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Asthma and diabetes: Diabetes and asthma: Is there a link?

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Diabetes and asthma: Is there a link?

There is some evidence that diabetes is a risk factor for asthma and vice versa. Some experts suggest that systemic inflammation could play a role in both conditions. Asthma medications may contribute to diabetes, and diabetes may cause changes in the lungs that contribute to asthma.

Asthma is a condition that affects a person’s airways, causing them to close and become inflamed. In diabetes, the body has difficulties maintaining optimal blood sugar levels, causing them to become too high. Although they are both chronic conditions, many people initially assume there is no link between asthma and diabetes.

However, scientists have begun to explore possible links between asthma and diabetes. This article explains the latest research, risk factors, and management strategies for both conditions.

There are two types of diabetes. Type 1 diabetes is an autoimmune condition where the immune system destroys insulin-creating cells. In type 2 diabetes, the body does not produce sufficient insulin or does not react properly to the substance.

Asthma and diabetes may be risk factors for one another. A 2020 study found that siblings of people with asthma had an increased risk of type 1 diabetes and vice versa. Additionally, a 2021 review found an association between asthma and type 2 diabetes.

Scientists are unsure what causes this link. One popular theory suggests systemic inflammation could increase the risk of both conditions. However, diabetes could contribute to asthma, and asthma could contribute to diabetes.

For instance, some researchers suspect that asthma can develop or worsen because of elevated blood sugar or blood-insulin levels in the lungs of people with diabetes. Conversely, steroids are a mainstay of asthma treatment, though they can cause or exacerbate diabetes.

Learn more about diabetes.

According to the American Lung Association, there are several risk factors for asthma. These include:

  • a family history of asthma
  • exposure to air pollution, tobacco smoke, or work-related pollutants
  • smoking
  • allergies
  • viral infections
  • obesity

That said, having risk factors for a condition does not guarantee it will develop.

Learn more about asthma.

According to the Centers for Disease Control and Prevention (CDC), risk factors for type 1 diabetes include:

  • having a close relative with type 1 diabetes
  • being a child, teenager, or young adult
  • being white

There are many more known risk factors for type 2 diabetes. These include:

  • having a close relative with type 1 diabetes
  • having prediabetes
  • being overweight or obese
  • being 45 years of age or older
  • being physically active no more than twice per week
  • having a history of gestational diabetes
  • having given birth to an infant who weighed more than 9 pounds

Race and ethnicity are also relevant to type 2 diabetes. The following groups are at an increased risk of developing this condition:

  • African Americans
  • Hispanic and Latino individuals
  • American Indians
  • Alaska Natives

Scientists also suspect that being a Pacific Islander or an Asian American could also be a risk factor for type 2 diabetes.

Learn more about diabetes risk factors.

Some scientists have concerns that asthma medications could worsen a person’s diabetes.

However, the data on this connection remains unclear.

The 2021 review found evidence that corticosteroids can increase blood sugar levels. They may also disrupt the body’s control over blood sugar levels. Since corticosteroids are crucial for managing asthma, this could complicate treatment for people with both conditions.

On the other hand, a 2020 study found that asthma only affects diabetes when it is severe. The study argues that inhaled steroids do not affect blood sugar levels at low or mild doses. With this in mind, more research into treatment for people with diabetes and asthma is necessary.

The CDC outlines some lifestyle choices that can help with diabetes. Some of these choices could also benefit people with asthma. Individuals can manage diabetes by:

  • maintaining a moderate body weight
  • eating a nutritious diet
  • getting regular exercise

According to the National Institutes of Health (NIH), these measures can positively affect asthma.

Learn about the consequences of a sedentary lifestyle.

Some studies suggest that asthma could increase the risk of type 1 and 2 diabetes and vice versa. This link could be due to systemic inflammation, which may be at the root of both conditions.

Appropriate lifestyle choices help individuals manage both conditions. For instance, obesity may worsen asthma and diabetes, so people may benefit from maintaining a moderate body weight.

Having both diabetes and asthma could cause some challenges. Inhaled corticosteroids are crucial for managing asthma, yet some experts believe they may worsen a person’s diabetes.

Association between Asthma and Type 2 Diabetes Mellitus: Mechanisms and Impact on Asthma Control—A Literature Review

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Bronchial asthma and diabetes mellitus

Bronchial asthma and diabetes mellitus occur against the background of impaired functioning of the immune system. Diabetes mellitus develops as an autoimmune disease with the production of antibodies against the pancreas’ own cells. In bronchial asthma, plant pollen, food, animal hair, bacteria, etc. act as an antigen. The risk of developing asthma in diabetics is higher than in people without autoimmune diseases.

There is also a risk of impaired carbohydrate metabolism for asthmatics using glucocorticosteroids for treatment. With this combination, the development of diabetes as a complication of steroid therapy is less common than osteoporosis or other side effects, but all steroids and a number of other drugs used to treat bronchial asthma worsen the course of existing diabetes, as they increase blood sugar levels.

Patients with asthma who are diagnosed with steroid diabetes usually have severe asthma, which is the reason for the prescription of systemic steroids. Their use in high doses or for a long time leads to obesity. Obesity, in turn, worsens the course of diabetes.

Bronchial asthma in diabetes mellitus occurs more often in the first, insulin-dependent type. There was no association between type 2 diabetes and the incidence of asthma.

For patients with bronchial asthma, a complete cessation of smoking is necessary, since this factor leads to frequent attacks of suffocation and causes circulatory disorders, vasospasm. In diabetes mellitus, in conditions of angiopathy, smoking increases the risk of developing diabetic neuropathy, heart disease, destruction of the glomeruli of the kidneys and kidney failure.

