Level of diabetes control correlates with adverse outcomes of COVID-19: experts
It is recommended that persons with diabetes, and associated conditions such as hypertension and heart diseases, take the COVID-19 vaccines as early as possible. These conditions put persons at a higher risk of complications if infected with COVID-19, according to A. Ramachandran, chairman and managing director of Dr. A. Ramachandran’s Diabetes Hospitals (ARH).
Speaking at a webinar on ‘Diabetes Management during COVID-19’ held as a part of The Hindu Wellness Series presented by Diahome and ARH, he said non-COVID-19 medical care was a casualty during the pandemic.
“A large number of patients with chronic diseases such as diabetes, hypertension and heart diseases, who need regular medical care, are suffering due to the pandemic for more than a year. These diseases, especially diabetes, are also age-related and increase the risk of complications and adverse undesirable outcomes in COVID-19 infection,” he said.
It was estimated that about 80% of deaths during COVID-19 were among people with comorbidities such as diabetes, hypertension and heart diseases, he said, adding that their study among 1,000 patients, who were hospitalised for COVID-19 in Chennai, found that mortality was twice as high in diabetics when compared to those without diabetes, and all complications were significantly higher among diabetes patients.
“We also found that the level of control of diabetes was directly correlated with adverse outcomes of COVID-19 infections. Therefore, keeping diabetes under good control during COVID-19 is of utmost importance,” he said.
Nanditha Arun, director and consultant diabetologist, ARH, said higher the HbA1C, which indicates blood glucose level for the three months prior to testing, increases the risk of complications and death due to COVID-19. HbA1C of more than eight indicates poor glycaemic control.
“In previously non-diabetics, there are new manifestations of high glucose that we find in some patients in COVID-19 infections — stress-induced hyperglycaemia and new onset diabetes — which is peculiar,” she said.
As a post COVID-19 recommendation, she said patients with diabetes should check blood glucose regularly, get a good diet plan and start exercise under medical advice.
Arun Raghavan, director and consultant diabetologist, ARH, highlighting the importance of vaccination, said those with diabetes, hypertension and other comorbidities, who were in the high-risk group, should get vaccinated at the earliest.
Elaborating on Diahome (Diabetes Care Comes Home), an app from ARH, he said, it could provide comprehensive diabetes care at home.
New studies show that the COVID-19 virus can attack the pancreas, destroy cells that make insulin, and cause some cases of diabetes
During the spring of 2020, physicians in New York City, the U.S. epicentre of the pandemic at the time, noticed a considerable number of people hospitalized with COVID-19 had too much sugar in their blood, a condition called hyperglycaemia that is a signature feature of diabetes.
“[My colleagues and I] found it very challenging to control the blood glucose level of some COVID-19 patients, even those without a history of diabetes,” says stem cell biologist Shuibing Chen at Weill Cornell Medicine. More surprising, says Chen, was that some patients who did not have diabetes prior to the infection, developed new-onset diabetes after recovering from COVID-19.
The COVID-19 virus, SARS-CoV-2, is best known for wreaking havoc in the lungs and causing acute respiratory distress. But how and why a COVID-19 patient would suddenly develop a chronic disease like diabetes is a mystery, as is the number of people who must then deal with this complication.
A global 2020 analysis led by population health researcher Thirunavukkarasu Sathish at McMaster University in Canada found that nearly 15 percent of severe COVID-19 patients also developed diabetes. But, he admits, “this figure is likely to be higher among high-risk individuals, prediabetes for example. ”Research led by endocrinologist Paolo Fiorina at Harvard Medical School and published in 2021 reported that of 551 patients hospitalized for COVID-19 in Italy, nearly half became hyperglycaemic.
Peter Jackson, a biochemist at the Stanford University School of Medicine, estimates “as many as 30 percent of patients with severe COVID-19 may develop diabetes.”
Intrigued by the startling connection between COVID-19 and diabetes, Chen and Jackson both launched independent investigations to uncover how SARS-CoV-2 might trigger hyperglycaemia. Both groups published their results in the May issue of Cell Metabolism.
“Their findings provide critical insights into the underlying mechanisms by which COVID-19 can lead to the development of new-onset diabetes in infected patients,” says Rita Kalyani, an associate professor of medicine at Johns Hopkins Division of Endocrinology, Diabetes, and Metabolism, who was not involved with either study.
