Those living with lupus have a higher risk of developing diabetes.  Yet, there are many ways to reduce these risks and maintain good health!  What are the risks, what are the signs to look for, and what does it take to successfully manage both lupus and diabetes?  Read on to find out!

 

• Introduction: The 1-minute Overview
• Diabetes Basics
• Lupus and Diabetes
• What can you do?
• In Conclusion: The Takeaways!

 

Introduction: The 1-minute Overview

Lupus and diabetes – each is a chronic, systemic condition that can affect any and all parts of the body.  Not only can each cause a bewildering number of symptoms, but they can interact in complex ways making treatments a challenge.

The good news is that there are a growing number of options for treating both lupus and diabetes – and new therapies are being developed all the time!

Little is known about how these two conditions interact, yet there are some facts to keep in mind:

• As with lupus, there are several types of diabetes.
• Type 1 diabetes is rare, but like lupus, it is an autoimmune condition.
• Type 2 diabetes, also called “adult onset,” is the most common form and develops over time – often occurring after the age of 45.
• Lupus is known to increase a person’s risk for insulin resistance and this can lead to diabetes.
• Studies suggest that patients with lupus have approximately twice the risk of developing diabetes as the general population.
• Chronic use of corticosteroids (prednisone) can also increase insulin resistance as well as weight gain.
• Fortunately, antimalarials, like hydroxychloroquine, seem to reduce the risk of getting type 2 diabetes.
• For those with lupus, it is critical to prevent getting diabetes because it can lead to many other complications such as neuropathy, cardiovascular disease and kidney damage.

If you happen to be pre-diabetic or you feel you are at risk of developing diabetes, there are a tremendous number of things you can do to avoid, as much as possible, the disease and its symptoms.  You can start by learning a bit more about diabetes itself!

Diabetes Basics

Diabetes, also called diabetes mellitus (DM),  is a chronic condition that affects how your body uses sugar – specifically glucose – to keep you alive and healthy.  The problems occur when the body is not able to either produce or effectively use the hormone insulin.

Insulin is produced by the pancreas and secreted into the blood.  It allows the cells of your body to take in glucose and use it as a source of energy.  Glucose is the body’s most important form of chemical energy and is particularly important for the brain.  Without insulin, glucose does not enter the cells; instead, it remains circulating in the blood stream, where it damages small blood vessels and can cause inflammation throughout the body.  This damage is most serious where the capillaries are particularly delicate – the retina of the eyes, in extremities like fingers and toes, and in organs like the kidneys.

Symptoms to look for include:

• Unusually strong feelings of thirst and frequent urination.
• Unusual hunger or weight loss without dieting.
• Ketones (sweet smell) in the urine – produced when muscle and fats are broken down for energy instead of sugars.
• Feeling tired, weak or irritable.
• Sores on the skin that are slow to heal.
• Frequent infections of mouth, gums and vagina.

 

There are 3 main types of diabetes:  Type 1, type 2 and gestational diabetes.

Type 1 diabetes is an autoimmune condition, somewhat like lupus, in that the body attacks itself – specifically the cells of the pancreas that produce insulin.

• In type 1 diabetes, the body can not produce insulin at all.
• Only about 5%-10% of those with diabetes have type 1.
• It is usually diagnosed in children or young adults, but it can occur at any age.
• Symptoms can appear suddenly.
• No one knows how to prevent type 1 diabetes.

 

Type 2 diabetes is the most common form of diabetes and is a growing healthcare concern with diagnoses doubling in the U.S. in the past 20 years.

• It is affects more than 37 million Americans (over 10%) and 450 million people globally, over 6.2% of the world’s population.
• It usually develops in people over 45 years old.
• Being overweight and sedentary increases the risk for developing type 2 diabetes.
• Type 2 diabetes is largely preventable, through diet, exercise and a healthy lifestyle.

 

Gestational diabetes is a temporary form of diabetes that occurs in a woman during pregnancy and usually ends after the baby is born.

• In the United States, between 3% and 8% of pregnant women are diagnosed with gestational diabetes.
• It is caused by hormones produced in pregnancy that make insulin less effective, but rarely has noticeable symptoms.
• It is known to cause premature births and larger than average babies (9 pounds or more).

Lupus and Diabetes

Can lupus affect your risk for diabetes?

Yes. While the relationship between both diseases are still unclear, there are some things we do know:

• Lupus significantly increases a person’s risk for insulin resistance and this can lead to diabetes. This is true even for those with mild or inactive lupus.  Again, lupus may increase your risk of getting diabetes 2 times compared to the general population.
• Overall, 30% of those with lupus have other autoimmune conditions and type 1 diabetes may be one of them.
• Anti-insulin antibodies have been found in patients with lupus, though it is still unclear what this means.
• Both lupus and diabetes can significantly damage the kidneys, making this a top concern. In one study, 33% of patients with lupus and diabetes had measurable kidney damage.
• Researchers in 2022 found that women with lupus were twice as likely to develop gestational diabetes mellitus as those without lupus (2.6% versus 1.5%).

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Can lupus medications affect diabetes?

