Key Takeaways

  • Diabetes significantly impacts respiratory health, increasing the risk of conditions like COPD, asthma, lung cancer, and pulmonary fibrosis.
  • Respiratory dysfunction is more common in individuals with diabetes than those without.
  • COPD and diabetes are frequently coexistent, sharing risk factors and physiological changes.
  • Type 2 diabetes can lead to airway hyperresponsiveness and a higher incidence of asthma symptoms.
  • Over 50% of people with type 2 diabetes have obstructive sleep apnea (OSA).
  • Diabetes may accelerate the growth and spread of lung cancer due to oxidative stress caused by high blood sugar levels.
  • Diabetic individuals are more prone to severe respiratory infections, partly due to weakened immune systems.
  • Proper management of diabetes is crucial in preventing lung complications.
  • Lifestyle changes, such as quitting smoking, maintaining a healthy diet, and regular exercise, are essential in mitigating respiratory risks associated with diabetes.
  • Vaccinations play a key role in protecting diabetic individuals from respiratory infections.

Diabetes is a complex, chronic condition known to affect the body’s ability to regulate blood sugars. There are several consequences of prolonged high blood sugar levels, including nerve damage, cardiovascular problems, hearing and vision issues, and respiratory complications. In terms of respiratory conditions, diabetes is linked to things like chronic obstructive pulmonary disease (COPD), asthma, lung cancer, and more. This article will discuss how diabetes is correlated to these diseases and what you can do to prevent them.

How does diabetes affect the respiratory system?

While diabetes has commonly known effects across an array of bodily systems, one of the lesser-known complications involves the respiratory system. Respiratory dysfunction occurs more frequently in individuals with diabetes than in those without. Such respiratory conditions that have been associated with diabetes include:

  • COPD
  • Asthma
  • Lung cancer
  • Pulmonary fibrosis (lung scarring)
  • Dyspnea (shortness of breath)

These conditions can not only impact one’s overall quality of life but also one’s survival when considering conditions such as lung cancer. But, how exactly does blood sugar imbalance contribute to breathing issues? There are several pathophysiologic mechanisms by which diabetes can contribute to lung dysfunction. However, these mechanisms are different depending on the disease at hand. Let’s review some common respiratory conditions that result from diabetes and how exactly these come to be.

Chronic obstructive pulmonary disease

COPD, or chronic obstructive pulmonary disease, encapsulates several conditions that block or disturb the airway and breathing. Such conditions include chronic bronchitis and emphysema. COPD affects up to 16 million individuals in the US, causing symptoms such as shortness of breath, coughing, wheezing, excess phlegm, and difficulties taking deep breaths. COPD is both preventable and treatable, however, there is no cure.

COPD and diabetes have been linked, as they frequently coexist. However, how diabetes impacts lung function is not yet clear to researchers, although they share various risk factors and physiological changes. Experts hypothesize that individuals with COPD have increased inflammation, which may contribute to getting diabetes. On the contrary, however, having diabetes alone does not increase one’s chances of developing COPD.

Asthma

Asthma is a condition affecting the lungs, characterized by wheezing, chest tightness, coughing, and breathlessness episodes. This is due to the inflammation and narrowing of the lungs, making it difficult for air to flow in and out. It is a very common condition, affecting about one in 13 individuals in the US. It commonly starts in childhood and can be exacerbated by triggers such as allergies, weather, infections, and physical activity.

So, is diabetes linked to asthma? Type 2 diabetes can lead to airway hyperresponsiveness. Insulin resistance, one of the major mechanisms underlying diabetes, is also linked to a higher incidence of asthma symptoms. Diabetic patients are twice as likely to have asthma versus non-diabetic patients. Additionally, asthma is more common in hospitalized patients who have type 2 diabetes. As a result, uncontrolled diabetes and uncontrolled blood sugar levels correlate with an increased chance of developing asthma.

Like COPD, the mechanisms underlying this association relate to inflammation. Inflammation and the presence of pro-inflammatory cytokines explain the pathological link between the two conditions.

Sleep apnea

Sleep apnea is an issue in which your body stops breathing during sleep. There are two types of sleep apnea: obstructive and central. Obstructive sleep apnea (OSA) is caused by airway blockage, while central apnea occurs because your brain improperly regulates your breathing. Limited oxygen can disrupt your sleep while also causing several other complications.

Sleep apnea is very much associated with type 2 diabetes. More than 50 percent of individuals with type 2 diabetes have OSA. Additionally, individuals with OSA are more likely to get type 2 diabetes versus individuals without OSA. OSA is often treated with continuous positive airway pressure (CPAP), a machine that keeps your airways open during sleep. Recent research suggests that treating OSA with a CPAP can improve blood sugar control and decrease insulin resistance in individuals with prediabetes or type 2 diabetes.