The pancreas is another target of the COVID-19 virus
SARS-CoV-2 affects people in very different ways. Many people experience only minor symptoms, but others develop severe, life-threatening disease. As the pandemic unfolded it became apparent that this virus could spread beyond the lungs and damage other critical organs, including the liver, heart, and kidneys. It also became clear that diabetes and obesity were common risk factors for severe COVID-19.
In an earlier study, Chen’s group grew various types of tissues in the lab and tested which ones were vulnerable to the COVID-19 virus. “Very surprisingly, we found that beta cells of the pancreas are highly permissive to SARS-CoV-2 infection,” says Chen. The pancreas, which lies behind the stomach, is a complex organ composed of numerous types of cells that assist with digestion. It also contains beta cells that make insulin, the hormone that escorts sugar molecules from the blood into the body’s cells where it is used for energy.
But just because a virus can infect cells grown in a dish in the lab doesn’t mean it attacks the body in the same way. To ensure the laboratory observations were a true reflection of what happens in living humans, both the Chen and Jackson teams acquired autopsy samples from patients who succumbed to COVID-19. Both groups detected SARS-CoV-2 in pancreatic beta cells from these deceased patients.
But how, exactly, does a respiratory virus move from the lungs to the pancreas? After patients experience pneumonia, the infection of the lower lung may cause tissue damage that allows the virus to leak from lung alveoli and into the blood vessels, explains Jackson. “Once in circulation, the virus can enter other highly vascularized tissues like the pancreas, brain, and kidney.” Others have speculated that the virus could get into the bloodstream by leaking out of the gut, which may occur in patients lacking healthy intestinal bacteria.
How the virus shuts down insulin production
Both research teams noted that beta cells infected with SARS-CoV-2 stop making insulin. In Jackson’s study, the infected beta cells died via apoptosis, a genetically-programmed autodestruct sequence initiated by injured cells.
Insulin is a hormone that keeps the blood glucose level in check.
Photograph by Klaus Ohlenschlaeger, Alamy Stock Photo
Chen’s group found that infected beta cells underwent a process called transdifferentiation, which means they converted into another type of cell; one that no longer manufactures insulin. It is possible that some infected beta cells undergo transdifferentiation while others self-destruct.
In both cases, the end result is the same: when the COVID-19 virus attacks the pancreatic beta cells, insulin production decreases.
This can lead to type 1 diabetes, which is usually caused by genetic risk factors that spur an autoimmune reaction that attacks and destroys beta cells. Type 1 diabetes is more commonly seen early in life and requires patients to inject insulin every day since their body no longer makes the hormone. Type 1 diabetes also involves an environmental trigger, such as an infection, to initiate the autoimmune reaction.
In contrast, the far more common type 2 diabetes occurs when the body becomes resistant to the insulin it makes. Type 2 diabetes can be managed with changes in diet and exercise, although sometimes medications that enhance insulin sensitivity are needed. Collectively, 34.2 million Americans have diabetes according to a 2020 report issued by the Centres for Disease Control.
The fate of the infected beta cells is important to study further as there may be a way to prevent their destruction in patients with severe COVID-19. Chen’s team surveyed a large panel of chemicals in hopes of finding one that could prevent the transdifferentiation process.
Possible therapies
The survey identified a compound called trans-ISRIB that helped beta cells maintain their identity and their ability to produce insulin when infected with SARS-CoV-2. Trans-ISRIB, which stands for Integrated Stress Response InhiBitor, is a compound discovered in 2013 that is able to prevent a cell’s normal response to stress. Such compounds are being explored as potential therapeutics to prevent widespread apoptosis and damage.
Chen cautions, “Trans-ISRIB is not an FDA-approved drug, so it cannot be used in patients yet. But our studies support the idea that a new drug could be developed to prevent COVID-19 from causing diabetes.” Jackson’s group found that a cellular protein receptor called neuropilin-1 was critical for SARS-CoV-2 to invade beta cells; blocking this receptor keeps them from being infected.
There is also great interest among the broader research community to develop drugs that stop cells from destroying themselves by apoptosis. Experimental compounds called caspase inhibitors, which prevent cell suicide, are being studied by others as potential therapies to ameliorate or prevent severe COVID-19. Unfortunately, caspase inhibitors have not proved a complete success in the clinic despite great promise and interest. Nonetheless, “they might work for short term exposure to limit viral damage,” Jackson says.
