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The eyes have long been called the “windows to the soul,” and increasingly, evidence is suggesting that they might be also windows to both the brain and body.
The eyes have long been called the “windows to the soul,” and increasingly, evidence is suggesting that they might be also windows to both the brain and body. Several health conditions can be detected by examination of the eyes, among them diabetes, multiple sclerosis, and even Alzheimer’s disease. Medical News Today spoke to experts in the field to discover how the eye can reveal the body’s secrets.
Most of us have our eyes tested regularly, but few may be aware that an eye test is not just for checking vision and correcting sight problems.
Because it has a “window” at the front, the eye is the only part of the body where doctors can, non-invasively, examine the inside of an organ. At the back of the eye is the retinaTrusted Source, where blood vessels and the optic nerve can be clearly seen.
Thanks to this, optometrists and ophthalmologists could diagnose not only disorders of the eye, but also systemic diseases — those that affect other organs in the body or the whole body.
If a routine eye test raises concerns, the optometrist can refer a person to a medical ophthalmologist who will investigate by carrying out further eye examinations. If their investigations reveal a systemic disease, they can then refer the person to the relevant specialist.
Dr. Hagar Ibrahim, senior specialist trainee (ST6) in medical ophthalmology at St. Paul’s Eye Unit, Liverpool University Hospitals NHS Trust, in the United Kingdom, told Medical News Today that “a routine eye examination in which the pupils are dilated using eye drops can provide a full and clear view of the optic nerve, which connects to the brain, the retina, […] and all the blood vessels supplying the retina.”
“Therefore, pathology in the eye can be clearly seen during [an] eye examination, both in localized eye conditions and in systemic disease, truly making the eye a window into the rest of the body,” she added.
What can be diagnosed?
“People are often surprised when an eye doctor diagnoses them with a systemic illness but they shouldn’t be. Many people with systemic illnesses are first diagnosed by their eye doctor, which is just one reason why all adults should have regular eye examinations at least every 2 years.”
– Dr. Philip Storey, a board-certified ophthalmologist and fellowship-trained retina specialist at Austin Retina Health
As well as identifying problems with vision, such as nearsightednessTrusted Source, farsightednessTrusted Source, and astigmatism, a routine eye test will detect other eye disorders, such as glaucoma, and age-related macular degenerationTrusted Source.
By examining the blood vessels in the retina and the optic nerve, the optometrist can also discover a lot about a person’s general health.
This non-invasive process can detect many other health conditions that may seem unconnected to the eyes, among them hypertension, diabetes, thyroid disorders, and neurodegenerative diseases such as Alzheimer’s disease, and multiple sclerosis (MS).
“Ocular inflammation can affect many parts of the eye, and can often be the first sign of a systemic disease. The key to diagnosing the cause is in focused history taking followed by [a] guided investigation of the relevant body systems, including blood tests,” explained Dr. Ibrahim.
Blood vessel changes
Changes in the blood vessels in the retina can be early indicators of both diabetes and hypertension.
Dr. Storey told MNT that “[d]iabetes is the most commonly diagnosed disease given the frequency of the illness as well as the classic findings on retina exam, which can include bleeding, leakage of fluid, and areas of poor blood flow.”
Although a firm diagnosis of diabetes can only be made with a blood glucose test, changes in the blood vessels of the retina can give a strong indication that a person may have diabetes. They can then be referred for further testing.
According to the American Academy of Ophthalmology, the signs of diabetic retinopathyTrusted Source can sometimes be detected by eye examination even before a person suspects they may have diabetes.
Once diagnosed, provided the diabetes is well controlled, the person can then minimize the risk of further eye damage, as Dr. Ibrahim explained: “In addition to localized eye therapies such as laser treatment or intravitreal eye injections, improving blood sugar levels by sticking to the proper pharmacological treatment, restricting sugar intake and making necessary lifestyle changes, can result in regression of diabetic retinopathy.”
However, for those with diabetes, the most important eye tests take place after diagnosis, to monitor changes in the eyes and take steps to prevent further damage, as Dr. Howard R. Krauss, surgical neuro-ophthalmologist and director of Pacific Neuroscience Institute’s Eye, Ear & Skull Base Center at Providence Saint John’s Health Center in Santa Monica, CA, noted:
“In most cases, diabetes is diagnosed before changes become evident in the retina, but the retinal examination is a vital part of routine diabetic evaluations, so as to aid in the management of the disease, and to intervene when indicated, with any of a variety of treatments to reduce the risk of blindness from diabetic retinopathy.”
