We are very happy that we are losing weight without doing anything but let me tell you friends that it is not a matter of happiness, it is a matter of concern. We should always check that why it is happening with us. We need to take extra care in this matter. We have to think that is it our muscle that we are losing?
A new concept, sarcopenia is basically defined as generalized loss of muscle mass, muscle strength, muscle functioning and it is directly related to adverse outcomes.
Recent studies show the prevalence of sarcopenia in various disease conditions such as diabetes, kidney diseases.
There are 2 component that define sarcopenia are muscle mass and muscle function. The simple way of assessing the muscle mass is by estimating MUAC (mid upper arm circumference). The functional
component is measured by grip strength ad gait speed test.
Sarcopenia is a marker of frailty. Frailty is defined as vulnerability to adverse health outcomes. Sarcopenia reduces the quality of life as it reduces functional capacity. The prevalence of frailty is 32-48% in diabetics who are 65 years as compared to 5-10% who are non diabetics of same age group.
Skeletal muscle insulin resistance is the key link between sarcopenia and diabetes. Due to the reduced glucose availability in the muscle, gluconeogenesis takes place. (The literal meaning of Gluconeogenesis is GLUCO – glucose; NEO – new; GENESIS – creation. Thus Gluconeogenesis is a biochemical term that describes the synthesis of glucose or glycogen from substances which are not carbohydrates). This result in the breakdown of muscle protein to provide energy. High sugar level also leads to release of free fatty acids encourages the production of pro inflammatory cytokines. Lower mitochondrial (power house of the cell) oxidative capacity leads to reduce fat oxidation activity. Thus muscle mitochondrial dysfunction causes accumulation of intra myocellular lipid metabolites producing marbling. Anabolic hormones such as testosterone are shown to be lower in diabetic men. Reduced testosterone leads to a further decline in the synthesis of muscle protein and cell activation.
The key treatment for sarcopenia is physical activity. Since resistance exercises improve muscle mass and endurance exercise increases functional capacity. Exercise improves skeletal muscle synthesis by increasing capillary blood flow, nutrient delivery to the muscle and insulin sensitivity in a diabetic patient. However, exercise regime must be planned accordingly by keeping in mind the diabetic patient’s micro and macro vascular complications. In addition to this dietary screening should also be taken care with qualified person. Detecting sarcopenia at an early stage has the potential to positively impact on patient’s daily activity and quality of life.
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