The Double Whammy

Did you know that over 52% of people with diabetes also have arthritis? We reported on this finding in June 2008, but it still brings up questions such as: Why should this be? And what does it mean for people with one or both conditions? Does it tell us anything about treatment or self-management? Maybe it does.


Just as with diabetes, arthritis comes in two main types (and several less common ones). Like Type 1 diabetes, rheumatoid arthritis (RA) is an autoimmune disease. In RA, a person’s own white blood cells attack the lining of her joints. (Usually it’s a her — RA is two to three times more common in women.)

The other common form of arthritis is called osteoarthritis (OA). It is similar to Type 2 diabetes, in that it tends to come later in life. In the case of OA, this is because the joints wear down with age, just as insulin resistance tends to wear down the beta cells and cause Type 2.

Both arthritis and diabetes can cause similar symptoms. According to an Arthritis Foundation pamphlet, “diabetes causes musculoskeletal changes that lead to symptoms such as joint pain and stiffness, swelling… tight, thickened skin, trigger finger, carpal tunnel syndrome, painful shoulders, and severely affected feet.” So if you have both, it’s really a double whammy.

What’s the Connection?
According to the Centers for Disease Control and Prevention, people with OA and with Type 2 both tend to be less physically active. The CDC suggests that lack of movement is a major cause of both illnesses.

The common denominator in RA, OA, Type 1, and Type 2 is inflammation. The redness, heat, and pain you have in a foot or hand after an injury is caused by inflammation. Your body brings more blood to an injured or infected area and releases chemicals called cytokines that help healing.

Inflammation is supposed to last just a few days and then stop. Now imagine that hot, painful process going on throughout your body, or in your joints or in your pancreas. And not just for a few days, but for years. Can you see how it might cause problems? Inflammation contributes to beta cell destruction and insulin resistance, and it also damages joints. Treating inflammation with aspirin or similar drugs can improve glucose control and reduce insulin resistance.

The arthritis drug hydroxychloroquine (brand name Plaquenil) seems to lower blood glucose significantly, as does the RA treatment anakinra (Kineret). So there must be similar targets for these drugs, something similar about the conditions. (It’s interesting that Plaquenil was originally a drug for malaria. Might there be a connection there, too?)

What to Do?
Self-management of arthritis and diabetes have similarities, starting with exercise and stress reduction. Pain from arthritis can make exercise more difficult, though. Some ways to get moving are covered here and here. It’s important to treat your arthritis pain seriously, with medicines, hot and cold treatments, massage, rest, and creams or oils, so that you’ll be able to move.

Rest, relaxation, and healthy eating also help both diabetes and arthritis. Changing unrealistically negative thoughts is also known to help.

Be aware that if you use acetaminophen for pain, this could affect your blood glucose readings. It’s probably better to take a salicylate like aspirin instead. (Aspirin is not suitable for everyone, however, so be sure to check with your doctor before using this medicine.) If you are being treated by different doctors for your arthritis and diabetes, make sure they both know all the medicines you are taking. Some of the drugs for one condition could affect the other.

It can be really difficult to get moving and stay motivated when you have both diabetes and arthritis weighing you down. It can even be hard to get out of bed in the morning! If you have these twin conditions, what do you do to cope with them? Let us know. Many readers might benefit from your story.

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  • l garrow

    I have found that emotional stress raises my blood glucose readings and also causes much pain in my arthritic joints. I have to use my heating pad, vibrator in my chair, aspercreme and listen to music, or in some way separate myself from the “source” in order to find releif. The problem is I have no respit from continuing stress.

  • Taberge

    It wasn’t a double whammy for me. It was a triple whammy. Diabetes mellitus and sleep apnea and ankylosing spondylitis. Yes, the inflammation markers were in the red zone. I have been reading up on the fact that in some studies, diabetes mellitus may be seen as an autoimmune disorder. I’m wondering if there is a possible link between my arthritis and my diabetes. The fact that in both conditions artherosclerosis is a complication does not bode well for my long term well being.

  • Janet

    I was just recently (3 weeks) diagnoised with OA. I am a type 2 diabetic on an insulin pump and I have a triple by-pass, and am an epileptic. Any advise of working/treating the OA would be greatly appreciated.

  • David Spero RN

    Thanks for these stories. My heart goes out to all of you. Having multiple chronic conditions is really hard. I know people who are doing well with it, though.

    Janet, check out Arthritis Self-Management magazine and Arthritis Today, the publication of the Arthritis Foundation. You’ll have to learn a new set of skills like those you use for your diabetes. But they’re not that different. See Garrow’s comment above for some ideas.

    Taberge, there is an autoimmune component to diabetes and arthritis. It all seems to be about inflammation. That could also be contributing to heart disease. Do what you can to reduce inflammation — maybe starting with anti-inflammatory meds and stress reduction. Maybe your doctor or our readers have some ideas.

  • Pattie Thomas

    I was diagnosed with lupus in 1997 and took 200 mg of plaquenil 2x a day for 10 years. I was diagnosed with hypothyroidism (eventually discovered it was Hashimoto’s thyroiditis) and when I took levothyroxine many of my lupus symptoms went away. I stop taking the plaquenil and had a couple of doctors who suggested the lupus diagnosis may have been wrong. Within a year of stopping the plaquenil, I was diagnosed with diabetes. Fast forward 10 years and I have severe polyneuropathy even though both diabetes and thyroid are well controlled. My neurologist tested for autoimmune disorders and the ANA count was through the roof along with several other indicators that the lupus was back (skin rashes being the main decider). I was put on plaquenil last September. It takes a while for it to kick in but in the past few months, I have had to reduce my insulin by about 25%-30% and I’m still having lows and working on readjusting. My last A1C was 5.4. I am feeling better than I have in years. Even my neuropathy is improving and I was going to be happy with it just not getting worse.

    I wish I had seen this 9 years ago and I wish I had never went off the plaquenil. I am a strong believer that autoimmune and endocrine diseases are inter-related and that a more integrated approach needs to be developed. My endo is the best doctor I’ve ever worked with and the effect of plaquenil is news to her. I am a victim of specialization, imho. More integrative studies of these kinds of disorders and integrative therapies are sorely (pun intended) needed. I know I would have been saved from a lot of heart-ache. I am now wondering if I would have ever developed diabetes at all if I had stayed on the plaquenil.

    Anyway, thanks for your work, David and sorry I didn’t see this earlier.