Classic signs of hypertension
Studies have shown that signs of hypertensionTrusted Source, or high blood pressure, are found in the eyes of around 10% of the adult, diabetes-free population.
On examination, an eye doctor might see traces of narrowing of arterioles in the retina, arteriovenous nickingTrusted Source, retinal hemorrhagesTrusted Source, and, as in diabetic retinopathy, microaneurysmsTrusted Source. All these are indicators of hypertensive retinopathyTrusted Source.
“Hypertension also presents with classic signs within the eye. The earliest signs of hypertension are narrowing of the vessels, often referred to as ‘silver wiring’ because of their appearance.”
– Dr. Philip Storey
The good news is that if the hypertension is controlled, the damage can be halted, as Dr. Ibrahim explained.
“Early detection means that appropriate precautions are taken and necessary lifestyle changes are made, such as eating a healthy diet and exercising regularly, in addition to starting the proper medical treatment thereby reducing the risk of heart disease,” she told us.
What the optic nerve can reveal
During a routine eye test, the eye doctor will also examine the optic nerve to look for any abnormalities or changes.
Dr. Ibrahim explained why: “The optic nerve connects the eye to the brain and is therefore an extension of the central nervous system. It is the only part of the brain that can be clearly visualized by examining the back of the eye.”
“Optic nerve swelling or inflammation can be detrimental to vision and color vision, and can diagnose MS, [which is] an autoimmune demyelinating disease of the brain and spinal cord, [as well as] neuroinflammatory disorders such as neuromyelitis opticaTrusted Source or brain tumor,” she added.
Vision problems in MS, which tend to flare up then resolve within a few weeks, are usually a result of optic neuritisTrusted Source, an acute inflammatory demyelinatingTrusted Source disorder of the optic nerve.
Optic neuritis is the first symptom in up to 20%Trusted Source of people who are subsequently diagnosed with MS, although it can indicate other disorders, or even be the result of a viral infection or vitamin deficiency.
If an optometrist suspects optic neuritis in a routine eye examination, they will refer a person for further testing to confirm the diagnosis and identify the cause.
Signs of Alzheimer’s in the eyes
“Retinal screening of Alzheimer’s disease is an exciting prospect at the forefront of current medical research. The retina […] is made up of multiple layers of specialized neural cells and there is strong evidence that the same changes in the brain can occur in the retina, potentially allowing screening patients for early signs of Alzheimer’s disease.”
– Dr. Hagar Ibrahim
Current methods of diagnosing Alzheimer’sTrusted Source are often lengthy, invasive and expensive, so being able to diagnose the condition from the retina would be a huge advance.
Although this is not yet a disease that can be diagnosed from a routine eye examination, recent research has suggested that doctors could, in the future, diagnose Alzheimer’s through retinal scans.
The new technique, so far tested only in mice, combines the results of two scans to assess the condition of the retina. Those with Alzheimer’s disease have a much rougher retinal surface than those without.
Other research has identified beta-amyloid plaques on the retinaTrusted Source as an indication of Alzheimer’s disease, and also in the lens of the eye, both of which can be detected by non-invasive methods.
Dr. Ibrahim explained some of the new developments:
“There are several areas under research. Firstly, looking for the presence of beta-amyloid fragments in the retina, which may be detected by specialist retinal imaging modalities, before symptom onset. […] Secondly, looking at biomarkers detectable on retinal OCT-ATrusted Source images in the form of differences of retinal microvasculature in patients with Alzheimer’s disease and mild cognitive impairment compared to healthy controls.”
Perhaps these findings may lead to easier, earlier diagnosis of Alzheimer’s disease enabling treatment to begin before symptoms become severe.
Get regular eye tests
As well as allowing an optometrist to detect diseases elsewhere in the body, changes in the eyes can tell a physician how a systemic disease is progressing.
So regular eye tests are important, particularly as we get older, as Dr. Benjamin Bert, an ophthalmologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, told MNT:
“While eye exams are mostly to check the health of the eyes, they do help to screen for systemic diseases. For adults, if you don’t have any need for glasses or contact lenses, it is still recommended to get an annual exam at least once in your 20s, twice in your 30s, and more regularly after 40. After 40 is when eye-specific ailments can start to become more common — including presbyopiaTrusted Source, glaucoma, cataractTrusted Source, and changes to the retina from diabetes or high blood pressure.”
