Got questions about life with diabetes? So do we! That's why we offer our weekly diabetes advice column, Ask D'Mine, hosted by longtime type 1 Wil Dubois, who is not only a diabetes author but also worked for many years as a diabetes community educator in a New Mexico clinic.

This week, Wil is looking delving deep, so to speak, to answer a question relating to the skin effects of diabetes...

{Got your own questions? Email us at AskDMine@diabetesmine.com}

Centeretha, type 2 from Arkansas, asks: Can your pores close up if you’re diabetic?  

Wil@Ask D’Mine answers: Let’s start by looking at some skin.

Oh, Lord, that didn’t come out quite the way I intended it to…

Starting over: Let’s start by looking closely at a pore. Pores are part and parcel of skin, and skin is complex stuff. It’s considered an organ by the anatomy crowd, and it’s the largest organ in the body—both by surface area and by weight. A typical adult’s skin, should they be unfortunate enough to have it removed, would weigh in at 20 pounds!

Skin is waterproof, heat and cold sensitive, and made up of many layers. It has several jobs. Skin serves as a barrier between our innards and the outside world. It’s tough stuff that does a great job at keeping out everything from germs to chemicals. It plays a key role in temperature regulation of the body via the built-in evaporative swamp cooler called sweat, and skin helps synthesize Vitamin D. Of course, in my personal favorite role, skin is called an “organ of sensation” by scientists—bristling with nerve cells, it keeps us in tune with our world, and, of course, can be deployed for pure pleasure.

The tippity top layer of the skin, that you see a lot of in Sport’s Illustrated swimsuit calendars, is called the epidermis. It’s pretty thin, actually. Much thicker is the next layer down, called the dermis, the area between the skin’s surface and the underlying subcutaneous fat that many of us inject our insulin into. 

Inside the dermis we find a blizzard of complex tiny structures, including sweat glands, hairs, something called sebaceous glands (which we’ll need to talk more about in a moment), miniature muscles, tons of nerves, and small blood vessels to keep all of the above fed and happy.

Now to pores. Pores are “openings” in the skin and there are two kinds: Tiny sweat pores and the larger pores which body hair grows up through. It’s these hair pores that most people think about when we talk about skin pores, and they are the only ones you can see with the naked eye. (You need a microscope to see sweat pores.) I’m told a typical adult has five million of these hair-based skin pores, although you won’t always see the hair growing out of many of them at first glance, as many of the hairs are so fine you can barely see them.

Like the ones on your nose for instance.

Now, these pores are more that just the biological equivalent of the pot the Ficus tree grows in. Remember the sebaceous glands I mentioned a bit ago? These are oil-producing glands that live inside the skin pore. They secrete an oily substance called sebum that travels up the hair shaft and keeps your skin baby soft. It’s nature’s hand lotion.

But wait, there’s more.

Skin pores also serve as garbage chutes that the body uses to get rid of dead cells and they apparently remain open all the time. I like the way Birchbox’s Amary Wiggin describes it: “Your pores don’t open and close like a doggie door.”

So pores don’t close, nor, contrary to miracle skin product ads, do they ever change size. Just like other parts of your anatomy, you are either blessed or cursed with the size nature gave you.

Pores, however, can become blocked. Hello pimples and black heads!

Now, how does our diabetes play into all of this? We all know there are long lists of skin troubles associated with diabetes. Sugar-hungry bacterial and fungal infections. Skin-darkening acanthosis nigricans from high insulin levels in T2s. Dry, itchy skin from hyperglycemia-induced dehydration. Dragon scales from diabetic dermopathy, and on it goes.

But what about the skin pores, specifically? While it turns out that skin pores never technically “close up,” on anybody, ours apparently are affected by our diabetes—but there’s conflicting research on the subject. One study shows that we D-folk have “impaired” sebaceous gland activity, which apparently leads to impaired skin elasticity. That would suggest dry “diabetic” skin isn’t limited to folks with poor control. But not so fast! This is at odds with other research suggesting that high levels of insulin, often seen in T2s like yourself, lead to increased sebum production, and thus an increased risk of acne. 

I guess, just like diabetes, your skin pores will vary.

Speaking of acne, are we more likely to get it than any one else? Given that diabetes seems to interfere with sebum, I would have expected so, but I couldn’t find any statistics to back it up.

Again, there’s nothing I could find about this in the scientific literature, but I would bet that skin pores could be affected by neuropathy. The skin is chock-full of nerves after all, including, one presumes, in the five million skin pores. You can prove that to yourself by tickling your arm hair. Just as the surface of the skin can be deadened by neuropathy, it seems logical that the nerves in the skin pores could be damaged as well, although how that would affect their function I couldn’t even hazard to guess.

So to answer your question: Nope, diabetes can’t cause your skin pores to close up, because, technically, skin pores don’t close on anybody. But it sure looks like your diabetes can wreak havoc with your skin pores in other ways—either increasing your acne risk or interfering with the process that fights dry skin.

But in one final interesting note about diabetes and skin pores, it looks like one of our diabetes medications can help some people with a rare skin pore disease. The type 2 diabetes starter drug, metformin, may help with a rare condition called hidradenitis suppurativa, that is caused by blocked skin pores—both the hair kind and the sweat gland kind.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.