Chen adds that SARS-CoV-2 is not the only virus that threatens the pancreas. “Coxsackievirus B, rotavirus, mumps virus, and cytomegalovirus have been shown to infect and damage beta cells. Whether they are a direct cause of type 1 diabetes has been controversial.” More research is needed to determine if it is possible to neutralize the viral attacks on the pancreas, either by blocking infection or preventing the virus from reaching the organ in the first place.
Kalyani stresses that these studies “further underscore the importance of getting vaccinated for COVID-19. Individuals who contract COVID-19, particularly those with prediabetes or other risk factors for diabetes, should let their health care providers know if they develop symptoms of hyperglycaemia such as frequent urination, excessive thirst, blurry vision, or unexplained weight loss."
These new findings emphasize that there is much to learn about COVID-19 and its aftereffects. It seems clear that for some unlucky people, defeating the virus is only the beginning. Additional complications may arise depending on which systems in the body have been damaged in the wake of the viral infection.
Scientists are developing a promising approach for treating type 1 diabetes by using stem cells to create insulin-producing cells (called beta cells) that could replace non-functional pancreatic cells
Type 1 diabetes, which arises when the pancreas doesn't create enough insulin to control levels of glucose in the blood, is a disease that currently has no cure and is difficult for most patients to manage. Scientists at the Salk Institute are developing a promising approach for treating it: using stem cells to create insulin-producing cells (called beta cells) that could replace non-functional pancreatic cells.
In a study published on June 7, 2021, in the journal Nature Communications, the investigators reported that they have developed a new way to create beta cells that is much more efficient than previous methods. Additionally, when these beta cells were tested in a mouse model of type 1 diabetes, the animals' blood sugar was brought under control within about two weeks.
"Stem cells are an extremely promising approach for developing many cell therapies, including better treatments for type 1 diabetes," says Salk Professor Juan Carlos Izpisua Belmonte, the paper's senior author. "This method for manufacturing large numbers of safe and functional beta cells is an important step forward."
In the current work, the investigators started with human pluripotent stem cells (hPSCs). These cells, which can be derived from adult tissues (most often the skin), have the potential to become any kind of cell found in the adult body. Using various growth factors and chemicals, the investigators coaxed hPSCs into beta cells in a stepwise fashion that mimicked pancreatic development.
Producing beta cells from hPSCs in the lab is not new, but in the past the yields of these precious cells have been low. With existing methods, only about 10 to 40 percent of cells become beta cells. By comparison, techniques used to create nerve cells from hPSCs have yields of about 80 percent. Another issue is that if undifferentiated cells are left in the mix, they could eventually turn into another kind cell that would be unwanted.
"In order for beta cell-based treatments to eventually become a viable option for patients, it's important to make these cells easier to manufacture," says co-first author Haisong Liu, a former member of the Belmonte lab. "We need to find a way to optimize the process."
To address the problem, the researchers took a stepwise approach to create beta cells. They identified several chemicals that are important for inducing hPSCs to become more specialized cells. They ultimately identified several cocktails of chemicals that resulted in beta cell yields of up to 80 percent.
They also looked at the ways in which these cells are grown in the lab. "Normally cells are grown on a flat plate, but we allowed them to grow in three dimensions," says co-first author Ronghui Li, a postdoctoral fellow in the Belmonte lab. Growing the cells in this way creates more shared surface area between the cells and allows them to influence each other, just as they would during human development.
After the cells were created, they were transplanted into a mouse model of type 1 diabetes, The model mice had a modified immune system that would not reject transplanted human cells. "We found that within two weeks these mice had a reduction of their high blood sugar level into normal range," says co-first author Hsin-Kai Liao, a staff researcher in the Belmonte lab. "The transplanted hPSC-derived beta cells were biologically functional."
The researchers will continue to study this technique in the lab to further optimize the production of beta cells. More research is needed to assess safety issues before clinical trials can be initiated in humans. The investigators say the methods reported in this paper may also be useful for developing specialized cells to treat other diseases.
A healthy diet plays a key role in the management of diabetes.