Dr. Krauss reiterated the same advice.
But it is also important to remember that eye examinations are only one tool in monitoring health conditions.
“An examination of the retina often reflects the severity of a disease throughout the body. […] However, patients should not rely on an eye examination to assess how well their systemic disease is controlled,” Dr. Storey cautioned.
“The damage that we see in the eye can take years to occur. Even when a patient’s eye examination is normal, their systemic disease — hypertension or diabetes for example — could be poorly controlled,” he explained.
So, make sure a regular eye test is part of your overall health care, particularly as you get older — it may just detect a condition that you were unaware of, helping you to take control of your health.
Age-related memory loss: Can we prevent or even reverse it?
Some mild forgetfulness is a normal part of aging. But when does this occasional absentmindedness become something we should be concerned about? And are there measures we can take to minimize or even prevent those episodes? Medical News Today spoke to experts about how to recognize the differences between normal memory lapses and neurocognitive issues, such as dementia, and looked at research into how we might keep our aging brains alert.
We all forget things sometimes. Who among us has not mislaid their keys or phone, or struggled to locate their car in a car park?
As we age, our brains change, and these memory lapses seem to become more frequent. But is memory loss a normal part of aging?
According to the National Institute on AgingTrusted Source (NIA), many older adults worry about their memory, but taking longer to learn new skills and occasionally forgetting details are usually not serious age-related memory problems.
And although normal brain aging may mean slower processing speeds and more trouble multitasking, the Centers for Disease Control and Prevention (CDC) adviseTrusted Source that routine memory, skills, and knowledge are stable and may even improve with age.
Normal aging vs. memory impairment
According to the Alzheimer’s Society, normal aging leads to most of the following, which people usually start to notice from their 40s or 50s:
becoming a little more forgetful
taking a bit longer to remember things
getting distracted more easily
finding it harder to do several things at once.
Although this may be frustrating, for most people, it is a natural part of aging, and it is not a sign of dementia.
However, around 40%Trusted Source of people aged 65 and over do have some age-associated memory impairment. But of these, only 1% will progress to develop a form of dementia.
Speaking to Medical News Today, Dr. Emer MacSweeney, CEO and consultant neuroradiologist at Re:Cognition Health, advised that people should not regard age-related memory loss as inevitable.
“It’s not normal to develop cognitive issues and short-term memory loss as we get older. As everyone knows, lots of elderly people do not develop this problem,” she said.
And Dr. Miriam Weber, clinical neuropsychologist and associate professor of neurology at the University of Rochester Medical Center, agreed:
“Many cognitive functions change across the entire lifespan, not just in older adulthood. Memory — learning new information and holding on to that information over time — may decline slightly beginning when one is in their 60s (usually later 60s), with perhaps more notable declines in the 70s and 80s.”
“However, this is based on group averages, and not everyone experiences this decline. There are also groups of people — sometimes called “super agers” — who are in their 80s or older, who show cognitive performance comparable to middle-aged adults,” she added.
Those more frequent memory lapses as we age are not necessarily a sign of any cognitive impairment, added Dr. MacSweeney.
“When we are more relaxed and not rising to challenges at work every day, we may not concentrate with the same level of focus and effort, and therefore not be so energetic about remembering details of events and conversations,” she explained.
“Also, as people develop problems with hearing and eyesight they may actually miss items of conversation and ‘appear’ not to have remembered,” Dr. MacSweeney continued.
Hearing problems may not just cause people to appear not to have remembered — a new studyTrusted Source suggests that treating hearing loss with hearing aids might reduce the risk of developing dementia by up to 19%. This study adds to the growing evidence of a link between hearing loss and cognitive impairment.
When to seek help
“Problems with memory can occur at any age, especially with brain fog from [COVID-19] and for lots of other reasons. However, new onset of short-term memory loss after the age of 65 should certainly raise the possibility of the early stages of mild cognitive impairment [MCI] due to Alzheimer’s disease.”
– Dr. Emer MacSweeney
In some people, MCI is caused by a hormonal imbalance or nutrient deficiency, so once this is resolved, the MCI can be reversed.
In others, it may be the first sign of dementia. People with MCI have mild memory and thinking problems, but can usually take care of themselves and carry out normal daily activities.
Symptoms of MCI may include:
forgetting about appointments or social events
misplacing household items, such as car keys, clothing, or other objects
having greater difficulty finding the right words than peers of the same age
having trouble remembering events, instructions, or conversations.
