"With women you have to take a closer look"

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Diabetes often develops very differently in men and women. Diabetes researcher and gender medicine specialist Alexandra Kautzky-Willer explains why this is the case and why the disease is often particularly problematic for women.

Prof. Dr. Alexandra Kautzky-Willer

Prof. Dr. Alexandra Kautzky-Willer is a specialist in internal medicine. Since 2010 she has been teaching and researching as a professor for gender medicine at the Medical University of Vienna.

houseofgoldhealthproducts: Prof. Kautzky-Willer, is there such a thing as male and female diabetes?

Yes and no. Basically, of course, it is the same metabolic disease. However, it is often very different for men and women. It starts with the diagnosis.

In what way?

We usually discover diabetes when the values ​​for the fasting blood sugar are too high. Measuring it is routine. In women, however, this value is often still in the normal range, even if they have already developed prediabetes, i.e. a preliminary stage of diabetes - or are even really diabetic.

That’s surprising. Why is that?

Women are naturally more sensitive to inulin. This means that your body's cells respond better to insulin, which in turn makes it easier for sugar to be absorbed from the blood. This is good at first, but it means that you often do not recognize the early stage in them and therefore do not treat them in good time. This is of course quite problematic because it increases the risk of vascular and nerve damage.

And you may miss the time window in which the disease can still be averted by a lifestyle change.

Exactly! Up to 70 percent of patients could normalize their metabolism again at a very early stage - through losing weight, through more exercise, but also through drugs such as metformin. You can do a lot!

What examinations could be used to detect diabetes in women in good time?

A so-called sugar stress test, the so-called glucose tolerance test, would be ideal. But it is time-consuming and time-consuming. Another possibility would be to determine the HBA1c value, which reflects the blood sugar level over a longer period of time. However, increased blood sugar can also be noticed if the measurement is not taken on an empty stomach, but after a meal.

Then women with an increased risk of diabetes should ask their doctor for an appropriate examination?

If there are special risk factors, you have to take a closer look in women, yes. For example, if there are already diabetics in the family or the women are very overweight. A very irregular cycle and early menopause are also associated with a higher risk of diabetes. And in women who had what is known as gestational diabetes, the likelihood of later type 2 diabetes is even extremely high.

Do psychological risk factors also play a different role in men and women?

Stress research is an exciting area in this regard. Apparently, psychosocial stress has a greater impact on the risk of diabetes in women than in men. In part, we can explain this by the fact that women tend to "emotionally eat" more often - in other words, to eat away at frustration - and then gain weight. Men, on the other hand, react more often to stress through exercise - which is of course the better option in terms of health.

But that only partially explains the difference?

In fact, the whole stress system is more sensitive in women than in men. With them, the stress hormone release is activated more strongly. For example, in situations in which you are overwhelmed but do not feel that you can actively shape the situation yourself.

This is typical of subordinate professional positions that women still hold more often than men.

That's right, the socio-economic status of women is not only more often low, it also makes them sick more often.

In principle, however, more men develop diabetes than women.

At least that is the case with us in the West. Men are not only naturally less sensitive to insulin, they also have more liver fat and an unfavorable fat distribution in general.

The famous belly fat that sends inflammatory messengers into the body?

Exactly. In women, the fat pads are more likely to be on the thighs. Above all, the female sex hormone estrogen has a protective effect - at least until menopause. In women, therefore, a lot has to come together before they develop diabetes at all: very overweight, high blood pressure and increased blood lipids. But when they have it then it often harms them more.

And they suffer more often from secondary diseases.

In particular, diabetes has a much greater impact on the condition of the heart and blood vessels in women. The risk of a heart attack in diabetics is very high compared to that of women with healthy metabolism! In men, diabetes plays less of a role, but their risk of heart attack is inherently much higher due to other factors.

Is there an explanation why diabetes is more problematic for women?

We don't really know them yet. But we know that women with diabetes are less likely to achieve target values ​​than male patients. The HBA1c value should be below seven, the blood pressure below 140/90 mmHg - and the cholesterol value should stay below 70. Women are less able to do this.

It always means that women take better care of their health!

It doesn't have to be a lack of commitment. It is also discussed, for example, that women are more often not prescribed the medication they need. Or that the dose may not be adjusted correctly. However, it can also be that women generally respond more poorly to the medication - or that they have more side effects and the women therefore take them less reliably. We just don't know yet.

Can it also play a role that drugs are tested more frequently on men?

That is possible. In the meantime, all drugs have to be tested on both sexes before they can be put on the market. But women are still clearly underrepresented in the studies.

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