Diabetes, Aging, and Muscle Loss: What You Need To Know
By Amelia Harnish
Living with diabetes is all about muscling through challenges. Another one to watch out for? Muscle loss.
Recent research has found a strong link between diabetes and sarcopenia, otherwise known as accelerated age-related muscle loss. The study also found that people with diabetes have three times the risk for sarcopenia compared to those without diabetes.
Sarcopenia in older adults is associated with an increased risk of falls, frailty, and mortality. As people with diabetes live longer – more than a quarter of Americans 65 or older have diabetes – this complication is increasingly on clinicians’ radars.
If you live with diabetes, it should be on your radar, too, said Dr. Betul Hatipoglu, assistant professor and director of the Case Center for Diabetes, Obesity, and Metabolism at Case Western Reserve University in Ohio.
“Sarcopenia is more common in older individuals who are at risk for muscle loss naturally. However, even younger people with diabetes could suffer from this side effect if not well-managed for a long time,” Hatipoglu said.
Here’s what you should know about muscle loss and diabetes.
What is sarcopenia?
Everyone experiences some loss of muscle mass and function with age. Beginning in your 30s, muscle mass naturally decreases roughly 3-8% per decade. By age 60, the rate of loss is even higher.
While some muscle loss is expected, sarcopenia is an unusually fast rate of loss. Sarcopenia involves a loss of muscle mass, as well as reduced function and strength of the muscles.
As muscle mass decreases, fat mass increases, which increases the risk of insulin resistance. Diabetes and muscle loss seem to be a two-way street; not only does the condition seem to lead to muscle loss, but muscle loss itself can also lead to diabetes.
Sarcopenia can make diabetes harder to manage, in addition to other negative effects like joint stiffness and decreased bone density. This can lead to a snowball effect where sarcopenia combined with diabetes speeds up overall health decline as you age.
Of course, you don’t need diabetes to experience overall health decline. Obesity plus sarcopenia can also contribute to negative impacts on health as you age.
The link between diabetes and sarcopenia
While the relationship between diabetes and muscle loss is well documented, there are still some open questions about the mechanism behind it.
“We know that for any insulin deficiency, such as type 1 diabetes or advanced type 2, the body cannot use sugar for energy and starts using fat and protein as alternative sources. Muscle loss occurs due to muscle being consumed as a source of energy,” Hatipoglu said.
“However, muscle loss is now also acknowledged even in people with type 2 diabetes without total insulin deficiency, and the explanation of why is not clear in those cases.”
There are theories, however. Many things related to diabetes likely increase the rate of muscle loss. For example, increased inflammation caused by diabetes may play a role.
Decreased insulin activity may also decrease the ability for your body to build muscle. One of the key things insulin does is help move proteins from your blood into skeletal muscle. With decreased insulin sensitivity, the process of protein synthesis is less effective. That means over time, your body can’t build muscle faster than it’s being lost.
Sarcopenia is also tied to metabolic syndrome, which the majority of people with type 2 diabetes have. Other diabetes complications, such as painful neuropathy, may make it harder to participate in physical activities (like weight lifting, for example) that protect against muscle loss.
What you can do to keep muscles strong
If you live with diabetes, the best thing you can do for your muscles is manage your blood sugar as best as you can, Hatipoglu said.
While there aren’t many studies linking glucose control to increased muscle mass, based on what we know about the possible mechanisms, improved blood sugar levels can likely help keep your muscles strong.
The next best thing you can do for your muscles is use them. Incorporate strength or resistance training into your routine. The increased risk for muscle loss among those with diabetes makes this aspect of exercise even more important.
Resistance training has long been known to help improve blood glucose control, in addition to helping your muscles stay strong and functional. That makes it a key to stopping the vicious cycle.
This doesn’t have to mean you need to be a CrossFit athlete or bodybuilder. Depending on your age, mobility, and whether you are already experiencing muscle loss, you may want to engage the help of a physical therapist or certified trainer who can work with you (and your doctor) to develop a plan that works for you.
“We recommend supervised weight training,” Hatipoglu said. “Having a coach in the process can help you stay motivated.”
