The main common link between diabetes and asthma is obesity. Experts say that obese people are at a higher risk for both diabetes and asthma.
Asthma and diabetes are very common conditions and because of the obesity factor, there are high chances of an individual developing both these conditions, one after the other, says Dr Suranjan Mukherjee, senior consultant, pulmonology, AMRI Hospital, Dhakuria, Kolkata.
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According to ‘Association between Asthma and Type 2 Diabetes Mellitus: Mechanisms and Impact on Asthma Control—A Literature Review’, a 2021 study by Raimeyre Marques Torres, Marcela Dos Santos Souza, et al published in the Canadian Respiratory Journal, obesity seems to be an important contributor for the association between type 2 diabetes and asthma. It further says that asthma can interact synergistically with obesity, increasing circulating levels of inflammatory cytokines and leading to an increased risk of insulin resistance and type 2 diabetes.
Blood sugar and asthma
In a 2019 study, ‘Association Between Prediabetes/Diabetes and Asthma Exacerbations in a Claims-Based Obese Asthma Cohort’, published in the Journal of Allergy and Clinical Immunology: In Practice, researchers Tianshi David Wu, Emily P Brigham and others found that diabetes is associated with higher rates of asthma exacerbation among obese adults with asthma. The study suggests that insulin resistance and metabolic syndrome — metabolic features common in prediabetes or diabetes — can influence asthma morbidity.
Dr Sandeep Reddy, senior endocrinologist, Kamineni Hospital, Hyderabad, however, says there isn’t much direct relation between diabetes and asthma. “But people with diabetes are more prone to respiratory infections due to low immunity, which can lead to increase in asthma attacks,” he says. “It can, in turn, lead to increase in the sugar levels.”
Does diabetes make asthma worse?
Some studies show that diabetes can put one at higher risk of asthma, even independent of obesity, but Dr Mukherjee disagrees. “I don’t think there is any strong evidence that diabetes causes asthma or diabetes predisposes one to asthma,” he says. “It’s difficult to come to any conclusion from those retrospective studies and to talk about the direct correlation between insulin resistance and asthma if you remove the confounding factor of obesity.”
But there is more unanimity on obesity being a major risk factor for asthma. “There are two types of respiratory manifestations,” says Dr Reddy. “One thing is: it will cause obstructive sleep apnea, where you snore at night and are, thus, tired and have headaches during the day. Obstructive sleep apnea can lead to increased cardiovascular problems, stroke and hypertension, and rise in blood glucose levels as well. Obesity can also restrict lung function.”
Diabetes and asthma treatment
Steroids are used for asthma treatment, which can increase a person’s insulin resistance and hence blood sugar levels, say experts. “People with asthma are given systemic steroids,” Dr Mukherjee says. “We inform the person when we treat them that they are being given steroids and their sugar levels will spike. Asthma and diabetes are managed in their own ways. So, again, the stress during an asthma exacerbation, can sometimes cause or worsen that diabetes control.”
Dr Reddy adds, “Anyone who is prediabetic, their condition might progress to diabetes due to use of steroids in the treatment of asthma.”
Due to complications of asthma, one can develop an acute exacerbation or flareup. “If asthma is not controlled, it can develop to permanent lung damage due to COPD, and if the person has diabetes, he can also develop chest infections,” says Dr Reddy. “Chest infections too can trigger an asthma attack.”
What triggers asthma attack
Asthma symptoms include frequent cough and cold, nasal blockage, chest tightness and wheezing. “It can trigger due to dust, pollen, exercise, perfumes, smoke, anxiety or psychiatric disorders,” Dr Mukherjee says.
Asthma can have an early onset or late onset. As it is genetic, one can develop asthma if a family member has the disease. “Asthma is often associated with allergic rhinitis — what’s commonly known as dust allergy — and therefore anyone with dust allergy is more prone to developing asthma in future,” says Dr Mukherjee. “So, treatment of dust allergy is also important to improve asthma control. One should visit the doctor immediately in case of any symptoms.”
Managing diabetes and asthma
“Treatment can get difficult if a person has both diabetes and asthma,” Dr Reddy says. “They might develop sepsis and severe infections.”
Managing diabetes and asthma could also affect one’s quality of life. “If you have recurrent asthma attacks and recurrent infections, that can lead to recurrent hospitalisations and hence loss of pay,” he says. “Infections can cause weakness and one may not be able to do anything.”
Below are some measures a person can take to reduce the risk of asthma:
- Lose weight (if obese)
- Avoid smoking
- Eat healthy
- Maintain a healthy lifestyle
- Ensure a good glycaemic control
- Avoid allergens
- Immunisation through flu and pneumonia vaccines
Recovery after asthma treatment will take time due to low immunity. So, it is important to get an annual flu vaccine and a pneumococcal vaccine to prevent any lung complications.
After 60 years of age, it’s recommended for a person with diabetes to take both flu and pneumococcal vaccines, say experts. “If you have other health complications like heart or kidney issues, it is mandatory for one to take the vaccines,” Dr Reddy says.