Many people are familiar with type 1 and type 2 diabetes. That’s because nearly 100 million adults in the U.S. have prediabetes or diabetes, according to the Centers for Disease Control and Prevention.

The economic impact of diabetes in the U.S. has steadily increased over the years and is now estimated at $327 billion, based on data from the American Diabetes Association. The costs have increased 26% since 2012. But, what do we know about type 3 diabetes? A body of research suggests a link between Alzheimer’s disease and diabetes based on many factors, including insulin resistance and brain cognition, according to research published in the Journal of Diabetes Science and Technology.

“Type 3 diabetes accurately reflects the fact that (Alzheimer’s disease) represents a form of diabetes that selectively involves the brain and has molecular and biochemical features that overlap with both type 1 diabetes mellitus and T2DM,” according to the researchers.

We need more research to better understand risk factors related to type 3 diabetes. But, researchers note those with diabetes are twice as likely to develop dementia as people without diabetes, said Gary W. Small, MD, professor of psychiatry and biobehavioral sciences at the UCLA Semel Institute for Neuroscience and Human Behavior.

We need to know more

But still, there are many unknowns when it comes to type 3 diabetes, Small said. Various research studies reveal correlations and shortcomings as researchers try to connect the dots between diabetes to Alzheimer’s.

“Type 3 diabetes is an interesting concept but doesn’t exactly fit what we see with most dementias where you have symptoms, like memory and confusion problems, but not necessarily low blood sugar,” he said.

“In studies of patients with the most common form of dementia, Alzheimer’s disease, with brain PET scans that use a radioactively-labeled form of glucose (FDG) show patterns of glucose uptake that are lower in certain parts of the brain that control memory and thinking,” Small said. “If Alzheimer’s dementia were truly type 3 diabetes, we’d see reduced glucose uptake throughout the brain, not just in areas controlling memory and thinking.”

In support of Small’s point, in a study published in the Journal of Nuclear Medicine, Mayo Clinic researchers explore how faulty insulin signaling affects brain metabolism as it relates to Alzheimer’s using FDG PET scans.

An educator’s insight on type 3 diabetes

Richard Main, MEd, NRP, has worked in EMS since 1993. Main is one of our lead instructors for Distance CME and a professor of emergency medical services at the College of Southern Nevada.
We caught up with Main to get his take on type 3 diabetes since he teaches a course on the subject.

Q: Do you think we need to raise awareness about type 3 diabetes?

In my opinion, awareness of type 3 needs to start with health class in middle school. The signs and symptoms of Alzheimer’s can take up to 10 years to manifest. By then it is too late.
Adults, in general, are not good about implementing lifestyle changes. This is a reason we introduce cardiovascular education in middle school health class. It’s too late before we realize it’s a problem and atherosclerosis starts at 14 years of age.

Q: Compared to types 1 and 2, are treatment protocols different with type 3?

Our treatment is not to resolve the Alzheimer’s but to manage the patient. We would manage this patient like we would for any other patient with an altered mental status. That is, work through the AEIOU-TIPS mnemonic and apply the correct treatment protocol as needed.

Q: What do paramedics need to be aware of if they suspect someone has type 3 diabetes?

Be prepared for a patient who needs regular orientation to the situation and environment. Be prepared to restrain for safety, if necessary, and allowed by protocol.

Q: What if a patient becomes combative? What should paramedics do when they need to inject the person with insulin or glucagon?

See above. As paramedics, we do not administer insulin. We should assess the patient’s blood sugar as part of the altered mental status protocol. If needed, we can administer D50, D10 or glucagon as per protocol.

Q: What if a person in advanced stages of Alzheimer’s becomes aggressive or combative toward the paramedic?

We should be prepared for an Alzheimer’s patient to become aggressive and to restrain as necessary for safety.

Q: It’s unclear to what extent the American Diabetes Association and other medical professionals accept type 3 diabetes as a clinical diagnosis. Do you think that matters?

While the American Diabetes Association may not have recognized type 3, it is being discussed by others like the Mayo Clinic. Yes, there is a lot of research we need. But we also have 10 years of research to support the connection.

American researchers also recently claimed that Metformin has a protective effect on the parts of the brain damaged by Alzheimer’s. Meformin has become a commonly prescribed medication for type 2 diabetics.

In the United Kingdom, studies closely link Alzheimer’s to type 2 diabetes. Researchers found that the beta-amyloid plaque and the Tau tangles that interfere with normal brain function block communication between brain cells in the pancreases of type 2 diabetics.

Learn more about type 3 diabetes in our Live Individual ALS L-9 – Diabetic, Seizures, Infectious Disease course.