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.

It is difficult to determine emotions because of the neurological differences, the surrounding in childhood, the psychological ways of survival, and absence of emotional training.

Alexithymia or "emotional blindness" is the neuropsychological trait associated with severe problems with identification, recognition, and description of the person's emotions. Alexithymia is not a psychiatric disease but a personality trait.

It is characterized by the inability to identify and distinguish emotions and body sensations, difficulty of finding the words to express feelings, inability to understand facial expression and body language of another person and emotional detachment during stressful situations.

It is diagnosed in people with autism spectrum disorder, depressive disorder, generalized anxiety disorder and after traumatic brain injuries. It can be inherited or acquired as a result of childhood trauma, abuse or neurological damage.

The Brain Science Behind Alexithymia

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The cause of alexithymia is the brain wiring and neurological differences. Therefore, there is impaired interception, which is the inability of the brain to recognize its own physical sensations. Also, an unusual structure of the brain regions like amygdala and insula, that regulate emotions, makes difficult to decode emotional signals.

Early childhood environment and emotional competence must be developed in childhood, because, without that, there can be emotional neglect and emotional vocabulary deficiency. Due to the inability to interpret emotional data, the person misses the compass that directs decisions and self-calming. This leads to emotional outburst, panic, hyperarousal, social and psychological consequences.

How Alexithymia Differs From Emotional Numbness

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Emotional numbness is the transient psychological state caused by acute trauma, deep grief or burnout.

The lack of emotional intelligence is the lack of social and emotional competence, when the person feels his emotions correctly, but he cannot control temper, lacks empathy, makes inappropriate social decisions or do not know what kind of effect his behaviour causes on the room.

But alexithymia is different since it is long-term personality trait and the person is unaware of the particular emotion.

In terms of neurodevelopment, the insular cortex and the anterior cingulate cortex (ACC) are the structural core of the brain's salience network. They work as a translator, transforming chaotic physical sensations into recognizable emotional experience.

Although there isn't any cure for alexithymia, one can improve his emotional awareness through certain measures. Interoceptive training where individuals are taught how to associate physical body sensations (such as tightness in the chest) with particular emotions (such as stress).

The use of emotion wheel or list of emotional words to bridge the link between vague physical sensation and precise description. Mindfulness, which involves observing oneself without judgment or without trying to suppress those internal feelings right away. And it is always good to seek professional help from a psychologist or a counselor.

By Dr. Arun Shah, Director - Neurosciences, Sir H.N. Reliance Foundation Hospital

Urine leakage after pregnancy is a common occurrence in many women. It is considered a normal part of motherhood. However, it doesn't have to be. Urine leakage can occur after childbirth, but persistent symptoms should not be ignored or tolerated just because you feel that it is not a big deal. It will be imperative for women to consult a pelvic health physiotherapist to examine the pelvic floor and guide women with the help of personalised rehabilitation for improving bladder control and recovering quickly.

Pregnancy and childbirth lead to changes in a woman's body. However, there can also be an impact on the muscles and tissues that support the bladder, uterus, and bowel. Hence, many women can experience urine leakage while coughing, sneezing, laughing, exercising, or lifting their baby after delivery. Vaginal delivery, prolonged labour, multiple pregnancies, a larger baby, excess weight, and chronic constipation can also cause pressure on the pelvic floor. So, the pelvic floor is a group of muscles that supports the pelvic organs and also contributes to bladder and bowel control.

During pregnancy, these muscles carry load, and childbirth can further stretch or affect their strength and even coordination. Hence, stress urinary incontinence is seen in women post-pregnancy, wherein the urine leaks during activities that increase pressure inside the abdomen. Some women may experience urinary urgency, difficulty controlling urine, pelvic heaviness, or discomfort during physical activity. Even signs such as vaginal pressure and heaviness, urinary leakage during exercise, or difficulty controlling gas can also indicate pelvic floor dysfunction.

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Why Pelvic Floor Recovery Is More Than Just Kegel Exercises

Pelvic floor recovery is more than just doing Kegel exercises: Pelvic floor muscle exercises, commonly known as Kegels, will help to enhance muscle strength and bladder control if done as recommended by the expert. However, not everyone will need the same type or intensity of pelvic floor exercise. Some women tend to have weak pelvic floor muscles, while others may have muscles that are poorly coordinated. So, a pelvic health physiotherapist will help to assess pelvic floor strength, relaxation, coordination, breathing patterns, posture, and abdominal muscle function.

The expert will also help women to understand how the pelvic floor responds to activities such as coughing, lifting, or exercise. The aim will be to have a stronger pelvic floor contract and relax muscles when the body needs it. Breathing and pressure management within the abdomen will also be crucial for women during exercise and doing daily activities. Women may need guidance before returning to running, jumping, gym workouts, or other high-impact activities. Recovery should also be gradual.

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What Women Can Do To Support Pelvic Floor Health

What women should know: It will be important for women to maintain an optimum weight, exercise daily, quit smoking, avoid constipation by having fiber in the diet and staying hydrated. Quit smoking, use appropriate lifting techniques to reduce unnecessary strain on the pelvic floor, and don’t hold urine for a long time. Women who opted for a Caesarean section should also ensure they prevent pelvic problems.

Pregnancy itself causes pressure on the pelvic floor, so pelvic floor rehabilitation can be recommended for women with a C-section. Motherhood should not mean silently living with bladder problems. So, pelvic floor rehabilitation can improve bladder control and confidence in women.

Standing up suddenly from your bed, sofa or chair can sometimes cause a brief “head rush”, you may feel light-headed, notice your vision dimming, feel weak or even slightly unsteady. While this can feel alarming, there is a simple physiological explanation for why it happens.

When you stand up, gravity causes some of your blood to temporarily move towards your legs and abdomen. This reduces the amount of blood returning to the heart. Within seconds, the autonomic nervous system usually steps in by tightening the blood vessels and adjusting the heart rate to maintain blood pressure and ensure enough blood reaches the brain.

When A Sudden Drop In Blood Pressure Becomes A Concern

A brief drop in blood pressure during this transition can be normal. However, if the drop is too significant or the body is unable to compensate properly, it can lead to dizziness, blurred vision, weakness and, in some cases, fainting. Orthostatic hypotension is clinically defined as a sustained fall in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg within three minutes of standing.

Several factors can contribute to this, including dehydration, heat, prolonged inactivity, blood loss and medications that lower blood pressure. Recurrent episodes can also be linked to problems with the autonomic nervous system, including autonomic involvement in Parkinson’s disease and other neurodegenerative disorders.

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How To Prevent The Head Rush And When To Seek Help

One simple precaution is to avoid changing positions too quickly, especially after lying down for several hours. Sitting on the edge of the bed for a few moments before standing gives the cardiovascular system time to adjust. Moving your feet or tightening your leg muscles before getting up may also help improve blood flow back to the heart. If you start feeling dizzy, it is safer to sit or lie down rather than trying to walk through it.

An occasional, very brief episode may simply be the body’s normal response to a sudden change in posture. However, frequent episodes, fainting, falls, palpitations or persistent dizziness should not be ignored and warrant medical assessment, particularly in older adults or people taking multiple medications.

Dr Sachin Adukia Sr Consultant M.B.B.S., MD (General Medicine), DNB (Neurology), LH Hiranandani Hospital