Managing Type 2 Diabetes is much more beyond controlling high blood sugar levels. Uncontrolled blood sugar may lead to other conditions such as heart disease, stroke, kidney disease, eye problems and prolonged or chronic inflammation.What is chronic inflammation?Whenever we get injured, our body's first reaction is inflammation, that is, the injured part becomes swollen, red, hot and painful. Within no time, our body sends an army of white blood cells to the affected area.These cells re-group at the site of inflammation and repair the area by restoring the chemical process. This is referred to as acute inflammation. Acute inflammation is a vital function of the body as it is the body's natural reaction to healing. It fights the infection and repairs an injury. It lasts from a few hours to few days and reduces gradually.Chronic inflammation refers to a prolonged injury in the body and it may last from several months to years. It occurs when the body's immune system fails to eliminate the infection. It may cause damage to a large number of tissues and cells in the body. Chronic inflammation may hamper the body's immunity and may lead to conditions such as Diabetes, heart disease, arthritis, various types of cancers and inflammatory bowel disease. A state of chronic inflammation is like having a fire burning in the body.What causes inflammation?Chronic inflammation can be caused by various factors that may trigger the immune system to respond against an injury. When there is an injury or infection in the body, the white cells in the body release chemicals to heal the affected area. These chemicals when re-group at the affected area, cause redness and swelling. In other words, they cause inflammation. The increased number of inflammatory substances and tissues in the body may cause joint pain, lowered immunity and may affect the functioning of other organs such as heart, lungs, pancreas and kidney.Inflammation and DiabetesMost people with Type 2 Diabetes have central obesity with an excess of visceral fat (fat surrounding abdominal organs). Abdominal fat releases inflammatory substances called cytokines such as Tumour Necrosis Factor alpha (TNF) Interleukin 6, free fatty acids (FFA) and C reactive protein (CRP). These cause insulin resistance, beta cell dysfunction, systemic inflammation and lipid imbalance in the body. Abdominal obesity is associated with low-grade chronic inflammation and increases the risk of heart disease independently of weight and body mass index (BMI). Chronic inflammation is a link between obesity and insulin resistance in people with Type 2 Diabetes. Hence, managing body weight would help maintain the metabolic and immune system and will reduce inflammation..Inflammation and heart diseaseArteries are lined by a smooth inner layer called the endothelium. Due to high blood sugar levels, high blood pressure and lipid imbalance, there is a break in the endothelium. White blood cells then penetrate this endothelium and convert into macrophages which secrete pro- inflammatory substances. Substances such as Tumour Necrosis Factor alpha (TNF), plasminogen activator inhibitor 1 (PAI-1), Interleukin 6 are responsible for chronic inflammation.There are good cytokines like adiponectin and leptin which try to reduce inflammation. Chronic inflammation is a war between good cytokines which prevent inflammation and bad cytokines which increase the fire of inflammation. In Type 2 Diabetes, pro-inflammatory bad cytokines dominate over good anti-inflammatory cytokines. These cytokines are responsible for chronic inflammation and lead to injury of the arterial wall (endothelium) predisposing and accelerating atherosclerosis (plaque build-up in the arteries) and atheroma (degeneration of the arteries walls) which leads to blockages in the blood supply..Inflammation and depressionResearch studies have shown that people who are diagnosed with depression and have high blood sugar levels have more inflammatory cytokines. Chronic depression affects the duration of sleep, causes fatigue and impairs concentration level. This affects the immune system and produces more inflammatory substances in the body. Earlier studies have established a positive link between lack of sleep and insulin resistance. Treating for depression reduces inflammation and also improves blood sugar control in Diabetes.Treating chronic inflammationRole of diet - Research studies have shown that vegetables and fruits are beneficial to the heart. CRP which increases after eating unhealthy food is pro-inflammatory and is harmful. Studies show that a high intake of saturated fat and a low intake of fibre and vitamins are related to the highest CRP levels. Reducing calorie intake leads to weight loss and reduces the level of inflammatory markers in the blood.Role of Nonsteroidal anti-inflammatory Drugs (NSAIDs) - In acute inflammation, NSAIDs are prescribed to people to reduce symptoms like pain and swelling but the role of NSAIDs in chronic inflammation is not proven yet. Aspirin has an antiplatelet effect and a low dose of aspirin is prescribed to prevent heart attacks and strokes in people with Diabetes.Role of Statins - Statins are cholesterol- lowering medications. Apart from reducing cholesterol, statins have a pleiotropic effect to reduce inflammation and prevent heart disease. In people with a risk of heart disease, statins reduce the levels of C- reactive protein (CRP) and pro- inflammatory cytokines in the blood.Role of exercise - Regular exercise is the most potent anti-inflammatory therapy for chronic inflammation. Research studies have shown that regular exercise reduces inflammatory cytokines, a marker of chronic inflammation. As per the American Diabetes Association guidelines, 150 minutes of moderate aerobic activity per week and two days of endurance exercise or strength training per week is recommended in people with Diabetes.To concludePeople with Diabetes not only need to monitor their blood sugar levels closely but they also need to be careful with other factors that may affect their blood sugar management. Managing normal blood pressure and lipid level reduces the risk of inflammation in Diabetes. Along with that, a balanced diet and regular exercise can improve immunity and reduce the risk of complications in Diabetes.Dr Vedavati Purandare is a Consulting Physician and Diabetologist
