Diabetes and Inflammation: Is There a Link?

So far, researchers have mostly focused on the role of obesity, the gut microbiome, and the pancreatic cells when it comes to diabetes. However, several studies in the recent past have explored the correlation between inflammation and type 2 diabetes.

Chronic inflammation is a risk factor for both type 1 and type 2 diabetes, but it can also be a result of diabetes. Moreover, if left unattended or untreated for long, chronic inflammation, along with diabetes, can lead to a whole host of diseases. These include heart disease, metabolic syndrome, certain autoimmune conditions, neurological issues, and, in extreme cases, even cancer.

Type 1 Diabetes and Inflammation

Studies suggest inflammation plays an important role in developing type 1 diabetes; however, further research is required. Type 1 diabetes is an autoimmune disorder in which the body’s immune system attacks the pancreas and causes inflammation. This inflammation can damage the insulin-producing beta cells in the pancreas and make it difficult for the body to produce insulin. This process is thought to be triggered by a combination of genetic as well as environmental factors, including infections caused by exposure to certain viruses. 

According to a study published in 2017 in the Endocrine Society’s Journal of Clinical Endocrinology and Metabolism, people with type 1 diabetes were found to have inflammation in the digestive tract due to bad gut bacteria.

Type 2 Diabetes and Inflammation

Chronic inflammation can cause insulin resistance, a condition in which the body’s cells become less responsive to insulin. Insulin resistance is a major risk factor for type 2 diabetes. 

Causes of Chronic Inflammation

1. Fat: Excess fat in the body can cause inflammation. Fat cells are known to produce the hormone leptin, which is secreted in our bloodstream. Excess leptin in the bloodstream can promote inflammation. Obese individuals are more prone to this type of inflammation, also known as "metabolic inflammation" or "metaflammation." Metabolic inflammation can lead to insulin resistance, which further leads to type 2 diabetes.

2. High Blood Sugar Levels: Continuously high blood sugar (hyperglycemia) can lead to insulin resistance, which has been termed a pro-inflammatory condition. Insulin resistance affects the endothelial cells, or cells that line the blood vessels. When affected regularly, blood vessels produce damage-causing molecules called free radicals, which in turn cause oxidative stress. In the end, it all leads to inflammation in the blood vessels. Hyperglycemia can also cause the oxidation of free fatty acids, which can lead to inflammation. In addition, high glucose levels can cause plaque buildup around blood vessels. Plus, it can also cause blood clotting.

Excess blood sugar levels can cause weight gain, especially around the abdomen, and lead to immune cell activation. In such cases, tissues begin to secrete large amounts of pro-inflammatory chemicals.

3. Poor Diet: A diet that is high in processed foods, refined carbohydrates, and saturated fats can contribute to inflammation. Alcohol consumption can also cause inflammation.

We need omega-6 and omega-3 fatty acids to survive, but our bodies aren’t capable of producing them on their own, so we have to get them from the food we eat. However, there should be a balance between the intake of omega-6 and omega-3 fatty acids. The ideal consumption ratio between omega-6 and omega-3 should be between 1:1 and 2:1 (Study: Crawford et al., 2003; Lukiw and Bazan, 2008). However, when the ratio goes haywire, especially due to the consumption of ultra-processed foods, it leads to inflammation and ultimately diabetes. In the Standard American Diet, the omega-6 to omega-3 ratio is between 10:1 and 20:1 (Study: Massiera et al., 2010), because it mostly consists of ultra-processed foods.

Consuming large portions of food or consuming food too regularly can lead to both abdominal and whole-body obesity because all that excess glucose is stored in the liver and fat cells. These fat cells release certain chemicals that can lead to inflammation.

4. Lack of Physical Activity: Lack of physical activity leads to an increase in visceral fat. The fat starts settling around important organs like the liver and causing inflammation. This plays havoc with insulin signalling and then leads to chronic inflammation, because of which one feels constantly fatigued and suffers from muscle wasting. Fat accumulating around adipose tissues is also susceptible to inflammation; it can increase cytokine (a small protein) production, which interferes with insulin signalling.

5. Smoking: Smoking is a known cause of inflammation. Nicotine makes the cells less responsive to insulin, and thus glucose uptake becomes difficult for the cells. The glucose thus remains in the bloodstream, leading to increased blood sugar levels and ultimately insulin resistance. Additionally, people who smoke are more at risk for belly fat and type 2 diabetes. Acute exposure to smoke can also lead to tissue damage. It can also suppress the number of eosinophils (a type of white blood cell), which keep the immune system strong.

Smoking increases the level of carbon monoxide in the blood, which can increase the number of inflammatory cytokines. Cytokines are small proteins secreted by the body that affect the growth of all cells responsible for the body’s immune and inflammation responses.

6. Chronic Stress: Stress impacts the hypothalamus-pituitary-adrenal axis (HPA axis) and contributes to inflammation. People whose HPA axis has been impacted are more prone to depression, increased gluconeogenesis, and dyslipidaemia. Managing these health conditions leads to further stress, which can furthermore; impact the HPA axis. Stress also reduces the number of lymphocytes (a type of white blood cell), which are important to keep the immune system healthy, thus putting us at risk of other health conditions.

Reducing Inflammation to Prevent and Manage Diabetes

Several lifestyle changes can help reduce inflammation and lower the risk of diabetes. Here’s what you can do:

• Eat a Healthy Diet: A healthy diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can help reduce inflammation in the body. Let go of ultra-processed foods.
• Exercise Regularly: Regular exercise can help reduce inflammation and improve insulin sensitivity. A brisk 20-minute walk can reduce inflammation. You can also do yoga asanas, bodyweight exercises, squats, push-ups, planks, and even cycling since they are known to reduce inflammation.
• Maintain a Healthy Weight: Losing excess weight by living a more active lifestyle can help reduce inflammation and lower the risk of type 2 diabetes.
• Quit Smoking: Smoking is a known cause of inflammation, and quitting smoking can help reduce the risk of developing diabetes. Take the help of professionals in overcoming nicotine addiction, and also reach out to your family and friends. Also, take regular breaks to relax your nervous system, so that you are not overwhelmed. We often turn to nicotine, alcohol, etc. because they help us relax. If we can relax on our own easily, then we won’t need cigarettes or alcohol.
• Manage Stress: Meditation and being close to nature are great ways of managing stress. Regular interaction with oneself (through journalling) and others gives us a sense of belonging, which reduces stress.

Conclusion 

Inflammation raises the chances of diabetes and other metabolic disorders, while it can also be a result of diabetes. A healthy diet, regular exercise, and managing stress can significantly reduce the risk and severity of inflammation and diabetes.