Although MCI may develop into dementia, for many the condition does not progress further.
However, if the symptoms persist, or start to impact daily functioning, this may mean that the person is developing dementia. In this case, they must seek medical help and diagnosis.
“Normal age-related declines might include occasionally having trouble finding a word mid-conversation — that may come to you later — occasionally misplacing objects, occasionally repeating yourself in conversation, occasionally missing a monthly payment. In dementia, these things happen much more frequently and are more consequential, and the cognitive difficulties interfere with one’s function.”
– Dr. Miriam Weber
Dr. MacSweeney emphasized that “[t]esting is essential, as there are lots of reversible causes of short-term memory loss, too, and it’s important to get a diagnosis.”
“If due to a reversible problem, this needs to be corrected, as quickly as possible, and if due to the early stages of [Alzheimer’s disease] or another neurodegenerative disease, it’s important to seek help, as early as possible,” she advised.
A healthy diet and lifestyle
Keeping physically healthy can help protect against memory loss and dementia. The NIATrusted Source recommends regular aerobic exercise, and a healthy diet with plenty of fresh fruit and vegetables.
In addition, getting the right amount of sleep, socializing, minimizing stress, and keeping health conditions such as high blood pressure and diabetes under control will help reduce the risk of cognitive decline.
Dr. MacSweeney reiterated this advice:
“It has been shown that as a population we can reduce risk of cognitive impairment due to Alzheimer’s by adhering to healthy lifestyle habits including exercise, diet (Mediterranean diet high in fish oils) and keep[ing] sugar intake low — the brain hates sugar. High levels of mental and social activity. The brain needs to be exercised just like our bodies to stay in good condition. Avoid excess alcohol and smoking.”
A new studyTrusted Source has also highlighted the importance of vitamin D in preserving cognitive function. In this study of postmortem brains, the brains of people with higher cognitive function before death contained higher levels of vitamin D.
The researchers found that although the higher levels of vitamin D were associated with up to 33% lower odds of dementia symptoms, they were not associated with any decrease in post-mortem dementia neuropathologyTrusted Source.
Therefore, they could not suggest a mechanism for the potentially protective effect of vitamin D, or show a causative link.
They advised that ensuring you get sufficient vitamin D from sunlight and from foods such as oily fish might be beneficial. However, they warned against taking high doses of the vitamin to try and prevent dementia, as this can cause other health problems.
Exercise the brain
“Engaging in cognitively stimulating activities is also beneficial. We also know that depression and anxiety can negatively impact cognition, so it is important to treat those conditions if present. Maintaining social connections, engaging in meaningful activities, and exercising also help mood, which in turn, can impact cognition. It is not only your body that benefits from exercise, keeping the brain exercised can help preserve your mental abilities well into older age.”
– Dr. Miriam Weber
Although keeping active and engaged as you age may not prevent dementia, mentally stimulating activities, such as volunteering, reading, playing games, or learning new skills could help lower the riskTrusted Source.
Doing word games, such as crosswords, has long been advocated in the popular press as a means of keeping yourself sharp, but until recently, there has been little evidenceTrusted Source in peer-reviewed journals.
Now, a new study published in NEJM Evidence has demonstrated their efficacy in a small group of people with MCI.
The participants, who had an average age of 71, and some degree of mild cognitive impairment, did either intensive crossword puzzle training or intensive cognitive games training on a computer for 12 weeks. They continued with booster sessions to 78 weeks.
At 78 weeks, crossword puzzles had improved both a primary cognitive outcome measure (ADAS-Cog) and a measure of daily functioning more than cognitive games. More strikingly, brain shrinkage — measured using MRITrusted Source — was less in those who did the crossword training.
Can memory loss be reversed?
So, you can reduce your risk of memory issues, but once the memory starts to fail, can the problem be reversed?
There is some evidence that it may be possible. In a mouse study,Trusted Source researchers managed to reverse memory loss using chondroitin-6-sulphate, a substance that has also been shown to increase lifespan in the nematode worm Caenorhabditis elegans. It might have similar effects in people, but has yet to be tested.
In a more recent studyTrusted Source, researchers improved memory function in adults aged between 65 and 88 years using electrical stimulation via a wearable cap.
The researchers found that giving 20 minutes of electrical stimulation on 4 consecutive days led to an improvement in both working memoryTrusted Source and long-term memory for at least 1 month. They could focus the stimulation to affect different types of memory.