Lung cancer

It is well established that diabetes can contribute to the development of cancer, particularly colon, liver, breast, pancreatic, bladder, and uterine cancers. This is because uncontrolled blood sugar levels support the growth and proliferation of cancer cells throughout the body. Recent research has shown that diabetes may also be a risk factor for the development of lung cancer.

Studies show that diabetes can accelerate the growth and spread of tumors, specifically in lung cancer, in animal models. This is due to the oxidative stress caused by high blood sugar levels. Oxidative stress is defined as an imbalance between free radicals and antioxidants in the body, resulting in damage and injury across the body.

Additionally, insulin therapy has been correlated with the development of non-small cell lung cancer (NSCLC). Insulin can also elevate airway inflammation, airway hyperresponsiveness, and bronchoconstriction. Other diabetic medications, like metformin, do not demonstrate these effects, and in fact, may be protective against lung diseases.

Respiratory infections

Diabetes is strongly linked to infections that can develop across the body, and this can even include respiratory infections. 52.3 percent of diabetic individuals experience severe respiratory infections versus 9.4 percent of non-diabetic individuals. This link may be due to several reasons, primarily high blood sugars that cause:

  • Changes to the small blood vessels in diabetic patients’ lungs
  • The creation of advanced glycation end-products (AGEs), which are linked to reactive oxygen species (ROS) and scarring

Additionally, diabetes can weaken your immune system, which makes it harder to fight off infection. Having high blood sugar levels leads to inflammation which causes the immune system to weaken. Likewise, diabetic individuals more frequently experience respiratory infections, pneumonia, and the flu. They are also more likely to experience other types of infections, like urinary tract and skin infections.

How can I prevent lung complications resulting from diabetes?

Knowing the lung risks and comorbidities associated with diabetes, you may be wondering what you can do to prevent these complications. Thankfully, proper management of diabetes, lifestyle changes, and vaccinations can help to avoid hurting your lungs long-term.

Pharmacologic management

Perhaps the best way to prevent lung complications due to diabetes is to properly manage your diabetes. High blood sugar levels contribute to the pathophysiologic mechanisms underlying lung dysfunction, so keeping blood sugar in check can help to avoid this.

If you have diabetes, your provider has likely started you on some sort of antidiabetic regimen with medication. Diabetes medication can include oral medicines such as biguanides, GLP-1 receptor agonists, DPP-4 inhibitors, SGLT-2 inhibitors, thiazolidinediones, and insulin secretagogues. One such medication is metformin, a biguanide, that is taken orally and is very effective in type 2 diabetes.

Your provider might also have you on insulin, which can be used for both type 1 and type 2 diabetes. In type 1 diabetes, the body does not make insulin, so this replenishes it. In type 2, either the body does not make enough insulin or can’t utilize it properly. There are several different types of insulin, and you may be on a few different types to keep your blood sugar in check.

If you have diabetes and are on any of these medications, you must be compliant with your regimen. Doing so will ensure you have proper blood sugar control, preventing downstream negative effects such as respiratory issues.

Nonpharmacologic management

We know that it is important to treat diabetes to prevent respiratory dysfunction. However, we don’t need to just treat diabetes with medication. It is also important to consider lifestyle and how our habits can worsen diabetes. The following are contributors to diabetes, and thus respiratory issues:

  • Smoking. Smoking is one of the major causes of COPD, a potential respiratory comorbidity with diabetes. Additionally, most cases of lung cancer are the result of smoking. Smoking can also trigger or worsen an asthma attack. Therefore, if you are a smoker, ask your doctor about what they can do to help you quit.
  • Obesity. Obesity can cause airway hyperresponsiveness and decreased airflow, resulting in asthma-like symptoms. Thus, losing weight can mitigate some of your risk of respiratory issues and other weight-related problems.
  • Alcohol. Prolonged alcohol consumption can induce inflammation and weaken the immune system, leading to infection and lung diseases. Consider cutting back on your alcohol intake.
  • Diet is a major contributor to the development of diabetes and consequent problems. To optimize your diet, reach for whole and natural foods like vegetables, fruits, complex carbs, healthy fats, and high-quality proteins. Avoid refined sugar, processed foods, and junk food.
  • Physical activity can also help to regulate blood sugar levels and prevent downstream diabetes complications. Aim for at least 150 minutes of aerobic exercise weekly.

Vaccination for infections

Another great way to avoid respiratory problems or exacerbation of existing lung issues is to keep up with your vaccinations. Vaccinations arm your immune system with what it needs to fight against dangerous respiratory illnesses, such as COVID-19 and pneumonia.