Found throughout the body; usually the body’s last choice as an energy source.
In general, what are the processes the body uses to maintain energy, especially glucose?
When a person is not eating or is exercising, the body must draw on its internal energy stored in various places. The major source is glucose, but the body follows several steps in order to obtain this energy:
Glycogenolysis , This is the process that occurs when the body breaks down carbohydrates, or glycogen, into simple glucose molecules.
Lipolysis , This is when the body breaks down fats into glycerol and fatty acids. Gluconeogenesis , This is a multistage process in which amino acids are used to make glucose.
Fatty acids , If there is no gluconeogenesis, the body can break fatty acids down directly to get energy.
What is muscle mass, and can it be affected by diabetes?
Muscle mass is usually interpreted as the amount of skeletal muscle in the human body.
And yes, it can be affected by diabetes.
In particular, people tend to lose muscle mass as they age.
If an older person also has diabetes, he or she tends to lose muscle mass much faster than people without diabetes of the same age.
Because of this, the American Diabetes Association recommends that people with diabetes partake not only in regular aerobic exercise but also in strength training at least twice a week if possible.
In the majority of cases, this will not only help increase muscle mass but also improve the person’s blood glucose levels.
Does muscle mass affect glucose?
There appears to be a link between glucose and muscle mass. In general, in response to insulin, skeletal muscles use glucose in the bloodstream for energy. For some people, this is good news, as it balances the amount of insulin in their system. This is also why exercise is so important to lower the risk of developing diabetes. (For more about exercise and diabetes, see the chapter “Diabetes and Exercise.”)
DIABETES AND TEETH
Can the gums be an indicator of diabetes?
Yes, in some people with diabetes, one of the more insidious and “hidden” signs of the disease is often red, tender, and/or swollen gums. It is estimated that nine out of ten people with gum disease are at high risk for diabetes, compared to six out of ten who do not have gum disease.
What are some signs of gum disease?
One of the first possible signs is called gingivitis, or when the gums become inflamed and sensitive or tend to bleed, especially while a person is brushing the teeth.
Gingivitis is usually caused by the buildup of plaque, or a combination of food, bacteria, and mucus, a mix that attaches to the gums and teeth (it is usually seen as an off-white soft layer, usually at the gum line).
If the teeth are not properly cleaned and the plaque removed, which is why visiting the dentist regularly, especially for a person with diabetes, is necessary, then this plaque can harden into calculus, a hard substance resembling whitish plaster, that can form at and under the gum line.
Calculus can irritate and infect the gums, eventually leading to periodontitis, an irreversible disease that is often thought to account for more tooth loss than dental cavities.
Dental problems are even more important to keep track of when one has diabetes because they can be precursors to even more serious health issues.
Why is it important for a person with diabetes to be aware of tooth pain?
A person with a toothache from tooth decay is most often actually experiencing problems, including infection, with the tooth’s pulp, or the inner structure in which the blood vessels and nerves reside.
When the decaying tooth is exposed to hot or cold foods or drinks, the person usually feels a great deal of tooth pain.
The solution is usually to remove the tooth pulp to stop the infection from reaching the bone that holds the tooth in place (in a procedure called a root canal).
If not caught in time, tooth decay can lead to root decay and also destroy the bone.
If the bone does become involved, then it can cause the tooth to loosen or even abscess (an internal infection usually below the gum line), with the affected tooth needing to be extracted.
For a person with diabetes, keeping track of tooth pain is even more important.
Because diabetics often have higher blood sugar levels, the sugar keeps their immune system from fighting off infections the way it should.
In addition, because high glucose levels tend to narrow blood vessels, the sugar can reduce blood flow, or circulation to the tooth, slowing down healing.
Thus, once such a tooth infection starts, it is often harder for a person with diabetes to fight it off. (For more about diabetes and the immune system, see the chapter “Diabetes and Body Connections.”)
DIABETES AND THE SKIN
What are the major functions of the skin?
The skin is considered the largest organ in the human body. It has several major functions, including:
Hydration , The skin provides protection from both injury (such as cuts or abrasions) and dehydration (water loss). Because the outer skin cells are dead, the skin is waterproof enough to prevent water loss and to prevent water from entering the body when a person is immersed.
Barrier , The skin is a barrier against invasion by bacteria and viruses and is involved in the regulation of body temperature.
Vitamin D , The skin is also the organ responsible for the synthesis of a form of vitamin D. A substance called 7-dehydrocholesterol forms from cholesterol in the wall of our intestines. When the sun’s ultraviolet radiation strikes the surface of the human skin, it causes the 7-dehydrocholesterol that reaches the skin’s surface to form cholecalciferol, or vitamin D-3.
Does the average person’s skin vary in thickness?
Y es, the thickness of a person’s skin varies, depending on where it is found on the body. Skin averages 0.05 inches (1.3 millimeters) in thickness, and most of the body is covered by thin skin, which is 0.003 inches (0.08 millimeters) thick. The thinnest skin is found in the eyelids and is less than 0.002 inches (0.05 millimeters) thick, while the thickest skin is on the upper back (0.2 inches or 5 millimeters).