If you have this condition, you may wonder whether a vegan diet can help you better manage it. Alternatively, perhaps you follow a vegan diet and have recently been diagnosed with diabetes.
If you’re interested in pursuing or continuing a vegan diet and you have diabetes, it’s essential to understand how to meal plan, shop, and self-monitor to be successful.
Although a vegan diet isn’t the only diet that can help manage diabetes, it is possible to manage the condition while following a vegan diet.
This article provides a guide to the vegan diet for diabetes, its benefits and downsides, and how to succeed on the diet, along with a 3-day sample meal plan.
The vegan diet is completely free of meat, dairy, and animal-based products. Although it can be a nutritious way of eating, it requires careful planning to make sure you’re meeting all of your nutritional needs.
For people with diabetes, following a vegan diet will require an extra layer of planning.
In general, people with diabetes need to keep their carb intake consistent throughout the day, as carbs affect blood sugar levels more significantly than protein and fat.
Meals and snacks should also be balanced with carbs, protein, and healthy fat since including noncarb foods in your meal can help reduce the carbs’ effects on your blood sugar.
All of this can be done using exclusively plant-based foods, although it may be a bit challenging if you’re new to the vegan diet.
Here are some examples of carbs, proteins, and fats that you can use to build meals and snacks if you’re following a vegan diet for diabetes:
Carbs: whole grain flour (bread, pasta), rice, potatoes, oats, grits, quinoa, fruit (fresh, frozen, or unsweetened canned), corn
Proteins: soybeans and soybean products (tofu, tempeh), beans, lentils, peas, peanuts, tree nuts, nut butters, seeds, plant-based meat alternatives
Fortunately, many plant-based foods, such as beans and grains, contain a mixture of carbs, protein, and fat, so they can pull double or triple duty in your meal planning.
Additionally, fibre — a type of indigestible carb — is found in most plant-based foods. Fibre helps make these foods more filling and may also help reduce their blood sugar impact.
Based on the type of diabetes you have, your physical activity level, age, sex, and several other factors, your healthcare team — including a registered dietitian nutritionist (RDN) — can help you pinpoint the optimal amount of carbs you need with each meal.
Summary
The vegan diet contains no meat or animal-derived products. The best way to follow a vegan diet if you have diabetes is to make sure that each meal and snack contains a healthy balance of plant-based protein, carbs, and fat.
Some of the potential, research-backed benefits of a vegan diet for diabetes include improved blood sugar management, insulin sensitivity, and weight management.
Blood sugar management
One 12-week study in 93 Korean people with diabetes compared the effects of a low glycaemic vegan diet and a conventional diet for diabetes. Researchers found that following a vegan diet resulted in slightly improved blood sugar management than following a conventional diet.
Another review noted that diets that emphasized plant-based food intake, including vegan, vegetarian, Mediterranean, and the Dietary Approaches to Stop Hypertension (DASH) diet, tended to reduce haemoglobin A1C by 0.8%.
Your haemoglobin A1C level is a measure of blood sugar management across the previous 3 months, and it’s a good indicator of long-term blood sugar management.
However, these findings aren’t unique to vegan diets. Several other dietary patterns may help improve blood sugar management. Some diets, including low carb or Mediterranean-style diets, have more compelling evidence to support their use for diabetes management.
Insulin sensitivity
Insulin is the key hormone that helps maintain normal glucose levels.
Because type 2 diabetes is characterized by insulin resistance (when cells stop responding to the hormone insulin), increasing insulin sensitivity can help reduce blood sugar and insulin levels, as well as the need for insulin injections among some people with diabetes,
One way researchers measure insulin resistance is called the homeostasis model assessment index for insulin resistance (HOMA-IR).
In one 16-week study among 244 overweight adults, researchers noted that those who switched to a low fat vegan diet had greater decreases in their HOMA-IR than those eating their normal diet, meaning they became more sensitive to insulin.
A similar study in 75 overweight adults noted that a vegan diet significantly reduced HOMA-IR, along with body weight and fat mass, compared with a control diet.
Researchers theorize that animal proteins may contribute more strongly to the development of insulin resistance than plant proteins. However, overall diet quality is likely a greater contributor than animal protein consumption or avoidance.
Weight management
Finally, a vegan diet may be beneficial for people with type 2 diabetes by helping them manage their weight.
