Diabetes and Lupus: Managing Comorbid Conditions

Many people with lupus also have diabetes, and the ways that the two diseases are related are complicated. It isn’t easy, but it is possible to navigate both illnesses at the same time.

Diabetes Mellitus is a disease that effect how the body processes and regulates its use of glucose, a digested, easily-used form of sugar.

It is usually caused by issues involving insulin, a hormone important to balancing the levels of, processing, storing, and using glucose. Insulin is responsible for telling cells in the body to take in the sugar and use it as energy. Or, if there is too much glucose in the bloodstream, to store glucose in the liver for later use.

There are 2 common scenarios for people with diabetes (that can overlap):

1. There is not enough insulin for the body to use
2. The cells are unable to respond properly to the insulin

What, exactly, is happening with insulin? This is a harder question to answer than one might expect. Diabetes is actually a family of several different diseases, with different causes, treatments, and symptoms. They are grouped together based on the primary issue: too much glucose ends up in the bloodstream.

Glucose and Symptoms

Glucose is the primary energy source for cells throughout the body, and every cell needs it to live. But, too much glucose can lead to serious problems in various organs and tissues throughout the body.

Symptoms of diabetes include:

• Extreme Thirst and Hunger: A sign that something is amiss with the body’s ability to balance its blood sugar and water levels.
• Metabolism Changes: Includes unusual weight loss, with ketones in the urine, a chemical compound that indicates that the body is processing fat and muscle tissue for energy.
• Frequent Urination: A result of poor regulation in the body, and also a result of increased drinking of water.
• Skin Lesions and Poor Healing: Open sores, blisters, and skin infections that heal slowly can be an indication of diabetes
• Frequent Infections in Soft Tissue: commonly found on the gums, the skin, and inside the vagina
• Neurological Symptoms: Including fatigue, irritability, and sensory issues such as blurred vision

While there are many different variations of diabetes, they are usually classed into 3 diseases:

1. Reversible diabetes
2. Type 1 diabetes
3. Type 2 diabetes

In reversible diabetes, the blood sugar is high but not dangerously so and can be controlled with diet. A form of reversible diabetes, known as gestational diabetes, happens during pregnancy and often ends after the baby is born.

Type 1 and Type 2 diabetes are not reversible once and are known as chronic diseases.

What is Type 1 Diabetes?

Type 1 diabetes is the least common form of diabetes and the form that usually occurs in childhood. Previously, it was commonly known as “juvenile diabetes.”

In Type 1 diabetes, the pancreas, the organ responsible for producing insulin, is not able to function properly. Because it does not produce enough insulin to meet your body’s needs, the body is unable to regulate the levels of sugar in the bloodstream.

The cause of type 1 diabetes could be genetics, viral infection, or damage. Still, in all cases it is an incurable condition. People with diabetes manage it with regular insulin injections and careful tracking of blood sugar levels.

What is Type 2 Diabetes?

Type 2 diabetes is also known as “adult onset” diabetes and is based on insulin resistance. Over time, your cells do not respond properly to insulin and the pancreas produces more insulin to compensate. Eventually, this resistance becomes so great that the pancreas cannot produce enough to get the glucose out of the bloodstream. High blood sugar has been shown to lead to prediabetes and type 2 diabetes.

Weight issues, as well as high carbohydrate and high sugar diets, are a major risk factor for type 2 diabetes.

Type 2 diabetes can be managed with diet, exercise, and insulin, but once it has reached the point of type 2 diabetes, there is no cure.

Lupus and Diabetes

As a chronic autoimmune disease, Systemic Lupus Erythematosus (SLE) also effects the entire body, and has many complex interactions with diabetes. Between organ damage, medications, dietary issues, fatigue, and an inability to get enough exercise, SLE can affect all aspects of a person’s life.

These effects cause people with SLE to have nearly double the risk of developing or already having diabetes.

