Diabetes Mellitus with Chronic Obstructive Pulmonary Disease
In this modern century, individuals have gone through different lifestyle modifications. Due to these changes, there has been an increase in health ailments too. The most common of these ailments is Diabetes Mellitus (DM). Diabetes affects many systems in our body. Here we are going to discuss the manner in which Diabetes affects the pulmonary (lungs) condition specific to Chronic Obstructive Pulmonary Disease (COPD)
In a healthy person:
Pancreatic cells in the Islets of Langerhans continuously monitor blood glucose levels. After a meal, the carbohydrates you eat are digested and broken down into glucose and other sugars, which pass into the bloodstream. As your blood glucose levels rise, beta cells in the pancreas respond by secreting Diabetes into the blood. Glucose then passes into your cells and the liver shuts down glucose production. Between meals, Diabetes also prevents excessive release of glucose from the liver into the bloodstream. If blood glucose levels drop too low between meals, alpha cells in the pancreas release a hormone called glucagon. This hormone signals the liver to convert amino acids and glycogen into glucose that is sent into the blood.
In a person with Diabetes:
In Diabetes, this glucose balancing system is disrupted, either because too little Diabetes is produced or because the body’s cells do not respond to Diabetes normally (a condition called Diabetes resistance). The result is an unhealthy rise in blood glucose levels. If Diabetes is left untreated, the two principal dangers are the immediate results of high blood glucose levels (which include excessive urination, dehydration, intense thirst, and fatigue) and long-term complications that can affect your eyes, nerves, kidneys, and large blood vessels.
Type 2 Diabetes Mellitus (DM) and metabolic syndrome are particularly common medical disorders and are leading causes of morbidity and mortality worldwide. Disturbances in glucose metabolism are more common in COPD patients than in COPD free individuals. COPD, Metabolic syndrome and type 2 DM are associated with advanced age, which may in part explain this observation. It is well known that offspring of affected parents are more likely to develop both COPD and type 2 DM. Due to delivery of low birth weight infants, which is a known risk factor for both diseases. In addition, smoking can contribute to the occurrence of these diseases via its effects on systemic inflammation and oxidative stress. However, the pathogenesis of glucose metabolism deregulation is likely to be much more complex, whereby myriads of pathways are likely to be implicated, and much is still to be discovered and clarified.
COPD or Chronic Obstructive Pulmonary Disease is a progressive disease that makes it hard to breath. COPD can cause coughing that produces large amount of mucus, wheezing, shortness of breath, chest tightness, and other symptoms. Cigarette smoking is the leading cause of COPD.
In COPD, less air flows in and out of the airways because of one or more of the following:
- The airways and air sacs lose their elastic quality.
- The walls between many of the air sacs are destroyed.
- The walls of the airways become thick and inflamed.
- The airways make more mucus than usual, which can clog them.
COPD develops slowly. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself.
COPD, Metabolic syndrome and DM are common and under diagnosed medical conditions. It is predicted that COPD will be the third leading cause of death worldwide by 2020. The burden of this disease is even greater if we consider the significant impact of COPD on cardiovascular mortality.
COPD may be considered as a novel risk factor for new onset type 2 DM. The pathophysiology of this is likely to be very complex with several factors being involved, including: inflammation and oxidative stress, administration of glucocorticosteroids, COPD related skeletal muscle dysfunction and abnormalities in adipokine metabolism etc. However, COPD should not be considered as a risk factor for type 1 DM, because of the unique pathophysiology of type 1 DM and different ages at disease presentation.
On the other hand, Diabetes may act as an independent factor negatively affecting lung structure and function. Diabetes can cause muscle and neuronal damage, which is relevant to deficient function of respiratory muscles. Moreover, Diabetes is independently associated with lower physical performance, which can be disabling for patients with COPD, who already have some limitation in physical performance. DM is able to detrimentally affect alveolar capillary membrane and decrease DLCO (diffusing capacity of carbon monoxide), similarly to other micro angiopathic complications, such as diabetic nephropathy. Furthermore, DM is associated with the presence of glucose in airway secretions, and this may contribute to the increased risk of pulmonary infections seen in diabetics. Metabolic syndrome can increase the risk of COPD exacerbation, and Diabetes is associated with worsened outcomes of COPD flare.
Antihyperglycemic medications may in fact improve diffusion capacity to carbon monoxide, as has been shown with Diabetes in patients with DM. However, concerns about safety and pharmacokinetics preclude the recommendation for inhaled Diabetes to be used at this time. On the other hand, oral antihyperglycemic medications such as metformin and thiazolidinedione may improve forced vital capacity in patients with DM. Moreover, metformin has been shown to have antitumor effects and may increase survival in patients with lung cancer.
Thus, it is essential to look at COPD as a potential independent risk factor for the incidence of metabolic syndrome and type 2 DM and for a complicated course of DM. Conversely, both types of DM and Metabolic syndrome are associated with a worsened clinical course of COPD and a greater degree of morbidity and mortality.
The risk of DM development is associated with elevated fibrinogen and other markers of inflammation . In fact, this inflammatory state may act as an independent risk factor and predictor for COPD exacerbations. Hyperglycemia is linked to impaired lung function. One study shows that Diabetes was associated with a lower FEV &FVC as association that was made worse by smoking.
In summary, people with COPD and Diabetes should monitor their blood sugar periodically to prevent the worsening of their condition.
Chronic obstructive pulmonary disease and glucose metabolism: a bitter sweet symphony by Aibek E Mirrakhimov
www.Diabetes self management.com.
Medical and Surgical Nursing by Joyce Black