Losing weight can help improve insulin sensitivity, and vegan diets tend to be lower in fat and calories than omnivorous diets, which may make it easier to lose weight.
Alongside the improvements in insulin resistance observed in the studies above, researchers also noted that the vegan diet resulted in more body fat and weight loss.
In another 6-month study in 63 overweight adults, researchers noted that those who followed a vegan diet experienced more than double the weight loss of those following less strict plant-based eating patterns like vegetarian, pescatarian, and semi-vegetarian diets.
Summary
There’s some evidence that a vegan diet can help improve blood sugar levels and insulin sensitivity, as well as aid weight loss among people with overweight or obesity.
There are some potential downsides to the vegan diet in general — and particularly for people with diabetes. Fortunately, these downsides are avoidable with careful planning.
Nutrient deficiencies
People who eat vegan diets are at a greater risk of developing certain nutrient deficiencies than other people, particularly deficiencies in vitamin B12, vitamin B6, niacin, iron, calcium, omega-3 fats, iodine, and zinc, which are all more prevalent in animal foods.
However, you can get all of these nutrients by either supplementing or purposefully including plant-based foods that are good sources of these nutrients in your diet.
Here are some examples of vegan sources of these nutrients:
It can also be difficult for people on vegan diets to get enough protein and the right variety of amino acids (the building blocks of protein) to maintain optimal health.
Protein is necessary for creating new bodily tissues, and amino acids play a variety of roles in your health.
Although again, this problem can be solved with a little bit of planning. Great vegan sources of protein include:
Soy: tofu, tempeh, soy nuts, black soybeans, soy milk
In addition, most vegan protein sources are considered incomplete — meaning that, unlike animal protein sources, they don’t contain all of the essential amino acids in the right amounts.
To make sure you’re getting all of the amino acids you need, mix up your protein sources and get your protein from various plant-based sources each day.
Excessive carbs
One final pitfall of the vegan diet that can affect people with diabetes, in particular, is that it’s easy to overdo it on the carbs, which can affect your blood sugar levels.
Plant foods tend to be higher in carbs than animal foods, so a vegan diet will naturally be higher in carbs than an omnivorous diet. If you eat many highly processed vegan foods, it can be easy to eat carbs in excess of what your healthcare team recommends.
While carbs as a whole aren’t unhealthy and can certainly be part of a healthy diet for diabetes, it’s important to moderate your intake to maintain healthy blood sugar levels.
Talk to your healthcare team about the optimal amount of carbs for you.
Summary
Some of the downsides of a vegan diet include an increased risk of certain nutrient deficiencies, the challenge of getting adequate protein, and the potential to eat too many carbs. With planning, all of these downsides are avoidable.
Want to succeed at a vegan diet for diabetes? Here are some tips to help you start strong and stay on track:
Plan ahead. Meal planning and having some healthy snacks on hand will go a long way in helping you succeed. Additionally, make sure to check out the menu in advance when you’re planning to dine out.
Eat plenty of non-starchy veggies. Non-starchy vegetables are very low in carbs but full of fibre and nutrients. They’ll have a minimal effect on your blood sugar while helping you feel full and satisfied.
Balance each meal and snack. Make sure that each meal and snack contains a healthy balance of carbs, fats, and protein, along with some non-starchy vegetables if possible.
Supplement wisely. Vegan diets can be low in certain nutrients so supplementation is typically necessary. To choose the right supplements, have your doctor order a blood test to see if you’re low in nutrients like iron, B12, and vitamin D.
Mix up your proteins. Eat a variety of plant-based protein sources to ensure that you’re getting essential amino acids in the amounts that you need for optimal health.
Monitor your blood sugar regularly. If you have diabetes, even if you’re not on a vegan diet, you should check your blood sugar regularly to stay aware of your blood sugar patterns and notify a healthcare professional if you notice any concerning trends.
Summary
To succeed at a vegan diet with diabetes, make sure to plan, balance each meal and snack, take supplements if necessary, vary your proteins, add lots of non-starchy veggies to your meals, and regularly check your blood sugar levels.
Likewise, here are some pitfalls to avoid when following a vegan diet for diabetes.
Excessive processed food intake
Highly processed foods — including vegan ones — are often loaded with sugar and additives and poor in fibre and protein. The same goes for drinks like sodas and fruit juices.
