Most people are aware of type 1 and type 2 diabetes, but did you know there is a type 3 diabetes as well! It is a more obscure term. Although it is not an accepted medical diagnosis, type 3 diabetes has been discussed in the literature as a possible relationship between insulin resistance in the brain and Alzheimer's disease. This link has been described to help explain how metabolic disorders impact brain health, causing cognitive decline and dementia.

What is Type 3 Diabetes?

Type 3 diabetes is more of a misnomer because it should not be confused with type 3c diabetes, which relates to pancreatic dysfunction. The term "type 3 diabetes," on the other hand, has been loosely used by some scientists to analogously propose that Alzheimer's disease is strongly implicated with insulin resistance in the brain.

This concept was conceptualized by Dr. Suzanne de la Monte and Dr. Jack Wands of Brown University in the year 2008. This hypothesis postulated that Alzheimer's disease may be called type 3 diabetes for it bears many similarities with glucose metabolism disorder type 2 diabetes. Their concept arises from the basic principle that insulin is fundamental to blood sugar regulation, but it is also the case with the brain. When brain cells become insulin-resistant, they lose access to glucose, impairing their function.

Research published in the Journal of Diabetes Science and Technology supports this hypothesis by indicating that insulin resistance can be a significant contributor to the occurrence of dementia, also referred to as Alzheimer's. The symptoms of memory loss and diminished reasoning are associated with impaired glucose metabolism in the body, especially in the cerebral tissue.

Symptoms of Type 3 Diabetes

Although type 3 diabetes is not a "medical term," its symptoms correlate well with Alzheimer's diseases that are known to reduce the ability to think in an efficient manner and bring down brain health. These signs are:

- Loss of memory, especially short-term.

- Poor judgment and judgment ability

- Failure in recognizing people or places familiar once.

- Failure in the process of reading, writing or processing numbers

- Anxiety, agitation, or mood changes.

- Disorganized thoughts or confusion

- Lack of impulse control

As the disease advances, patients may be afflicted with severe complications including an inability to swallow or control their bodily functions. In the final stages, most patients die from fatal complications such as aspiration pneumonia.

Causes of Type 3 Diabetes

This may not be well understood with regards to type 3 diabetes, or the exact link between insulin resistance and Alzheimer's disease. Some identified contributing factors include the following:

1. Insulin Resistance

Insulin acts as an important regulatory mechanism of brain functions such as memory and cognition. The reduction in insulin signaling may impair metabolism of brain cells, thus bringing about neurodegeneration.

2. Type 2 Diabetes

These diseases show a strong relationship and those individuals diagnosed with type 2 diabetes have double chances of getting Alzheimer's. In the two, the main causes can be chronic inflammation, oxidative stress, and a defect in glucose metabolism.

3. Environmental and Lifestyle Factors

Insulin resistance associated with obesity, stress, and an unhealthy diet is considered a cause that may increase the chances of Alzheimer's disease.

Researches in Frontiers in Neuroscience and The Lancet Neurology have also highlighted that drugs used for antidiabetic medication may be crucial for the prevention or at least slowing down the course of Alzheimer's.

Treatments for Type 3 Diabetes

In 2022, in a study in Pharmaceuticals, researchers studied biomarker uptake in brain regions implicated in the faulty uptake and metabolism of blood sugar in Alzheimer’s patients.

Emerging Therapies

Research into such treatments as intranasal insulin has also been promising. Intranasal delivery of insulin directly to the brain has been reported to enhance glucose uptake by brain cells, improve memory, and boost cognitive performance. While such clinical trials have been shown to be successful, additional research is needed for safety and efficacy.

Medications

For patients being aggressive or agitated, antipsychotic drugs may be prescribed; however, therapies such as cognitive rehabilitation as well as cognitive stimulation therapy serve to preserve memory and executive function.

Lifestyle Interventions

Diet, exercise, and stress management are critical in preventing and managing insulin resistance. A review in the Journal of Alzheimer's Disease also highlighted the benefits of Kirtan Kriya meditation, which can regulate genes involved in insulin and glucose metabolism, improve sleep, and reduce inflammation.