Yes.  A great deal of research still needs to be done, however:

• Long-term use of corticosteroids (prednisone) has been shown to increase blood glucose as well as increase insulin resistance and the chance for getting diabetes.
• Antimalarials, like hydroxychloroquine (HCQ), may actually reduce the risk of type 2 diabetes. However, chronic use of HCQ can also lead to retinal damage, which can also occur with diabetes.  So, it is important to have your eyes checked frequently.

  

What can you do?

There are many things you can do to either avoid diabetes altogether or lessen its symptoms.  Here is a list of the things to keep in mind, and by the way, these are good ideas for everyone!

1. Eat a healthy diet.
2. Follow your lupus treatment plans.
3. Don’t smoke! Yes, this can be difficult, but it is a simple way to lower your risk of not only getting type 2 diabetes, but also of a host of complications, including:  reduced control of blood sugar, reduced blood flow to extremities, heart disease, stroke, and increased risks of damage to your eyes, nerves, and kidneys.
4. Carefully monitor and control your blood pressure.
5. Drink alcohol responsibly. Alcohol has an effect on the liver and can make blood sugar levels go too high or too low.
6. Stay Fit. Talk with your healthcare provider about safe and healthy exercise routines.
7. Take care of your teeth.
8. Take care of your feet.
9. You may want to consider taking aspirin daily, if you have a history of cardiovascular disease.
10. Keep up-to-date with vaccines.
11. Take care of your eyes and get regular eye exams.

As always, check with your healthcare provider before making significant changes to your diet, exercise or lupus treatment plan!

 

In Conclusion: The Takeaways!

Both lupus and diabetes come in different types and can affect each person in different ways.  If you have lupus and are concerned about your risk for developing diabetes, check with your healthcare provider for advice on maintaining a healthy lifestyle and stick to your lupus treatment plan!  If you develop diabetes, take extra care in observing symptoms, avoid flares and stick to your lupus and diabetes treatment plans!  In particular, take every precaution to avoid kidney damage and cardiovascular disease.

Life with lupus and diabetes can be extremely fatiguing and entail navigating a complex array of medications and changes to your lifestyle.  Yet, it is possible to live very well with both if you take the time to educate yourself … and yes, stick to your treatment plans!

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References

American diabetes association. (2022, November 20). Diabetes symptom, causes and treatment. ADA. https://diabetes.org/diabetes

Chang, Y., Di, W., & Wu, J. (2022). Systemic lupus erythematosus increases the risk of gestational diabetes: Truth or illusion? The Journal of Rehumatology, 49(5), 441-442. https://doi.org/10.3899/jrheum.211374

Chen, Y.-M., Lin, C.-H., Lan, T.-H., Chen, H.-H., Chang, S.-N., Chen, Y.-H., Wang, J.-S., Hung, W.-t., Lan, J.-L., & Chen, D.-Y. (2015). Hydroxychloroquine reduces risk of incident diabetes mellitus in lupus patients in a dose-dependent manner: a population-based cohort study. Rheumatology,, 54(7), 1244-1249. https://doi.org/10.1093/rheumatology/keu451

Cortes, S., Chambers, S., Jerónimo, A., & Isenberg, D. (2008). Diabete mellitus complicating systemic lupus erythematosus – analysis of the UCL lupus cohort and review of the literature. Lupus, 17(11). 977-980. https://doi.org/10.1177/0961203308091539

Gernaat, S., Simard, J.F., Wikström, A.,  Svenungsson, E., &  Arkema, E.V. (2022). Gestational diabetes mellitus risk in pregnant women with systemic lupus erythematosus. The Journal of Rheumatology, 49(5), 465-469. DOI: https://doi.org/10.3899/jrheum.210087

Jiang, M.Y., Hwang, J.C. & Feng, I.J. (2018). Impact of diabetes mellitus on the risk of end-stage renal disease in patients with systemic lupus erythematosus. Scientific Report, 8, Article 6008. https://doi.org/10.1038/s41598-018-24529-2

Kondrateva, L., Popkova, T., Nasonov, E., & Lila, A. (2020). AB0420 risk of developing type 2 diabetes mellitus in patients with systemic lupus erythematosus. Annals of Rheumatic Diseases, 79. Article 1510. https://ard.bmj.com/content/79/Suppl_1/1510.2

Salmasi, S, Sayre, E.C., Aviña-Zubieta, J.A., Esdaile, J.M., & De Vera, M., A. (2020) Adherence to antimalarial therapy and risk of type 2 diabetes mellitus among patients with systemic lupus erythematosus: A population‐based study.  Arthritis Care & Research, 73(5), 702-706. https://doi.org/10.1002/acr.24147

Weiss, G.M. (2018, January 29). Lupus independently increases insulin resistance. Rheumatology network. https://www.rheumatologynetwork.com/view/lupus-independently-increases-insulin-resistance

 

Author: Greg Dardis, MS

Professor Dardis was formerly the Chair of the Science Department at Marylhurst University and is currently an Assistant Professor at Portland State University.  His focus has been human biology and physiology with an interest in autoimmunity.

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