damage, muscle weakness, episodes of low blood sugar, and vision problems can increase the risk of falls and fractures.

Osteoporosis management strategies

Strategies to prevent and treat osteoporosis in people with diabetes are the same as for those without diabetes.

Nutrition. A diet rich in calcium and vitamin D is important for healthy bones. Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Many low-fat and low-sugar sources of calcium are available. Also, supplements can help you meet the daily requirements of calcium and other important nutrients.

Vitamin D plays an important role in calcium absorption and bone health. It is synthesized in the skin through exposure to sunlight. Although many people are able to obtain enough vitamin D naturally, older individuals are often deficient in this vitamin due, in part, to limited time spent outdoors. They may require vitamin D supplements to ensure an adequate daily intake.

Exercise. Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best exercises for your bones are weight-bearing and resistance exercise. Weight-bearing exercises force you to work against gravity. They include walking, stair climbing, and dancing. Resistance exercises – such as lifting weights – can also strengthen bones. Regular exercise can help prevent bone loss and, by enhancing balance and flexibility, reduce the likelihood of falling and breaking a bone. Exercise is especially important for people with diabetes since exercise helps insulin lower blood glucose levels.

Healthy lifestyle. Smoking is bad for bones as well as for the heart and lungs. Women who smoke tend to go through menopause earlier, triggering earlier bone loss. In addition, people who smoke may absorb less calcium from their diets. Alcohol can also negatively affect bone health. People who drink heavily are more prone to bone loss and fracture because of poor nutrition as well as an increased risk of falling. Avoiding smoking and alcohol can also help with managing diabetes.

Bone density test. Specialized tests known as bone mineral density (BMD) tests measure bone density in various parts of the body. These tests can detect osteoporosis before a bone fracture occurs and predict a person’s chances of fracturing in the future. It can measure bone density at your hip and spine. People with diabetes should talk to their doctors about whether they might be candidates for a bone density test.

Medication. Like diabetes, there is no cure for osteoporosis. However, several medications are approved by the U.S. Food and Drug Administration for the prevention and treatment of osteoporosis in postmenopausal women and men. Medications are also approved for use in both women and men with glucocorticoid-induced osteoporosis.

Ever heard of polycystic ovary syndrome (PCOS)? If you’re a woman who has had trouble getting pregnant, you might have. Just about everyone else? Probably not.

What is PCOS?

PCOS is one of the most common causes of female infertility, affecting 6% to 12% (as many as 5 million) of US women of reproductive age. But it’s a lot more than that. PCOS is a lifelong health condition that continues far beyond the child-bearing years.

Women with PCOS are often insulin resistant; their bodies can make insulin but can’t use it effectively, increasing their risk for type 2 diabetes. Women with PCOS have higher levels of androgens (male hormones that females also have), which can stop eggs from being released (ovulation) and cause irregular periods, acne, thinning scalp hair, and excess hair growth on the face and body.

Women with PCOS can develop serious health problems, especially if they are overweight:

• Diabetes—more than half of women with PCOS develop type 2 diabetes by age 40
• Gestational diabetes (diabetes when pregnant)—which puts the pregnancy and baby at risk and can lead to type 2 diabetes later in life for both mother and child
• Heart disease—women with PCOS are at higher risk, and risk increases with age
• High blood pressure—which can damage the heart, brain, and kidneys
• High LDL (“bad”) cholesterol and low HDL (“good”) cholesterol—increasing the risk for heart disease
• Sleep apnea—a disorder that causes breathing to stop during sleep and raises the risk for heart disease and type 2 diabetes
• Stroke—plaque (cholesterol and white blood cells) clogging blood vessels can lead to blood clots that in turn can cause a stroke

PCOS is also linked to depression and anxiety, though the connection is not fully understood.

What Causes PCOS?

The exact causes of PCOS aren’t known at this time, but androgen levels that are higher than normal play an important part. Excess weight and family history—which are in turn related to insulin resistance—can also contribute to PCOS.

Weight…

Does being overweight cause PCOS? Does PCOS make you overweight? The relationship is complicated and not well understood. Being overweight is associated with PCOS, but many women of normal weight have PCOS, and many overweight women don’t.

Family History…

PCOS tends to run in families. Women whose mother or sister has PCOS or type 2 diabetes are more likely to develop PCOS.

…and Insulin Resistance

Lifestyle can have a big impact on insulin resistance, especially if a woman is overweight because of an unhealthy diet and lack of physical activity. Insulin resistance also runs in families. Losing weight will often help improve symptoms no matter what caused the insulin resistance.

Do You Have PCOS?

Sometimes PCOS symptoms are clear, and sometimes they’re less obvious. You may visit a dermatologist (skin doctor) for acne, hair growth, or darkening of the skin in body creases and folds such as the back of the neck (acanthosis nigricans), a gynecologist (doctor who treats medical conditions that affect women and female reproductive organs) for irregular monthly periods, and your family doctor for weight gain, not realizing these symptoms are all part of PCOS. Some women with PCOS will have just one symptom; others will have them all. Women of every race and ethnicity can have PCOS.