Dr. Robert Reinhart, of Boston University, corresponding author on the study, explained: “We developed two brain stimulation protocols — one for selectively improving short-term memory via low-frequency parietal stimulation, and another protocol for selectively improving long-term memory via high-frequency prefrontal stimulation.”
However, the improvement was only tested over one month, so the researchers call for further investigation into whether similar treatments might have a long-term benefit.
The bottom line
As we age, many of us will find we experience more frequent memory lapses, but unless these start to interfere with daily functioning, they are unlikely to be a sign of impending dementia.
To minimize the occurrence of memory issues, the advice is to keep active, eat well, look after your health, and stay engaged in lots of social and stimulating activities. And remember, like any part of the body, the brain will function better if it is exercised.
So keep up the daily word puzzle, and for even greater benefit tackle it with a friend. It could well be doing you more good than you realize.
In Conversation: 100 years of insulin
This November, we celebrate 100 years since the discovery of insulin, the hormone that provides the key to understanding and treating diabetes. In this Special Feature and podcast, we look at how far insulin research has come, and we consider what its future may hold.
Insulin is the hormone that helps regulate blood sugar levels, keeping them at healthy concentrations. The pancreas is the organ that produces this hormone, which is normally released in quantities dependent on the levels of blood sugar present in the system at any one time.
People whose bodies are unable to regulate blood sugar levels have diabetes mellitus, which can be of two types, depending on why this regulation does not occur.
In type 1 diabetes, the body does not produce insulin, while in type 2 diabetes, it does not respond to the insulin produced and released by the pancreas.
Around the world, hundreds of millionsTrusted Source of people live with a form of this chronic condition, and insulin treatments are key to its management, particularly to the extent that type 1 diabetes is concerned.
People with type 1 diabetes must take insulinTrusted Source, as their bodies do not produce it. Individuals with type 2 diabetes control their blood sugar levels typically through special medication and dietary and lifestyle interventions.
However, some may also require insulin treatment if the cells that produce insulin — called pancreatic beta cells — deteriorate in time and stop producing sufficient insulin.
In this Special Feature and associated “In Conversation” podcast, we offer an overview of the importance of insulin, its history, and what future research likely holds for insulin therapy and the management of diabetes.
To find out more about the impact of type 1 diabetes and the challenges of using insulin, we spoke to Virginie, a woman who received a diagnosis for this condition in her 30s.
For insights into current insulin research and potential future developments, we interviewed Dr. Thomas Barber, honorary consultant endocrinologist and assistant professor at the Warwick Medical School in the United Kingdom.
The history of insulin
Diabetes was known — as a collection of symptoms — over 3,500 yearsTrusted Source ago, as a papyrus dating from 1550 before the common era (BCE) was already describing a condition consistent with the symptoms of diabetes.
Even though physicians have encountered and treated diabetes throughout history, researchers only discovered the reason behind it around 100 years ago: insulin, the hormone that regulates blood sugar levels.
In 1889, Joseph von Mering and Oskar Minkowski, two researchers at the University of Strasbourg in France, removed the pancreases of dogs and found that the animals would then go on to develop diabetes.
As we now know, the pancreas is the organ that produces insulin. However, von Mering and Minkowski were not able to establish this connection at the time.
It was a little over 30 years later, in 1921, that Sir Frederick Banting and Charles Best — working in the laboratory of John Macleod — from the University of Toronto in Canada extracted insulin from the hormone-producing cells found in the pancreases of healthy dogs.
They then injected dogs with diabetes with this “extract” and thereby made the discovery that changed the face of type 1 diabetes treatment forever.
In 1922, Banting and Best treated a young boy with type 1 diabetes by injecting him with insulin. This saved his life — at the time, type 1 diabetes became a terminal illness more often than not — and cemented the importance of the researchers’ discovery.
Banting and Macleod won the Nobel prize in medicine “for the discovery of insulin” in 1923.
In 1946, researchers discovered intermediate-acting insulin, also known as Neutral Protamine Hagedorn (NPH)Trusted Source insulin, which persists in the body for 14–24 hours, which means that people who take it require fewer injections. This is still one of the most widely used types of insulin to this day.
At present, however, NPH insulin is no longer extracted from animal sources. Instead, researchers synthesize artificial human NPH insulin in the lab.
Insulin therapy today
At present, there are several different typesTrusted Source of therapeutic insulin, and people may have taken one or several of these, depending on their individual needs.