Can Type 3 Diabetes Be Prevented?

Although type 3 diabetes is not officially recognized, its connection to Alzheimer’s disease underscores the importance of proactive measures for brain health. Some prevention strategies include:

1. Healthy Diet

Consuming a balanced diet rich in antioxidants, whole grains, and healthy fats may support brain health.

2. Regular Exercise

Physical activity improves insulin sensitivity, reduces inflammation, and enhances overall metabolic health.

3. Stress Reduction

Mindfulness practices, including meditation, have been shown to lower stress levels, which can reduce the risk of cognitive decline.

The term type 3 diabetes brings out the complex relationship between metabolic disorders and brain health. Even though it is not a recognized medical condition, the concept emphasizes the crucial role of insulin in brain function and its possible contribution to Alzheimer's disease. Continued research will hopefully provide hope for therapies such as intranasal insulin and lifestyle modifications.

When one thinks about cancer, the first thing that comes to mind is a mass of irregular cells growing wildly. But what is a tumour? It is much more than mere cancer cells surrounded by an extensive network of blood vessels, immune cells and various supporting cells. This is the tumour microenvironment.

One of the key residents of the tumour microenvironment is the cancer-associated fibroblast (CAF), which attracts increasing interest of cancer researchers due to the fact that such cells may affect tumour growth, metastasis and therapy response.

Normal fibroblasts have a supportive function in maintaining tissue integrity through the production of collagen and other structural components. However, when cancer arises, some fibroblasts located in or near the tumour acquire an additional function and become activated. Such activated fibroblasts are called CAFs.

How CAFs May Help Cancer Grow And Spread

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CAF involvement could be likened to that of a helper to the tumour. These cells are able to modify the stroma around the cancer cells and thereby facilitate growth and invasion into adjacent tissue. CAFs are also capable of releasing factors that facilitate angiogenesis as well as the behaviour of cancer cells. Evidence exists of a correlation between CAF involvement and tumour progression and metastasis in various types of cancer.

Perhaps more significantly, CAFs can affect the immune response of the body. The immune system in humans is able to detect and target foreign bodies including cancer cells. However, some forms of CAFs play a role in ensuring an immunosuppressed environment that makes it difficult for the immune cells to interact effectively with the tumour cells. This could explain the wide variation in immunotherapy response among patients and different tumour types.

The involvement of CAFs in treatment resistance is another issue that must be considered. Cancer-associated fibroblasts are known to remodel the extracellular matrix, an environment where cells are surrounded by proteins, and generate signals that help cancer cells resist stress induced by chemo and targeted therapy. CAFs therefore make treatment difficult for certain tumours.

Could CAFs Become A New Target For Cancer Treatment?

This field of study is especially important when considering that cancer treatments are becoming increasingly personalized. Today, oncologists take into consideration such features of cancer as genetic mutation, its stage and molecular profile. Tomorrow, taking into account tumor microenvironment can give them additional knowledge on how to treat a specific type of cancer.

But there is one major issue to be taken into consideration: CAFs are not one homogenous group of cells. There can be many types of CAFs that have very different functions, sometimes even opposing. Some of them contribute to tumor growth and some may hinder it. Thus, simply killing all fibroblasts will hardly help. Instead, there are studies on how to selectively target tumor promoting CAFs and how to reprogram them. Several such methods have already been tested clinically.

There is one important point that this research gives to patients: cancer is not just a mass of aberrant cells. Cancer is an ecosystem where cancer cells constantly interact with their environment.

Understanding this ecosystem might someday help oncologists tackle the mechanisms of tumor survival and resistance to therapy- and maybe make current cancer treatments more efficient.

By Dr Pritam Kalaskar, Director, Co-founder and Medical Oncologist- M|O|C Cancer Care, India

Obesity is often associated with obstructive sleep apnea or OSA. Extra body fat is a key risk factor. Still, it is a mistake to think OSA only happens when someone is heavy. Many people who have a normal weight may not connect their symptoms to a sleep issue.

