Does diabetes effect the immune system?

With the Covid-19 pandemic and flu season both in full swing, immune health is a topic on everyone’s minds. Luckily the lovely folks over at Pure Pharmacy published a “Health and Immunity” edition of their LivePure publication with tons of great information on optimizing our immune function (which you can pick up at any of their pharmacy locations, or at this link https://purepharmacy.com/pages/livepure-autumn-2021). I was tasked with writing an article on the link between diabetes and the immune system - and how diabetics and non-diabetics alike can keep their immune systems healthy.

Diabetes has many harmful effects on the body, which is why its impact on the immune system is often overlooked. 

Type 2 diabetes affects approximately about 3.4 million Canadians, most of whom probably know that it increases their heart disease riskrisk of heart disease.  But did you know diabetes also affects your immune system?  In this article I’ll explain how diabetes and the immune system are linked, and take you through my tips for managing diabetes and improving immune function (and don’t worry, cutting out carbs isn’t one of them).

How type 2 diabetes affects the immune system

Type 2 Diabetes is a disease of insulin dysfunction.  Think of insulin as a hormonal ‘key’ that opens the cellular ‘doors’ in our bodies, allowing the sugars we’ve digested to travel from our blood into our cells to be used for energy.  In Type 2 Diabetes the body becomes desensitized to insulin’s signals – the lock no longer recognizes the key.  This causes blood sugar and insulin levels to rise, producing the classic diabetes  symptoms.  So, how does diabetes affect the body’s immune system? 

Think of your immune system as your body’s personal army against the huge number of potentially harmful microbes you come into contact with every day.  Similar to an army, your immune system has different types of operatives.  If we break it down to the basics, the immune system has three main categories; reconnaissance cells (who recognize the pathogens), communication cells (who alert the rest of the immune system that there is an intruder) and attack cells (who trap and kill the pathogens).  A healthy immune system uses the full extent of its “team” to keep the infections from taking hold.  However, when the immune system is compromised your risk of getting an infection, or having a more serious infection, increases.  

While the mechanism isn’t totally clearly understood, research has shown that altered blood sugar and insulin levels in diabetes interferes with all three types of your immune cells.  This leaves the body at higher risk of infection, including skin infections and lower respiratory tract infections.  New COVID-19 data has shown that diabetes also increases your risk of experiencing a more serious COVID-19 infection. 

Tips to lower your risk of infection when living with diabetes

Lowering blood sugar can help to reduce the risk of diabetes complications, including infections. 

Optimize your diet

There is a lot of confusing diet advice for diabetics online.  Some advice says you need to eat high fat and cut carbs, while other fad diets promote the exact opposite.  I’ve been studying nutrition for 8 years (first in my bachelor’s degree, and then naturopathic medicine), and if I’ve learned one thing it’s this: moderation is key for achieving long-term success.  Extreme diets do not work long term because they are too difficult to maintain past the first couple of months.

“Moderation” can be interpreted in different ways; in the context of diet, moderation means that every single food can be a part of a healthy diet ((yup, even Cheetos and ice cream).  The key is to balance the proportions of the food you are eating.  My advice is to use the “healthy plate” model, where half of your plate consists of fruits and/or vegetables, one quarter is protein, and one quarter is carbohydrates or grains (the updated Canada’s Food Guide is a great resource to learn more about this).  For diabetics and pre-diabetics in particular, this model of eating ensures that you are balancing your fiber and carbohydrate intake to optimize your blood sugar levels.

Stay active

Exercise is a cornerstone of any diabetes treatment program.  If insulin is the key that opens the cellular doors to sugar, exercise is like a crowbar that can physically pry open that door.  Exercising increases your muscular uptake of sugars, helping to keep your blood sugar and insulin levels in check.

If you aren’t currently exercising, start slow with activities like walking, stretching, or yoga.  As these activities get easier, you can gradually up the ante, working your way to a target of 30-60 min of moderate intensity exercise 5 days per week.

When it comes to seeing improvements in your blood sugar and insulin levels,  getting out and moving consistently is key (even if it isn’t a full workout).  The best thing you can do is to find a type of exercise that you genuinely enjoy – that way you’re more likely to make time for it in your schedule. 

Support your microbiome

Your microbiome is made up of over 30 trillion bacteria that live in your gut – and they are an integral part of your immune system.   Based on ongoing research, there are significant differences in the microbiome makeup of diabetic vs non-diabetic individuals.  However, studies on this topic are still in the early stages, and we don’t know yet whether the differences in microbiome are a consequence or a cause of diabetes, and how diet plays into that relationship. 

Regardless of the unknown factors in the interplay between microbiota, the immune system, and diabetes, we know that the microbiome has a significant role in the immune system.  It affects intestinal permeability, acting as a first line of defense against the absorption of harmful bugs that we may ingest.

The best way to support your microbiome is through a varied diet, including plenty of vegetables, fruit, and fiber.  Including fermented foods (like yogurt or kimchi) is a great way to support microbiome diversity as well. 

Research on probiotic and prebiotic supplements are still in the early stages, but have shown promise.  One study in particular showed that prebiotic fibers supplements (like inulin fiber) have been shown to support microbiota health, as well as to decrease blood sugar in type 2 diabetics.

Medication

Lifestyle changes take time, and can be really difficult to make.  If you have been prescribed medication to help control your blood sugar levels, do your best to take them as prescribed. 

Take home message

Your immune system functions best when your overall health is at its best. Treating underlying conditions like diabetes is critical in protecting yourself from infection this fall.