Although you don’t have to avoid these foods totally, you should limit them, especially if you have trouble managing your blood sugar levels.
Excessive ultra-processed food intake has been linked to weight gain and an increased risk of developing diabetes, high blood pressure, and certain types of cancer.
Low fat and low protein meals
On the same note, you should try to avoid meals or snacks that primarily comprise carbs and contain little protein or fat.
Protein can help reduce carbs’ effect on your blood sugar levels and may help enhance sensations of fullness.
In addition, fat sources like olive oil may provide some additional health benefits like improving heart health and helping boost the absorption of certain nutrients.
Summary
Avoid large amounts of highly processed food, and make sure that your meals and snacks contain a balance of fat, protein, and carbs to promote optimal health on a vegan diet.
It’s possible to help successfully manage your diabetes with a vegan diet. Research shows that vegan diets may help improve blood sugar levels and insulin sensitivity, as well as reduce body weight among overweight people.
However, you’ll need to make sure you’re getting enough of the protein and nutrients you need, avoiding excessive carbs, and not building your diet around highly processed foods.
That said, the vegan diet isn’t the only one that’s research-backed for diabetes. Other diets that are helpful for people with diabetes include the Mediterranean diet and low carb diet.
Regardless, whether you’re new to veganism or veganism is an important part of your life, you can rest assured that you can follow a vegan diet with some careful planning if you have diabetes.
By better understanding the biological underpinnings of different types of fat in the body, scientists hope to uncover new ways to tackle obesity and conditions relating to it. Researchers have now found that increasing levels of a certain protein in brown fat could offer protection against diabetes in at-risk individuals, by altering the behaviour of white fat cells.
White fat is the type of fat that forms love handles and beer bellies, storing most of the body's excess energy in flabby tissues. Brown fat, on the other hand, burns calories to keep the body warm in the cold. There is considerable interest in promoting brown fat formation instead of white fat as a way of helping folks shed weight, but the authors of this new study have focused on how it might also safeguard against the development of type 2 diabetes.
Carried out at the University of Texas Southwestern Medical Centre, the research focuses on a protein called perilipin 5 (PLIN5), which coats lipid droplets inside cells, especially those of the brown fat variety. The scientists explored its role by carrying out experiments on mice that had been genetically engineered to possess high levels of PLIN5 in their brown fat tissue, and observing the effects.
A large percentage of type 2 diabetes is driven by obesity, and the hallmarks of this condition include high blood-sugar levels, a resistance to insulin that helps the body process glucose, and fatty liver disease. The genetically engineered mice showed good signs in all these areas, with significantly lower blood sugar, higher insulin sensitivity and less fatty livers than a control group of mice with regular PLIN5 levels.
Scientists have found that boosting a certain protein in one type of fat cell can lead to healthy changes in another, which could lower the risk of diabetes in vulnerable individuals
Ugreen/Depositphotos
Through further investigations, the team zeroed in on the reasons behind these effects. Part of this related to changes in the mitochondria of the brown fat tissue, which they found had adapted to burn greater amounts of fat at room temperature, as if the animals had been placed in the cold. But the scientists also found that white fat cells in the engineered mice had shrunk in size and showed signs of reduced inflammation, both hallmarks of improved insulin sensitivity and ability to process sugar.
“By taking advantage of this natural system, we may be able to help make fat depots more metabolically healthy and potentially prevent or treat obesity-associated diabetes,” says study leader Perry E. Bickel.
The findings are promising for better understanding how obesity drives type 2 diabetes and similar conditions, and offers a new potential target for treatment. There is still plenty of work to do, however, and not just in trying to translate the results from mice to humans, but understanding how the brown fat confers these downstream changes in white fat. The scientists say one possibility is that it sends some sort of molecular factor through the bloodstream.
“The next question we want to address,” says Bickel, “is what that factor is and whether we can harness it for therapeutic benefit.”
DIABETES arises when the hormone insulin - a regulator for blood sugar - becomes less effective. People with high blood sugar levels are three times more likely to encounter dental issues than those who don't have the condition. What should you look out for?