Managing Type 2 Diabetes is much more beyond controlling high blood sugar levels. Uncontrolled blood sugar may lead to other conditions such as heart disease, stroke, kidney disease, eye problems and prolonged or chronic inflammation.What is chronic inflammation?Whenever we get injured, our body's first reaction is inflammation, that is, the injured part becomes swollen, red, hot and painful. Within no time, our body sends an army of white blood cells to the affected area.These cells re-group at the site of inflammation and repair the area by restoring the chemical process. This is referred to as acute inflammation. Acute inflammation is a vital function of the body as it is the body's natural reaction to healing. It fights the infection and repairs an injury. It lasts from a few hours to few days and reduces gradually.Chronic inflammation refers to a prolonged injury in the body and it may last from several months to years. It occurs when the body's immune system fails to eliminate the infection. It may cause damage to a large number of tissues and cells in the body. Chronic inflammation may hamper the body's immunity and may lead to conditions such as Diabetes, heart disease, arthritis, various types of cancers and inflammatory bowel disease. A state of chronic inflammation is like having a fire burning in the body.What causes inflammation?Chronic inflammation can be caused by various factors that may trigger the immune system to respond against an injury. When there is an injury or infection in the body, the white cells in the body release chemicals to heal the affected area. These chemicals when re-group at the affected area, cause redness and swelling. In other words, they cause inflammation. The increased number of inflammatory substances and tissues in the body may cause joint pain, lowered immunity and may affect the functioning of other organs such as heart, lungs, pancreas and kidney.Inflammation and DiabetesMost people with Type 2 Diabetes have central obesity with an excess of visceral fat (fat surrounding abdominal organs). Abdominal fat releases inflammatory substances called cytokines such as Tumour Necrosis Factor alpha (TNF) Interleukin 6, free fatty acids (FFA) and C reactive protein (CRP). These cause insulin resistance, beta cell dysfunction, systemic inflammation and lipid imbalance in the body. Abdominal obesity is associated with low-grade chronic inflammation and increases the risk of heart disease independently of weight and body mass index (BMI). Chronic inflammation is a link between obesity and insulin resistance in people with Type 2 Diabetes. Hence, managing body weight would help maintain the metabolic and immune system and will reduce inflammation..Inflammation and heart diseaseArteries are lined by a smooth inner layer called the endothelium. Due to high blood sugar levels, high blood pressure and lipid imbalance, there is a break in the endothelium. White blood cells then penetrate this endothelium and convert into macrophages which secrete pro- inflammatory substances. Substances such as Tumour Necrosis Factor alpha (TNF), plasminogen activator inhibitor 1 (PAI-1), Interleukin 6 are responsible for chronic inflammation.There are good cytokines like adiponectin and leptin which try to reduce inflammation. Chronic inflammation is a war between good cytokines which prevent inflammation and bad cytokines which increase the fire of inflammation. In Type 2 Diabetes, pro-inflammatory bad cytokines dominate over good anti-inflammatory cytokines. These cytokines are responsible for chronic inflammation and lead to injury of the arterial wall (endothelium) predisposing and accelerating atherosclerosis (plaque build-up in the arteries) and atheroma (degeneration of the arteries walls) which leads to blockages in the blood supply..Inflammation and depressionResearch studies have shown that people who are diagnosed with depression and have high blood sugar levels have more inflammatory cytokines. Chronic depression affects the duration of sleep, causes fatigue and impairs concentration level. This affects the immune system and produces more inflammatory substances in the body. Earlier studies have established a positive link between lack of sleep and insulin resistance. Treating for depression reduces inflammation and also improves blood sugar control in Diabetes.Treating chronic inflammationRole of diet - Research studies have shown that vegetables and fruits are beneficial to the heart. CRP which increases after eating unhealthy food is pro-inflammatory and is harmful. Studies show that a high intake of saturated fat and a low intake of fibre and vitamins are related to the highest CRP levels. Reducing calorie intake leads to weight loss and reduces the level of inflammatory markers in the blood.Role of Nonsteroidal anti-inflammatory Drugs (NSAIDs) - In acute inflammation, NSAIDs are prescribed to people to reduce symptoms like pain and swelling but the role of NSAIDs in chronic inflammation is not proven yet. Aspirin has an antiplatelet effect and a low dose of aspirin is prescribed to prevent heart attacks and strokes in people with Diabetes.Role of Statins - Statins are cholesterol- lowering medications. Apart from reducing cholesterol, statins have a pleiotropic effect to reduce inflammation and prevent heart disease. In people with a risk of heart disease, statins reduce the levels of C- reactive protein (CRP) and pro- inflammatory cytokines in the blood.Role of exercise - Regular exercise is the most potent anti-inflammatory therapy for chronic inflammation. Research studies have shown that regular exercise reduces inflammatory cytokines, a marker of chronic inflammation. As per the American Diabetes Association guidelines, 150 minutes of moderate aerobic activity per week and two days of endurance exercise or strength training per week is recommended in people with Diabetes.To concludePeople with Diabetes not only need to monitor their blood sugar levels closely but they also need to be careful with other factors that may affect their blood sugar management. Managing normal blood pressure and lipid level reduces the risk of inflammation in Diabetes. Along with that, a balanced diet and regular exercise can improve immunity and reduce the risk of complications in Diabetes.Dr Vedavati Purandare is a Consulting Physician and Diabetologist
