Diabetes-related problems

Q: I’m 68 and have had Type 2 diabetes for 12 years. My oral medications work pretty well, but I am beginning to have some memory issues and I don’t feel as steady as I used to. I read something about a nasal insulin spray that might help. Any info would be appreciated.

Jessie R., Louisville, Kentucky A: Type 2 diabetes causes a wide variety of complications, including premature brain aging and dementia. That’s because insulin doesn’t just regulate blood glucose levels, it’s also used in the brain to allow blood vessels and neurons to interact correctly. If there is a lack of insulin production and/or insulin resistance, as happens in Type 2 diabetes, that diminishes brain function.

Also, slow walking speed and unsteady gait may be signs of an inadequate blood flow to the brain, and that can cause cognition problems.

Recently, Harvard researchers, some with ties to the pharma company that makes the insulin nose spray, conducted a phase 2, randomized, double-blinded trial looking at 24 weeks of treatment with intranasal regular insulin spray and 24 weeks of follow-up observation. The researchers saw that the participants taking the nasal spray had better executive functioning while getting treatment — and afterwards — and better memory during follow-up. They also had a faster walking speed than before treatment.

It’s too soon to know if this will truly become a therapy for diabetes-related cognition and mobility problems. A couple of phase 3 trials that show longterm benefits and risks compared to other newer diabetes meds such as GLP-1 and SGLT2 and FDA review are still needed. What we do know is that if you maintain tight control of your Type 2 diabetes, you can do a lot to protect yourself from brain and body complications. So, enjoy brain games (Google “speed of processing games”) and ask your doctor for a referral to a diabetes educator, nutritionist and physical therapist who can help you design a lifestyle renovation to enhance your cognition and mobility.