Touch , The skin contains receptors that receive the sensations of touch, vibration, pain, and temperature. In fact, for many people with diabetes, the skin’s touch is most often affected, as high blood glucose levels can damage the nerves in the skin.
Why should people with diabetes pay particular attention to their skin in the summer?
For a person with diabetes, the summer heat can cause certain problems with the skin.
For anyone, heat can cause more sweating, and moisture can get trapped in the folds of skin or between a person’s toes.
This excessive moisture can cause more of a problem for a person with diabetes, as bacteria feed off the sugar-concentrated skin cells, and this bacteria growth, in turn, can lead to infections.
In addition, dry skin is often a problem in the summer (and sometimes in the winter with dry, inside heat).
If a person’s diabetes is not under control and he or she has too much glucose in the bloodstream, then it is difficult for the body to retain moisture.
When this happens, the skin can become dry and cracked, often leading to infection.
Thus, health care professionals suggest that one of the best ways for a person with diabetes to help his or her skin in the summer (or in any season) is to keep the blood glucose under control. (For more about diabetes and being outdoors, see the chapter “Taking Charge of Diabetes.”)
What is diabetic dermopathy?
Much like age spots, diabetic dermopathy causes light-brown, scaly patches to form on a person’s skin. They are also called “shin spots,” as they most often form on the shins. These spots usually occur in people who have diabetes and are over 50 years old. They have also been associated with heart disease, which means a person with diabetes and such spots should mention the patches to a health care provider.
Is there a connection among psoriasis, obesity, and diabetes?
According to a 2016 Danish twin study (in which all the participants were twins), there seems to be a link among psoriasis, obesity, and diabetes.
Psoriasis is a chronic skin condition in which the skin is inflamed and breaks out in red-and-pink itchy patches.
The researchers looked at the participants’ psoriasis conditions, along with their body mass indexes (or BMI, which usually indicates whether a person is obese or not; for more about BMI, see the chapter “Diabetes and Obesity”) and diagnosis of type 2 diabetes.
The results indicated that there appears to be an association among the three conditions, but the cause of the connection is still unknown.
Some researchers suggest that psoriasis could lead to a sedentary lifestyle (people with the skin condition are often afraid to go out into the public), which can lead to obesity and diabetes.
Another suggestion is that diabetes and obesity could cause skin inflammation, eventually causing psoriasis.
Should people with diabetes use antibacterial soap to clean their skin?
For most people, keeping their skin clean is necessary to fight dirt, grime, and certain bacteria.
In the case of insulin-dependent diabetes (mainly people with type 1) diabetes, keeping the skin clean at an injection site is necessary.
But all skin normally has some type of bacteria, and many of those bacteria help us fight off disease and infection.
Thus, keeping skin clean is good, but not necessarily by using antibacterial soap.
Most health care professionals suggest that using regular soap is enough and that thorough and consistent hand washing is truly what keeps away infection, not antibacterial soap.
Many experts believe the overuse of antibacterial soap may eventually help lead to a proliferation of antibiotic-resistant bacteria.
In fact, in late 2016, the Food and Drug Administration (FDA) banned the use of certain chemicals found in antibacterial soap.
They found data that suggested long-term exposure to certain active ingredients used in antibacterial products, for example, triclosan (liquid soaps) and triclocarban (bar soaps), could pose health risks, such as bacterial resistance or hormonal effects.
Thus, the FDA ruled that over-the-counter consumer antiseptic-wash products containing certain active ingredients can no longer be marketed.
Do certain diabetic medications affect the skin?
Yes. For example, glipizide, a common diabetic medication classed as a sulfonylurea, can make the skin more sensitive to sunlight. Because of this, many dermatologists and other health care professionals suggest that a person with diabetes who is on certain medication similar to glipizide wear sunscreen with an SPF of 30 or higher. Some dermatologists suggest an even higher SPF number, especially if the person is fair skinned.
What skin problems are often experienced by people with diabetes at injection sites?
People with diabetes who rely on insulin injections should watch their injection sites for signs of infection.
But two other common skin problems often accompany injections.
Lipoatrophy and hypertrophy are two main skin problems at insulin-injection sites.
Lipoatrophy occurs when the fatty tissue that lies under the skin essentially sinks, causing dents or dimples in the skin at injection sites (it somewhat resembles cellulite but on a smaller scale).
It is thought that lipoatrophy may be caused by the body’s immune reaction.
In other words, the body believes the insulin is a “foreign” substance, and the immune system responds.
In most cases, the problem does not occur if the person with diabetes is using highly purified insulin and preferably human insulin.
Because certain diabetes medications can make your skin more sensitive to sunlight, protecting skin from the sun is critical. Wear a strong sunscreen when planning to be outdoors during the day for an extended time.