These types are:
fast-acting insulin, which starts to take effect around 15 minutes after entering the body
short-acting or regular insulin, which takes effect around 30 minutes after entering the body
intermediate-acting insulin, which starts to work 2–4 hours after entering the body
long-acting insulin, which starts to work several hours after entering the body and has a longer effect
Depending on their needs and what is accessible to them, people may receive therapeutic insulin through:
syringe injections, the traditional delivery method
an insulin pen, which also injects insulin but is easier to use than a syringe
an insulin pump, which automates the process of insulin delivery throughout 14 hours
While the subcutaneous delivery of insulin may make it harder for some people to adhere to the correct treatment regimen, other delivery methods have so far proved unsuccessful.
For example, in the 1990s, some companies have also developed and attempted to commercialize insulin inhalersTrusted Source, which would deliver the hormone in aerosolized form.
However, these never took off, most likely because they are less effective than delivering insulin subcutaneously, as some of the insulin gets lost in the process.
What does the future hold?
So what does the future hold for insulin research and therapy? In some ways, we could say, the future is now, as people are already using smartphone technology to assist them in adhering to their treatments and determining how much insulin they need to use.
Today, individuals use mHealth technology — referring to the practice of healthcare supported by mobile smart devices — to help them monitor their blood sugar levels, so they know how much insulin to take. Glucose monitors are currently available — these are small sensors placed under the skin that pick up on variations in blood sugar levels.
These connect to a smart device and allow the person to read their blood sugar levels at any time and share them with a doctor in real-time.
Some fully automated insulin delivery systems are also available. These are called “closed-loop insulin systems,” also known as “artificial pancreasesTrusted Source.” They work by transmitting real-time blood sugar level data to a smart device that then communicates with a person’s insulin pump, regulating how much insulin enters the system at any one time.
However, some challenges remain that future developments need to address. These include insufficiently accurate glucose monitoring devices, as well as concerns regarding user data collection. Current closed-loop systems also rely on user control, while researchers are yet to develop fully independently running artificial pancreases.
Dr. Barber noted that independently functioning artificial pancreases are akin to the “Holy Grail” of diabetes therapy.
“There is some fascinating research to suggest that [the independent artificial pancreas] can be done,” Dr. Barber told us.
“It’s been shown that can actually reduce hypoglycemic rates by having that kind of technology in place. But we’re some way away from actually being able to have an artificial pancreas, which doesn’t rely on the patient at all. And really, […] I think it will come, but we’re not quite there yet.”
– Dr. Thomas Barber
Another pathway for future research is gene therapy that would trigger the expression of insulin-producing cells, thereby tackling the cause of type 1 diabetes at the root. The research so far, while it has garnered some interest, has been in animal models, and scientists are yet to take this to the next step: clinical trials in humans.
Finally, scientists are also looking at ways of developing better insulin, and several areas of investigation appear to hold promise.
One option is developing glucose-responsive or “smart” insulinTrusted Source. One of the main challenges in treating type 1 diabetes and severe type 2 diabetes remains administering insulin doses that accurately “match” blood sugar levels.
If blood sugar levels become or remain too high, a person can experience hyperglycemia. This, in turn, can lead to various complications in the long term, such as eye problems or diabetic ketoacidosis.
Yet if a person takes too much insulin, they can develop hypoglycemia, where their blood sugar levels are too low. Its symptoms can include heart palpitations, dizziness, and blurred vision. It can also lead to further complications, such as seizures and loss of consciousness.
Smart insulin would help address the risk of hyperglycemia and hypoglycemia by responding to changes in a person’s blood sugar levels in a way that would mimic healthy insulin function.
Eliminating or attenuating insulin fibrillation and aggregation — a process that renders insulin manufacturing more difficult — would make it easier to produce and store insulin.
Another area of development looks at ultrarapid insulin, which starts acting sooner after delivery. It helps improve the management of fast changes in blood sugar from before to after a meal — a process known as “postprandial glucose excursions.”
Insulin and anxiety
Another issue that needs addressing in the near future is the lack of accurate and consistent information regarding both insulin therapy and the unexpected factors that can influence a person’s blood sugar levels, besides diet.
Virginie, for instance, wondered how much researchers and clinicians know about the relationship between anxiety and blood sugar levels and how this might affect people with diabetes who require insulin therapy.
In answer to her question, Dr. Barber explained that “glucose control is far more complex than simply what [a person’s] levels of insulin are, and indeed how much insulin you inject.”
