Diabetes: A Serious Problem for the Brain
A mountain of evidence amassed by scientific researchers attests to the damaging effects of diabetes on the brain. But the precursors of diabetes—insulin resistance and prediabetes— also take a toll. If not carefully controlled, diabetes and its precursors can increase risk for health problems such as stroke, heart attack, and kidney disease, as well as cerebral changes that, over time, increase the risk of mental deterioration.
“Insulin, a hormone secreted by the pancreas, regulates the amount of glucose in the bloodstream that is available to fuel cellular activities,” explains Enrico Cagliero, MD, an endocrinologist and researcher at MGH’s Diabetes Unit and an Associate Professor of Medicine at Harvard Medical School.
Abnormal glucose (or blood sugar)levels associated with diabetes, insulin resistance (in which the body stops responding normally to insulin) and prediabetes (characterized by abnormally high levels of insulin and glucose) are linked with increased risk for depression, negative changes in cerebral blood vessels, problems with memory formation, attention, information processing, and executive function (such as planning and decision-making), and dementia.
“Moreover, type 2 diabetes is associated with high blood pressure, abnormal lipids, and other physical problems that may damage brain health,” Dr. Cagliero adds. “We’re waking up to the fact that insulin abnormalities and diabetes are a major problem for the brain. However, the good news is that lifestyle changes and treatment with medications are often effective in restoring normal glucose and insulin levels and preventing many of these serious consequences.”
WHAT YOU CAN DO
See your doctor if you develop the symptoms listed below. They may be indications that blood sugar levels are high.
- Increased urination
- Thirst
- Weight loss
- Fatigue
- Changes in
vision - Muscle cramps
- Moodiness; problems concentrating
- Numbness/ tingling of hands and feet
- Opportunistic infections, such as yeast infections.
Dodging Diabetes Damage
Dr. Cagliero suggests the following strategies to help prevent brain injury associated with insulin abnormalities:
- Have regular medical checkups. In wellness exams, ask your doctor to test your fasting blood sugar levels and your cholesterol levels for signs of metabolic problems.
- Take your medications. If you are diagnosed with diabetes, take your medications as prescribed and closely track your glucose levels. Know the signs of hypoglycemia, or low blood sugar, since repeated incidents may cause injury to the brain.
- Exercise regularly. Exercise helps make body cells more sensitive to insulin. Try to get about 30 minutes a day of brisk exercise at least five days a week.
- Get adequate sleep. Too little sleep can raise insulin levels and lead to weight gain and insulin resistance. Seven to eight hours a night are considered to be adequate for most people.
- Eat a healthy diet. Consume a diet with plenty of whole grains, fresh fruits and vegetables, fish, and low-fat dairy products and meats. Avoid saturated and trans fats as much as possible, along with sweets, syrups and refined grains that can boost blood sugar levels. Get plenty of fiber to help lower insulin and cholesterol levels. Watch your calories.
- Maintain a healthy weight. Excess body fat can increase your risk for insulin resistance, prediabetes, and type 2 diabetes.
- Seek treatment for depression. Studies show that depression and diabetes are often interrelated, and that treating the mood disorder can lead to improvements in diabetic symptoms.
Lifestyle Changes Work
In a study published March 29, 2016 in Diabetes Care, researchers compared a control group of overweight older adults with type 2 diabetes who received standard care with a similar group who received counseling and diet and exercise support. After 10 years, brain scans revealed that the diet and exercise participants—who limited dietary fats and proteins, exercised at least 175 minutes per week, and lost an average of seven percent of their body weight—had larger volumes of brain tissue and smaller areas of diseased white matter than the control group. Both brain atrophy and white matter disease are linked to cognitive decline.
“This research is good news because it supports earlier findings that lifestyle interventions can help limit diabetes-related brain changes,” says Dr. Cagliero. “Over the past decade or so, lifestyle changes and effective treatments have succeeded in lowering average blood sugar levels among people who have been diagnosed with the disease, and the incidence of stroke, heart attack, and kidney disease has declined as well.
“That means that by taking steps to lead a healthier life, individuals with glucose and insulin abnormalities or diabetes can stay mentally alert and protect their brain. It’s possible to avoid problems if you follow your doctor’s advice.”
Brain Effects of Insulin and Glucose Abnormalities
- Damage to cerebral blood vessels leading to blockage or reduced blood flow that may starve brain tissue of oxygen and nutrients, impairing function and promoting brain atrophy. Risk for stroke and cognitive decline may be significantly increased.
- Pro-inflammatory processes, which have been implicated in increased formation of plaques and tangles associated with Alzheimer’s disease (AD), and the generation of unstable oxygen molecules called free radicals that can damage neurons.
- Increased accumulation of beta-amyloid plaque, a key characteristic of AD. Both insulin and amyloid plaque are degraded by the same enzyme, insulin degrading enzyme (IDE). The competition for IDE from higher levels of insulin is thought to be involved in greater accumulation of toxic beta-amyloid in the brain.
- Excessive levels of the stress-related hormone corticosterone. Chronic exposure to high levels of stress hormones is linked to memory and learning problems.
- Slowed executive functioning and speed of response. Tests show that people with diabetes may be more likely to have trouble with executive functions such as working with new information to solve problems, focusing, or giving thoughtful answers to questions, and may be slower to respond to mental challenges.
- Increased risk of AD. A number of studies suggest that people with type 2 diabetes, and even borderline diabetes, are at greater risk than people without insulin problems to develop AD.
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