It’s common for women to find out they have PCOS when they have trouble getting pregnant, but it often begins soon after the first menstrual period, as young as age 11 or 12. It can also develop in the 20s or 30s.

To determine if you have PCOS, your doctor will check that you have at least 2 of these 3 symptoms:

1. Irregular periods or no periods, caused from lack of ovulation
2. Higher than normal levels of male hormones that may result in excess hair on the face and body, acne, or thinning scalp hair
3. Multiple small cysts on the ovaries

Just having ovarian cysts isn’t enough for a PCOS diagnosis. Lots of women without PCOS have cysts on their ovaries and lots of women with PCOS don’t have cysts.

Treatment for PCOS

See your health care provider if you have irregular monthly periods, are having trouble getting pregnant, or have excess acne or hair growth. If you’re told you have PCOS, ask about getting tested for type 2 diabetes and how to manage the condition if you have it. Making healthy changes such as losing weight if you’re overweight and increasing physical activity can lower your risk for type 2 diabetes, help you better manage diabetes, and prevent or delay other health problems.

There are also medicines that can help you ovulate, as well as reduce acne and hair growth. Make sure to talk with your health care provider about all your treatment options.

Diabetes can lower your interest in sex and your ability to enjoy it. For some women, vaginal dryness can make intercourse uncomfortable or even painful. Causes can include nerve damage, reduced blood flow, medications, and hormonal changes, including those during pregnancy or menopause.

What You Can Do: Be sure to talk to your doctor if you’re having any sexual issues. He or she can let you know your options, from using vaginal lubricants to doing exercises that can increase sexual response.

Many women will get a vaginal yeast infection at some point, but women with diabetes are at higher risk especially if their blood sugar levels are high.

More than 50% of women will get a urinary tract infection (UTI) in their lifetime, and your risk may be higher if you have diabetes. Causes include high blood sugar levels and poor circulation (which reduces your body’s ability to fight infections). Also, some women have bladders that don’t empty all the way because of diabetes, creating a perfect environment for bacteria to grow.

What You Can Do: To prevent yeast infections and UTIs, keep your blood sugar levels as close to your target range as possible. Other ways to prevent UTIs: drink lots of water, wear cotton underwear, and urinate often instead of waiting until your bladder is full.

There’s a lot to do to manage diabetes, from daily care you do yourself to lab tests and visits with your health care team.

Use this list to stay on schedule with self-checks, exams, and appointments throughout the year.

Got questions about everyday diabetes care? Ask your doctor about a referral for diabetes self-management education and support (DSMES) services. If you already have a referral, find a diabetes care and education specialist.

Every Day

• Blood sugar checks
  Check up to several times a day as directed by your doctor. Keep a record of your numbers and share with your health care team during your next visit.

• Foot check
  Use a mirror if you can’t see the bottom of your feet or ask a family member for help. Let your doctor know immediately if you have any cuts, redness, swelling, sores, blisters, corns, calluses, or other change to the skin or nails.

• Diabetes medicines
  Take the amount prescribed by your doctor, even when you feel good.

• Physical activity
  Get at least 150 minutes a week of moderate activity, such as brisk walking or riding a bike.

• Healthy eating
  Eat healthy foods that give you the nutrition you need and help your blood sugar stay in your target range.

Every 3 Months

• A1C test
  If your treatment has changed or if you’re having trouble meeting your blood sugar goals, have this test every 3 months.

• Doctor visit
  If you’re having trouble meeting your treatment goals, visit your doctor every 3 months. Your blood pressure and weight will be checked, and your self-care plan and medicines will be reviewed. Ask your doctor to check your feet if you’ve ever had diabetes-related foot problems.

Every 6 Months

• Dental exam
  Get your teeth and gums cleaned at least once a year (more often if your doctor recommends), and let your dentist know that you have diabetes.

• A1C test
  If you’re meeting your treatment and blood sugar goals, have this test every 6 months.

• Doctor visit
  If you’re meeting your treatment goals, visit your doctor every 6 months. Your blood pressure and weight will be checked, and your self-care plan and medicines will be reviewed. Ask your doctor to check your feet if you’ve ever had diabetes-related foot problems.

Every Year

• Flu shot

• Kidney tests

• Cholesterol test

• Dilated eye exam
  You may need this exam more often if you have diabetes-related eye problems.

• Hearing check

• Complete foot check
  You may need this foot check more often if you have ever had diabetes-related foot problems.

Just Once

• Pneumonia shot
  Get a pneumonia shot as an adult before you’re 65 (you’ll need two more doses when you’re 65 or older).

• Hepatitis B shot
  Get a hepatitis B shot if you’re 60 or younger and haven’t had the shot before. Talk to your doctor about getting the shot if you’re over 60.

As Needed

• Mental health check
  Let your doctor know right away if you’re feeling sad or hopeless so you can get help.

• New symptoms or health problems
  If you notice new health problems or if existing problems are getting worse, call your doctor immediately so you can be evaluated.