They can go for years without a proper diagnosis. Research also makes it clear that OSA can show up in people who are not obese. Risk may be more than weight-dependent and include factors such as upper airway anatomy, age, sex, family history, and others.

How Airway Anatomy Can Increase The Risk

Weight is only part of the story. The jaw, the palate, the tongue, and the passages in the upper throat can affect what happens during sleep. The airway can narrow or collapse more easily for some people. A person may not be big in body size but can have a tight or smaller upper airway.

They might have a jaw that drops back. Other facial and skull features can also increase the likelihood of OSA. Your nose problems, smoking, drinking and other unwholesome activities on Sunday could also be factors.

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Why Age And Menopause Matter

Age matters too. With time, muscle tone can change. The way the airway works can also shift. As a result, the upper airway may be more likely to collapse during sleep. For women, the risk may also shift around menopause and after it. This is why OSA should not be treated as a problem that only affects overweight men.

The symptoms should be taken seriously, not the scale. Signs such as loud snoring or snoring often, pauses seen in breathing, waking up suddenly and feeling short of breath, or choking during sleep can all call for assessment. Morning headaches can occur as well. Day-to-day problems like poor focus, irritability, and being very sleepy in the daytime are common clues. Some people do not report classic sleepiness. They may mainly notice restless sleep or ongoing tiredness during the day without a clear reason

How Doctors Assess Sleep Apnoea

A clinician should look at more than BMI. They can start with symptoms, a sleep history, neck size, what the upper airways look like, and any related health issues. If obstructive sleep apnoea is a real concern, a sleep test can show whether breathing problems happen during sleep.

The main point is this: a person can be slim and still have sleep apnoea. Deciding on testing should follow the full clinical picture, not body weight by itself. When this is remembered, some people may get help sooner, instead of having their tiredness written off as stress, bad sleep, or just normal fatigue.

A patient suffering from a rare tumour involving the sciatic nerve has made a good recovery following a successful robotic-assisted sciatic nerve schwannoma resection, marking an important milestone in advanced, minimally invasive surgical care.

Sciatic nerve schwannomas are uncommon, benign tumours that develop from the cells surrounding a nerve. Because the sciatic nerve is responsible for important motor and sensory functions of the lower limb, surgery in this region can be technically challenging. The key objective is to remove the tumour while preserving the functioning nerve fibres and minimizing the risk of neurological complications.

How Robotic Technology Can Aid Complex Surgery

The patient underwent robotic-assisted surgery under the care of a multidisciplinary surgical team. The use of robotic technology provided enhanced visualization and precise control of surgical instruments, allowing meticulous dissection around the affected nerve.

For the patient, the successful procedure meant not only removal of the tumour but also the prospect of returning to normal daily activities with preservation of neurological function.

Whenever the doctor operates on a tumour involving an important nerve, their priority is to achieve complete and safe tumour removal while protecting the nerve and its function. Robotic assistance can offer greater precision and visualization in carefully selected cases.

Following the procedure, the patient was closely monitored for neurological recovery and postoperative complications. The patient is doing well and recovering satisfactorily, providing an encouraging outcome following this complex surgical intervention.

How Minimally Invasive Techniques May Benefit Patients

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The case demonstrates how advances in surgical technology can translate into meaningful benefits for patients. Robotic-assisted surgery, when used in appropriately selected cases, can support surgeons in performing delicate procedures with enhanced precision while potentially reducing tissue trauma and facilitating recovery.

For patients diagnosed with nerve tumours, early evaluation and appropriate treatment planning are important. Symptoms can vary depending on the location and size of the tumour and may include pain, tingling, numbness, or weakness in the affected limb. Detailed imaging and neurological assessment help specialists determine the most appropriate treatment strategy.

The successful outcome reflects the importance of combining experienced surgical expertise, advanced technology, and patient-centred care. For this patient, the journey from diagnosis to successful tumour removal and recovery offers an encouraging example of what modern surgical care can achieve.

By Dr. S.K. Bala, Consultant Department of Surgical Oncology & Advanced Robotic Surgery, CMRI, CK Birla Hospitals, Kolkata