In studies, researchers have noted that people with SLE have higher resistance to insulin overall. Insulin resistance is a failure of the body to respond to normal levels of this hormone, leading to issues with the levels of glucose in the bloodstream, both too much and too little. Other hormones, such as C-peptides, associated with diabetes are found in people with lupus. Resistance to insulin appears to be caused by organ damage, and can lead to worse symptoms of lupus. It can also lead to diabetes.

Effects of Diabetes on Lupus

Diabetes is well known to worsen other conditions, and SLE is no exception. Diabetes worsens lupus symptoms, creating a cycle of interaction between the diseases. Insulin resistance also increases some of the risks inherent in SLE. Oddly enough, it is less certain whether hospitalization is increased or decreased. But there is a lot that is not known about the interactions between diabetes and lupus.

For example, ideal dosing of medications can be complicated. Anti-rheumatic medications that deal with the joint pain of SLE do not appear to have an effect on diabetes. However, glucorticoids or corticosteroids, a common immunomodulatory medication for lupus, appear to directly affect insulin resistance. Prednisone in particular made insulin resistance worse. Corticosteroids also can cause weight gain, which can lead to many complications in diabetes in particular.

It is very clear that the two illnesses have many links, and even share symptoms (including kidney disease). They cannot be treated individually in a vacuum. The whole person with lupus and diabetes must be taken into account when managing treatment and medication. But what exactly does that mean?

Lupus Medication and Diabetes

Research shows that certain medications for lupus might reduce the risk of diabetes. In particular, antimalarial medications like hydroxychloroquine, which bring down inflammation and prevent lupus from damaging the body, seem to prevent people from developing type 2 diabetes. You can read more about hydroxychloroquine, also known as Plaquenil, here.

In a study, 1498 patients with SLE were followed over the course of their treatments. The median time of follow up was 4.62 years. The study focused on prescribed antimalarial medications and development of diabetes. Since glucocorticoids and prednisone in particular, another lupus medication, increases the risks of type 2 diabetes, the combination may help mitigate the risks. You can read more about prednisone and corticosteroids here.

Metformin, on the other hand, is an anti-diabetic drug that might be useful for lupus. It effects the metabolism of the immune system, so might help with lupus. But, it is known to interact negatively with other medications including ibuprofen and insulin.

Of course, managing lupus is more than just the medications – it is the entire lifestyle of a person with lupus. This lifestyle also effects diabetes in many ways.

Diet, Diabetes, and Lupus

According to the American Diabetes Association, diet and exercise are vital to managing diabetes. This is the same for SLE, and the exercise and dietary requirements of the two overlap very well.

For diabetes, controlling timing and amount is the most important aspect. Although what one eats is also vital, people with diabetes should eat carefully measured amounts of food at regular times. This prevents blood sugar spikes while maintaining a healthy weight.

For lupus, nutrition is more important than regular timing of meals. While a person with lupus should do their best to stick to regular meal plans, aiming for a diet that provides good nutrition is crucial.

So, What Should You Eat to Control Both Lupus And Diabetes?

A varied and balanced diet with whole vegetables, lean meats or fish, fruits, nuts, whole and grains. Keep it rich in fiber and omega-3s, and low in sugar, fat (especially saturated and trans fats) and sodium (often via salt).

Sugar in particular has a major effect on both lupus and diabetes. It causes major spikes and swings in blood sugar and also contributes to inflammation.

Keeping calories at a healthy level is also important. And helps prevent weight issues, which can make the symptoms of both diabetes and lupus worse. Read more about calorie-restricted diets here. Limiting alcohol consumption is also something to consider.

Diet, along with staying active and exercising regularly, can help reduce the risk of heart disease, a very serious symptom of both illnesses.

A Lupus Warrior’s Takeaway

Diabetes and lupus have different causes and symptoms, but they can occur together and affect each other in many ways. To prevent kidney damage, cardiovascular disease, and serious symptoms, a person with lupus and diabetes needs to treat both conditions as best as they can.