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Need help navigating life with diabetes? You can always Ask D'Mine... Welcome back to our weekly Q&A column, hosted by longtime type 1 and diabetes author Wil Dubois.

Life with diabetes can be complicated enough on its own, but when other health issues referred to as "comorbidities" get thrown into the mix it's even more challenging. Today, Wil tackles an issue that might arise if someone's facing both type 2 diabetes and trouble breathing.

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

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Beckie, type 3 from New Hampshire, writes:My grandma has had type 2 diabetes forever, but keeps her blood sugar pretty OK most of the time. Her doctor told her the time has come where she will need to use oxygen 24-7. Will going on oxygen affect her blood sugars? 

Wil@Ask D’Mine answers: It probably will, so it’s important for her to have extra glucose testing materials on hand, especially for the first week, and she should test like a banshee during that time. But unlike most things that affect our blood glucose, this time, her new therapy is likely to make her sugar go down!

That’s why frequent testing is important. In all probability, her diabetes meds will need to be reduced, and she might even be able to kick one of them to the curb! How on earth is this possible? Well, there are actually two different ways adding oxygen can lower blood sugar in PWDs (people with diabetes), and both are likely to come into play for your grandmother.

First, there’s a fascinating interplay between O2 and insulin resistance. Research on mountain climbers scaling Mt. Everest shows that as oxygen levels decrease, insulin resistance increases. As the climbers come back down, the insulin resistance decreases again. Of course, for type 2s, insulin resistance is the big driver of elevated blood glucose. But what’s this got to do with grandma? Well, as your grandmother has recently been ordered on supplemental oxygen, we can safely infer that she’s been living with short-of-ideal oxygen levels for some time now. Right. Grandma has been standing on top of Everest. At least metaphorically. Now, with her tank and tube she’s back at base camp. Adding oxygen will restore her insulin resistance to some degree, and should lower her blood sugar, all other things being equal.

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It’s a bit off topic, but there’s some interesting new research that suggests that a lack of oxygen on the cellular level may even be one of the triggers in the development of type 2 diabetes in the first place. Apparently, in mice fed a high-fat diet, the excess saturated fatty acids activated a mitochondrial protein in fat cell membranes that caused increased oxygen consumption, which reduced the O2 to the rest of the cell. To compensate, the cells released distress chemokines, resulting in an inflammatory response, which, unchecked, led to insulin resistance, and ultimately to the big D in the little critters. Like I said, a bit off topic, but it just shows how oxygen and glucose are intertwined like the snakes on a caduceus

Hey, wait a second… what about the converse of the Everest effect? If breathing less oxygen raises insulin resistance, would breathing more oxygen lower it? As a matter of fact, yes. For years, wound care specialists have recognized that PWDs receiving hyperbaric oxygen therapy (HBOT) often see blood sugar drops. For type 1s, HBOT is like an insulin bolus dose, with one study showing a whopping 72 mg/dL drop! That same study showed T2s had a 36-point drop. Not a big deal if grandma’s blood sugar is 200, but a real problem if it starts at 90.

What causes this? During HBOT a patient is placed in a chamber pressurized to three times that of sea level, where they breathe 100% oxygen—the purpose being to supersize the O2 to the lungs, oxygenating the bloodstream, which in turn stimulates the release of growth factors and stem cells to speed wound healing. It also apparently increases the activity of insulin receptor sites and decreases insulin resistance. Hmmmm… If all T2s could just live in hyperbaric chambers their diabetes would be a problem of the past! And if you think I was kidding (and I was), apparently there’s some serious research being conducted on using O2 as a diabetes treatment.

Granted, taking a couple of liters of oxygen in your living room isn’t the same has being locked into a pressurized space capsule, but it illustrates the interplay of oxygen and sugar. But HBOT aside, grandma will definitely benefit from the Everest effect, and might possibly get some added benefit of the HBOT action, simply by being kept reliably on the high side of normal oxygen saturation thanks to the supplemental oxygen.

Meanwhile, your grandma’s current lack of proper oxygen “sat” is causing a blood sugar raising effect, separate from the mountain climber insulin resistance, from the simple fact that her body is working harder than it was designed to. Her current lack of proper oxygen places a strain on her system, a physical stressor just as effective at raising blood sugar as illness or chronic pain. By normalizing her oxygen levels, her body won’t be struggling anymore, and this will remove the “stress sugar” and lower her blood glucose just as effectively as any pill in her medicine cabinet.

So going on oxygen will likely decrease your grandmother’s glucose levels. Both by lowering insulin resistance in a biological dance inside her body, and by reducing the physical stressors that can drive blood sugar upward.

It’ll be a double-whammy for grammy. But in a good way, so long as everyone is prepared for it.

 


Will Dubois lives with type 1 diabetes and is the author of five books on the illness, including "Taming The Tiger" and "Beyond Fingersticks." He spent many years helping treat patients at a rural medical center in New Mexico. An aviation enthusiast, Wil lives in Las Vegas, NM, with his wife and son, and one too many cats.


 

 

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. Bottom Line: You still need the guidance and care of a licensed medical professional.