Hair loss is a relatively common, although rarely discussed issue. It can affect many different people and can be a feature of diabetes.
Links have been discovered between hair loss and metabolic syndrome features, including insulin resistance and high blood sugar levels.
Addressing uncontrolled diabetes can help to manage hair loss. There may also be a benefit of vitamin supplementation among those who are deficient.
This article will provide an overview of hair loss as a complication of diabetes and outline some of the other main complications. We will explore some of the causes of hair loss and share some of the evidence around how to manage this side effect of diabetes.
What diabetes is and how it can affect the body?
Diabetes is a serious condition that can be characterized by one or more of the following (1):
- High blood glucose levels (hyperglycemia)
- Insufficient or inefficient insulin (type 2 diabetes)
- Insulin resistance
- The beta cells (that are produced by your pancreas), becoming damaged or completely losing their function
- In some cases, low blood glucose levels (hypoglycemia)
There are two main types of diabetes: Type 1 diabetes and Type 2 diabetes.
Type 2 diabetes is the commonest type of diabetes, thought to affect around 90% of people with the condition (2). Figures from the World Health Organisation (WHO) in 2014 showed that overall, diabetes affects an estimated 422 million people worldwide (3). The WHO also reports that diabetes was the seventh leading cause of death in 2016.
Both types of diabetes can lead to serious complications. These can be separated into micro and microvascular complications. They may also be referred to as acute or chronic complications. Acute complications are those that can happen at any time, whereas chronic complications build up over time (4).
Acute complications include:
- Hyperglycaemia (high blood sugar level). A hyper occurs when your blood sugar is too high.
- Hypoglycaemia (low blood sugar level). A hypo occurs when your blood sugar level is too low.
- Hyperosmolar Hyperglycaemic State (HHS). A HHS can occur among those who are severely dehydrated and experiencing significant hyperglycemia. HHS can be life-threatening and is a risk only for those with type 2 diabetes.
- Diabetic Ketoacidosis (DKA). DKA is another acute complication of diabetes that can be life-threatening. DKA can result from a significantly high blood sugar level (hyperglycemia) and insulin deficiency, which can lead to a build-up of ketones.
Chronic complications include:
- Cardiovascular disease and associated complications. Poorly controlled diabetes can increase your risk of having a heart attack or experiencing a stroke.
- Problems with your eyes (retinopathy). Uncontrolled diabetes can lead to problems with your eyes, also called diabetic retinopathy.
- Problems with your kidneys (nephropathy). Your kidneys are responsible for clearing waste and fluid from your body, as urine. Over time, persistent hyperglycemia and hypertension can lead to kidney damage and issues with your kidney function.
- Nerve damage (neuropathy). Nerve damage can affect every part of your body, from how you see, feel, and hear. It can occur in people living with diabetes due to high blood sugar levels.
- Problems with your feet. Nerve damage can affect the feeling in your feet. Your circulation can also be affected by high blood glucose levels, which makes cuts and injuries harder to heal. Foot problems in people with diabetes can be serious and can lead to amputation if not identified and treated appropriately.
- Gum disease. Persistent hyperglycemia can lead to excess sugar in your saliva. This brings bacteria that leads to the production of acid, which can increase the risk of infection and cause gum damage.
- Hair loss, which can occur on your head, but also on other parts of your body, like your arms and legs. Damaged blood vessels can struggle to deliver sufficient oxygen to nourish your hair follicles. This lack of oxygen can negatively affect your normal cycle of hair growth.
Both acute and chronic complications can be caused by uncontrolled diabetes and persistently high blood glucose levels. Over time, having persistent hyperglycemia can damage blood vessels, which can lead to the above complications as they cannot do their job properly.
For example, damage to your blood vessels surrounding your heart can occur due to prolonged hyperglycemia, which, as already mentioned, can sometimes lead to heart attacks and strokes. High blood pressure (hypertension) and raised blood lips (hyperlipidemia) can also lead to damaged blood vessels around your heart.
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Diabetes management
However, there are lifestyle modifications you can make that can help you better manage your diabetes, thus reducing your risk of complications (4).
- Smoking. Giving up smoking is the best thing you can do if you have diabetes. For those living with diabetes, smoking makes it more difficult for blood to flow around your body.