“There’s actually 101 things [that] can influence blood sugar levels. And in fact, one of those is mental and emotional status at the time. And if you’re worried, or stressed, or anxious, that in itself can actually push your blood sugar levels up, because it’s associated with the release of the stress hormone cortisol and also the sympathetic response as well, which is the fight or flight adrenaline release, both of which act to raise your blood sugar levels.”
– Dr. Thomas Barber
This is one of the many reasons why it is so important for doctors to listen closely to the experiences of people living with diabetes.
“[W]hen I’m seeing patients in clinic, I’m acutely aware of the fact that they have far more insight into their own diabetes than I do,” Dr. Barber noted. “They’ve been living with this [condition] day after day, hour after hour, week, months, years, sometimes even decades. And I think it’s really important that as healthcare professionals, we’re aware of this and we respect that.”
Virginie further noted that anxiety regarding insulin treatments can also affect those living with diabetes in another way. Often, those around her are anxious about how the condition affects her and whether she has been able to take the correct insulin dose at the correct time.
Diabetes can also take a heavy toll on the friends and families of those with this condition, she pointed out.
Dr. Barber acknowledged the real human impact of a diabetes diagnosis and the serious lifestyle adjustments that come with having to undergo insulin therapy.
One of these is the necessity of self-injecting insulin, which, he said, causes anxiety in many patients. “And understandably, because of all of these factors, there’s often quite a lot of resistance to the idea of going on to [insulin] therapy,” he admitted.
The solution? Empathetic sensitive, and mental health-aware care, according to Dr. Barber:
“There is a relative lack of proper psychology and talking-based therapies for patients with diabetes, and one almost feels as if there’s a need for these patients not just to have the standard education on diabetes, but to have the focused psychological support, which is really a separate thing from education. I think they should have, obviously, the two together, but the psychological support is often lacking. And I think that really is an unmet need. And I think it’s something we could certainly do a lot more on in the future.”
The issue of equitable access
Perhaps the greatest challenge going forward, however, is ensuring equitable accessTrusted Source to appropriate care and education for the management of diabetes.
While this condition is common worldwide, it does not affect everyone in the same way, and not everyone has timely access to diagnosis and care.
Black, Hispanic, and American Indian individuals have a higher likelihood of developing diabetes compared with people of other races and ethnicities.
Yet, people from these groups face the highest rate of disparities in access to appropriate healthcare, often due to systemic racism and socioeconomic factorsTrusted Source.
To this day, Dr. Barber told us, lack of access to insulin remains the number one cause of death among children with type 1 diabetes worldwide:
“Did you know that globally, the most common cause of death for a child living with type 1 diabetes is actually [the] lack of access to insulin? That’s an incredible fact. It’s a tragic fact. And it’s actually quite shameful that after 100 years of having insulin, [which the World Health Organization (WHO) classes] as an essential medication, that children around the world with type 1 diabetes are dying because they don’t have access to this therapy. Something needs to be done.”
However, solving the issue of inequitable access to insulin therapy, glucose monitoring systems, and even basic education about diabetes is going to be no mean feat, according to Dr. Barber.
“[I]t’s a hugely complex issue,” he pointed out. “It’s not just the case of providing insulin, […] there [are the] huge complexities of […] infrastructure, data collection, [taking] cultural differences [into account] and so on.”
Some initiatives do exist to address these disparities. One example is the 100 Campaign, “which is aiming to improve the situation for patients around the world to have access to insulin,” Dr. Barber told us. However, we are still a long way away from solving this problem.
Virginie emphatically expressed a hope that going forward, healthcare decision-makers will work to improve access to care, health education, and diagnosis for people living with diabetes.
“I think it’s very important that […] we make sure we provide the access for all […] not just […] to insulin, but access to the diagnosis, and to actually think about our own assumptions [about diabetes],” she told us.
“Certainly, I didn’t know that thrush could be a symptom of diabetes. I also had a foot drop, which I didn’t know could be a symptom. I was thirsty all the time. [Before my diagnosis,] I was drinking more than 6 liters [of liquid] per day and only stopping because I knew 6 liters — that’s a lot. […] So my hope is that […] any sort of worry and concern is taken seriously. […] It has taken a while for me to get the diagnosis, and we’re only talking months. So I’m thinking about people who have to wait for years for [a] diagnosis. And I think it’s really important that […] we consider that as well.”