Insulin is a hormone that amongst its many functions helps control blood glucose levels. It also plays a part in bone formation and the reduction of cellular inflammation. For diabetics who either produce too little or no insulin (type 1); or don’t respond to the insulin they produce (type 2) lack of insulin can be a problem.
Type 1 diabetes (T1D) risks:
- T1D often occurs at a young age when bone mass is still being accrued. It is possible that people with T1D achieve lower peak bone mass (the maximum strength and density that bones reach). People usually reach their peak bone mass by age 30. Low peak bone mass can increase one’s risk of developing osteoporosis later in life.
- Duration of diabetes seems to play a role too. Patients who have had diabetes for >5 years have shown to have lower Bone Mass Density (BMD). In the Iowa Women’s Health Study, women with type 1 diabetes were 12.25 times more likely to report having had a fracture compared to women without diabetes.
- Pre-pubescent T1D girls have a reduced rate of calcium retention (weber, et al). This is due to increased calcium excretion through the urine, rather than through reduce calcium absorption.
Type 2 diabetes (T2D) risks:
T2D is often characterised by those who are overweigh. Weight bearing exercise helps build skeletal strength and T2Ds tend to gain a slight bone density benefit from carrying this excess weight. However, although bone density is increased, fracture rates are too. The sedentary lifestyle often associated with T2Ds affects balance and muscle strength, which may increase the risk of falls. Uncontrolled blood sugar levels may increase the risk of inflammation, infection, and poor wound healing.
The body doesn't produce calcium, so it relies on calcium from the diet to meet its daily requirement. Vitamin D is needed to help the body absorb calcium effectively and although it does occur in some foods (such as oily fish, egg yolks and mushrooms) vitamin D from sunshine is the most easily absorbed form.
Beans and Bones:
Although beans contain many valuable nutrients (including calcium, fibre, magnesium and b-vitamins) they also contain a substance known as phytates. Phytates interfere with the body’s ability to absorb calcium. To reduce the phytate level, pre-soak the beans before cooking. Be sure to use fresh water when cooking.
Coffee and soft drinks:
Coffee and cola appear to have some effect on women’s bone density and calcium absorption, although the same has not been found true for men. Other soft drinks, such as lemonade don't seem to have the same effect, and it is believed that the phosphates found in cola drinks are to blame. If you enjoy drinking coffee, try to stick to no more than 3 cups a day and ensure you’re getting enough calcium in other parts of your diet.
The National Osteoporosis Foundation (NOF) recommends that adults get at least 1,200 mg/day of elemental calcium and 400–800 IU/day of vitamin D. Supplements should be taken with meals to enhance absorption.
Get enough Sunshine:
90% of our vitamin D supply comes from the skin’s production of this nutrient through sunlight activation. Read my blog on Vitamin D and Diabetes.
Exercise can have many clinical benefits. In addition to improvements in bone mass, it also results in improved overall muscle strength, and blood glucose control. If you get the chance, why not exercise outside to double up on the bone benefits!
American Diabetes Association; Diabetes and your joints: Clinical Diabetes 2001, Jul; 19(3): 136-136
Chau, DL; Edelman, SV; (2002); Osteoporosis and diabetes, Accessed: 22 Oct 2017; Available at: http://clinical.diabetesjournals.org/content/20/3/153
Green, MF, et al: (2002); Diabetic foot: Evaluation and Management. Available at: http://go.galegroup.com/ps/anonymous?id=GALE%7CA83036749&sid=googleScholar&v=2.1&it=r&linkaccess=fulltext&issn=00384348&p=AONE&sw=w&authCount=1&isAnonymousEntry=true
Klein, GL; (2014): Insulin and bone: recent developments; Accessible at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932424/
NIH, Osteoporosis and related bones diseases; Accessible at:https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/diabetes
Weber, DR, et al; (2017): Evidence of disordered calcium metabolism in adolescent girls with type 1 diabetes; Available at: https://www.ncbi.nlm.nih.gov/pubmed/28882565