Excess sugar in the blood results in more sugar in your saliva – the ideal breeding ground for bacteria – explained the charity Diabetes UK. Bacteria produces acid that attacks the tooth enamel and damages the gums. High blood sugar can also damage the blood vessels in the mouth, which can trigger infections. Tooth decay, gum inflammation (i.e. gingivitis), and a dry mouth (xerostomia) can all be linked to high blood sugar levels.
Other dental issues can include:
Periodontitis
Oral thrush
Irritated and sore mouth
Tooth loss
Abscesses
Gingivitis – also known as gum disease
The NHS stated that healthy gums "should be pink, firm and keep your teeth securely in place".
"Your gums should not bleed when you touch or brush them," the NHS added.
Early warning signs of gum disease include:
Red and swollen gums
Bleeding gums after brushing or flossing your teeth
Diabetes type 2 symptoms: Look inside your mouth for signs (Image: Getty)
Left untreated, the tissues and bone that support the teeth can also become affected – this is known as periodontitis.
Periodontitis – the symptoms:
Bad breath (halitosis)
An unpleasant taste in your mouth
Loose teeth that can make eating difficult
Collections of pus that develop under your gums or teeth (i.e. gum abscesses)
The best way to look after your teeth
The NHS recommends brushing twice daily, once before bed, for two minutes.
Do make sure the toothpaste you're using contains around 1,350ppm to 1,500ppm fluoride – this information will be on the side of the toothpaste tube.
As for mouthwash, this is best used at an alternative time (not when you're brushing your teeth).
This is because it washes away the fluoride in the toothpaste – the mineral that helps prevent tooth decay.
The NHS also suggests flossing teeth daily, before brushing your teeth, and to visit the dentist at least once every two years.
Dental treatments such as scale and polish can remove plaque and tartar that has built up on the teeth – this is a "professional clean".
Oral thrush
Adults with oral thrush will have a red mouth that has white patches on it.
If you wipe off the white patches, they can leave red spots that can bleed.
Other symptoms of oral thrush include:
Cracks at the corners of the mouth
Not tasting things properly
An unpleasant taste in the mouth
Pain inside the mouth (for example, a sore tongue or sore gums)
Difficulty eating and drinking
Do note that oral thrush "is not contagious", so it can't be passed on to someone by kissing.
A pharmacist will be able to direct you to the best over-the-shelf treatment for oral thrush.
"If you leave oral thrush untreated, the infection can spread to other parts of the body," the NHS warned.
If you'd like to know whether or not you have diabetes, you need to get a blood test.
Tell your doctor specifically that you would like a blood test that tests for diabetes. Other symptoms of high blood sugar include:
Written by Jon Johnson – Medically reviewed by Susan Bard, MD
Research into psoriasis and diabetes and the connection between them is still ongoing. However, scientists currently believe that inflammation from psoriasis may cause insulin resistance, which can lead to type 2 diabetes.
It is important to treat both conditions and try to prevent potential complications. Making certain lifestyle changes can also sometimes be effective in reducing the risk of comorbidities or minimizing the symptoms of both conditions.
In this article, we discuss the connection between psoriasis and type 2 diabetes, the prevalence of comorbidities, and the treatment options.
Definitions
Psoriasis is a skin condition in which the immune system mistakenly overreacts and attacks healthy tissue, causing skin cells to build up too quickly for the body to shed them. As a result, inflamed raised areas of skin with white or silvery flakes called plaques may appear anywhere on the skin. Psoriasis may also affect other areas of the body, such as the nails and scalp. In some cases, inflammation affects the joints, resulting in psoriatic arthritis.
The medical community defines psoriasis as an autoimmune condition in which the immune system starts working too much in response to certain triggers. Factors that can increase the risk of psoriasis include infections, medications, smoking, and obesity.
Diabetes is a condition that impairs the body’s ability to process blood sugar. There are two main types of diabetes: type 1 and type 2.
In type 1 diabetes, which is also known as juvenile diabetes, the body is unable to produce the hormone insulin because the immune system attacks the cells that carry out this function. In type 2 diabetes, the body either does not produce enough insulin or becomes resistant to it. This is the most common type of diabetes, and it has strong links with obesity.
Link between the two
Evidence indicates a clear link between psoriasis and type 2 diabetes. People with psoriasis have a higher risk of developing several metabolic conditions, including type 2 diabetes.
Researchers are still studying the exact reason for the connection, but evidence suggests that a few factors may play a role.