In order to prevent complications of diabetes in the treatment of bronchial asthma, patients are recommended to:

1. Constant monitoring of blood sugar levels and dose adjustment while prescribing glucocorticoids.

2. Follow a diet that limits simple carbohydrates and foods that can cause allergic reactions.

3. It is important to take hypoglycemic agents or inject insulin on time and in the correct dosage.

In addition, some general recommendations should be followed:

1. Every day, walk in the fresh air for about 30 minutes.

2. If your health permits, do breathing exercises.

3. Eat small meals often.

4. In the presence of asthma and diabetes, contact with things that provoke an attack of suffocation should be minimized.

5. Check your blood glucose and blood pressure regularly.

6. Limit salt intake and drink water in moderation. Especially this rule applies to people suffering from diabetic nephropathy and cardiovascular disorders.

7. Control your weight.

8. Dispensary observation at the endocrinologist and pulmonologist, allergist.

The information was prepared by the endocrinologist of the ME “Grodno Regional Endocrinological Dispensary” Petsevich IS

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Long-term use of glucocorticosteroids can cause a special form of diabetes, German doctors warn.

Diabetes mellitus is a disease in which the level of sugar in the blood is constantly at a very high level. In type 1 diabetes, the pancreas does not produce insulin at all or does not produce enough insulin. In type 2 diabetes, the interaction of insulin with tissue cells (insulin resistance) is disrupted, that is, the cells do not perceive the insulin produced by the body. Type 1 and type 2 diabetes, gestational diabetes – these metabolic disorders are well known. However, there are other forms of diabetes that doctors cannot always recognize, informs the German Diabetes Society (DDG). These special forms include, in particular, steroid, or steroid-induced, diabetes mellitus, which, as the name implies, develops as a result of long-term use of cortisone, prednisone and other systemic corticosteroids that are used to treat asthma, autoimmune diseases, various inflammation, including arthritis. These drugs affect the activity of the immune system and reduce inflammation, preventing tissue damage. The higher the dose of corticosteroids and the longer it is taken, the higher the risk of developing steroid diabetes, which, like the more commonly known type 1 and type 2 diabetes, is characterized by elevated blood sugar levels. The risk of developing diabetes mellitus in patients taking chronic corticosteroid hormones is about 1.5–2.5 times higher than the general population (J. Clore, L. Thurby-Hay. Glucocorticoid-Induced Hyperglycemia. – Endocrine Practice, 2009;15(5):469-474 doi: 10.4158/EP08331.RAR).

Patients with obesity, hereditary diabetes, and glycated hemoglobin, or glycohemoglobin HbA1c, (a blood chemistry that measures the average blood sugar over a period of three to four months) greater than 5.7% are at particular risk of developing the disease.

Other risk factors include:

  • age 45+;
  • history of gestational diabetes;
  • impaired glucose tolerance.

People who are at risk of developing diabetes, or who have diabetes, should be careful when taking glucocorticoid drugs.

Steroid hormones and blood sugar

The pancreas produces insulin to keep blood sugar stable. Prednisolone and other corticosteroids can cause a spike in blood sugar levels by inhibiting the production of insulin in the pancreas and at the same time contributing to the development of insulin resistance – the body’s insensitivity to insulin.

How does this happen? When the glucose in food passes from the digestive system into the bloodstream, blood sugar levels rise. Then the pancreas begins to produce the hormone insulin, which promotes the flow of glucose (sugar) into the cells to supply them with energy. Glucose is distributed throughout the cells, and blood sugar levels return to normal.

If the pancreas produces little insulin or the cells do not respond to it, glucose remains in the blood; its level does not decrease to normal levels, but gradually increases.

Corticosteroids act, in particular, on the liver, which is also involved in the production of glucose, reducing the inhibitory effect of insulin on this process. The liver continues to produce glucose, in addition, glucose comes from food, and it accumulates in the body so much that insulin can no longer “force” the cells to take it. This is how insulin resistance occurs. Cells no longer respond to this hormone, even if the body continues to produce it or a diabetic patient injects it. As a result, blood sugar levels do not normalize, but remain consistently high.

This is steroid diabetes. It is similar to type 2 diabetes in that the cells stop responding properly to insulin.

Symptoms of steroid diabetes

  • dry mouth;
  • constant, unquenchable thirst;
  • feeling tired;
  • unexplained weight loss;
  • increased urine production and frequent urination;
  • blurred vision;
  • nausea and vomiting;
  • dry skin, itching;
  • violation of thermoregulation in the hands and feet, tingling, loss of sensation, numbness and burning in the feet and fingers.

Some may not have any symptoms at all, so blood sugar levels should be constantly monitored when taking corticosteroids. If corticosteroids have indeed caused diabetes, the sugar level should usually rise sharply within the first two days after starting therapy. When taking drugs in the morning, it most often rises in the afternoon or evening.

Treatment of steroid diabetes mellitus

Normally, blood sugar levels return to normal within 1-2 days after steroid withdrawal. “This type of diabetes can completely regress if the dose of cortisone or its analogues is gradually reduced,” explains Monika Kellerer, a doctor from Stuttgart, professor, president of the DDG. This is good news because both type 1 and type 2 diabetes are incurable and require constant monitoring. However, some people may develop type 2 diabetes, and then appropriate therapy will be required.

If steroid therapy affects blood sugar levels, it is worth discussing with your doctor about stopping the drugs.