A 2019 study highlights that psoriasis is associated with systemic inflammation. This includes inflammation in multiple organ systems, which may explain the increased risk of metabolic disorders such as diabetes. The research also indicates that there may be metabolic genetic links between the two conditions.
Another possible link is that psoriasis contributes to diabetes by increasing insulin resistance. A 2018 study on mouse and human skin indicates that skin inflammation from psoriasis can result in insulin resistance, which is a risk factor for type 2 diabetes.
A 2020 study suggests that diabetes and psoriasis also share similar mechanisms that drive disease. Together, the conditions may lead to more cell and tissue damage, creating a vicious cycle.
Both conditions are also associated with similar risk factors, such as obesity, metabolic disorders, cardiovascular disease, and renal disease. The authors of a 2017 article also suggest that psoriasis may actually be an independent risk factor for diabetes.
Prevalence of comorbidity
Diabetes and psoriasis are common comorbidities for each other, meaning that they often both affect the same person. Evidence notes that both conditions are fairly common in the United States, with more than 8 million people having psoriasis and more than 34 million people having diabetes.
Although little information is available on the prevalence of comorbid psoriasis and diabetes, research suggests that the prevalence of type 2 diabetes among people with mild or severe psoriasis is roughly 37.4% and 41%, respectively. This finding indicates that the risk of developing diabetes may increase with the severity of psoriasis.
Treatments
There is currently no cure for either psoriasis or diabetes. Instead, treatments focus on managing the condition.
For psoriasis, treatments aim to reduce symptoms by decreasing inflammation, stopping skin cells from growing as quickly, removing scales, and avoiding potential triggers of flare-ups.
For diabetes, treatments aim to keep blood glucose levels stable and at a healthy level through a combination of diet, exercise, and synthetic insulin.
In people with both conditions or other comorbidities, doctors may adjust the treatment approach to avoid complications. For example, if a particular treatment method for psoriasis will affect another health condition that the person has, doctors may recommend other treatments.
Home remedies
Home remedies, which centre around lifestyle changes, are an important part of managing both psoriasis and diabetes.
Eating a nutritious diet
Along with other health benefits, eating a well-balanced diet can help a person better control their diabetes and prevent potential complications. Likewise, eating well can help lessen the severity of psoriasis symptoms. Certain dietary choices may also help lower the likelihood of comorbidities developing and reduce inflammation in the body.
Exercising regularly
Regular exercise keeps the body healthy, and it may also play a role in helping people manage both diabetes and psoriasis. Regular exercise can reduce stress and boost the immune system, which may help with psoriasis. It may also help with diabetes by keeping blood glucose levels within target ranges.
People can also use regular exercise to help control other risk factors for these disorders. For instance, it can help a person manage their weight.
Maintaining a moderate weight
Steps such as eating a nutritious diet and engaging in regular exercise can also help a person manage their weight. As obesity is a risk factor for both conditions, maintaining a moderate weight is an important step to reduce the risk.
Reducing stress
Stress is a potential trigger for psoriasis flare-ups, and it can also make it difficult for a person to control their blood glucose levels. Therefore, finding ways to reduce stress may help manage these conditions.
The most effective stress management techniques may vary among individuals, but common approaches include:
breathing exercises
meditation
mindfulness
yoga
tai chi
aromatherapy
Other lifestyle adjustments
Other lifestyle adjustments that may benefit health and potentially reduce the symptoms of psoriasis and diabetes include limiting alcohol, stopping smoking, and getting adequate sleep.
A doctor should work with a person who has psoriasis, type 2 diabetes, or both conditions to help them manage and control the symptoms. A person may also benefit from seeing a dermatologist for skin issues or an endocrinologist for a diabetes treatment plan.
Working with primary care doctors and specialists to help control and manage these conditions may increase a person’s quality of life.
Anyone who notices any troubling symptoms or potential complications should consult a doctor.
Summary
Psoriasis and diabetes are common comorbidities for each other, meaning that people with psoriasis are much more likely than other people to develop type 2 diabetes. Both conditions have similar risk factors and involve the immune system and inflammation.
Correctly managing both conditions is important to promote good health and reduce the risk factors for other comorbidities. Through treatments and lifestyle changes, people may be able to control both conditions and prevent potential complications.