- Diet. There are dietary changes you can make that can help you to improve your HbA1c levels. For example, eating more fruit and vegetables and whole grains reduces your intake of refined carbohydrates, and eats more healthy fats like the polyunsaturated fats found in nuts, seeds, and oily fish. Check out these articles for more information on suitable dietary changes for managing diabetes, and some great recipes.
- Exercise. There is evidence to support the benefits of exercise for reducing HbA1c among those with diabetes. Studies have shown significant reductions in HbA1c among those who take part in regular physical activity.
- Stress, sleep, and wellness. It’s not all about what you eat and how you move. How you think and relax can have an impact on your health, too! In this study, the researchers looked at the effect of meditation on those with coronary artery disease (CAD). CAD is strongly linked with insulin resistance and risk of type 2 diabetes. They found that within the group who practiced meditation and mindfulness for 6 months, a significant decrease was seen in, blood glucose levels, glycosylated hemoglobin (HbA1C), serum insulin levels.
Hair loss in diabetes
As previously mentioned, hair loss is also a complication of diabetes. Yet, interest has also been expressed around exploring the relationship between hair loss among those who do not have diagnosed diabetes but are susceptible to the disease.
In this 2016 study, damage to hair follicles was hypothesized as being a useful early marker for the risk of developing type 2 diabetes and chronic complications, including damage to organs and blood vessels.
The rationale was focused on the fact that there has been an association found between insulin resistance and alopecia in individuals without diabetes. Furthermore, hair loss on the legs has been found to be a key characteristic among the presentation of peripheral arterial disease (PAD) in type 2 diabetes.
Hair loss among those living with diabetes is a lesser-known complication, but one that can significantly impact the quality of life for those who experience it (5). A common cause of hair loss is androgenetic alopecia, which affects both men and women (an estimated 50 million men and 30 million women in the United States).
Androgenetic alopecia can start in teenage years, with the risk increasing with age. It is estimated that more than 50 percent of men aged 50 and above have some degree of hair loss, whilst in women, menopause is a pinnacle time for the risk of hair loss, and incidence increases during this phase (6).
This next section of the article will explore what causes hair loss in diabetes and what you can do to address it.
Common causes of hair loss in people with diabetes
Firstly, we will be looking briefly at a condition called alopecia areata. Alopecia areata is an autoimmune condition that can lead to patchy hair loss.
Over time, this patchy hair loss can lead to more significant hair loss that covers larger areas of the head. The causes of alopecia areata are not well known, although it appears to be more common among those who have a family history of autoimmune conditions, including type 1 diabetes. Alopecia aerates differs from telogen effluvium, which is hair loss, usually as a result of stress or shock.
As mentioned, androgenetic alopecia is another and the most common form of hair loss or thinning hair. It can occur in men and women, and in men, it can also be known as male-pattern baldness.
Table 1 shows a few key differences between the presentation of androgenetic alopecia in men and women and lists some of the associated conditions, such as PCOS and diseases related to insulin resistance, including diabetes (6).
Table 1: key characteristics of androgenetic alopecia, and associated conditions (5)
Whilst the mechanisms leading to hair loss is somewhat unknown, there have been studies looking into which populations experience hair loss the most frequently, and what this may be attributed to. In this 2019 study looking at hair loss among African American women with type 2 diabetes, an increased risk of severe central scalp loss was found.
The researchers recommended that this patient group with type 2 diabetes be assessed closely for hair loss or hair thinning to discuss appropriate treatment options. In this particular ethnic population group, hair loss has been found to be higher among those with type 2 diabetes. The researchers suggested that hyperglycemia leading to vascular impairment can damage the hair follicles, contributing to hair loss.
Among non-black populations (mainly men), this study found androgenetic alopecia to be associated with insulin resistance and other key characteristics of the metabolic syndrome. The myriad of evidence in this area demonstrates that there is a link between diseases related to insulin resistance and hair loss.
We have already discussed how persistently high blood glucose levels can lead to damaged blood vessels. Consequently, your blood vessels can struggle to deliver sufficient oxygen and necessary nutrients to your hair follicles. As a result, the lack of oxygen and nutrients can impact your normal cycle of hair growth.
Although links between certain metabolic conditions and androgenetic alopecia have been found, there is still a lot of unknown. Researchers have, however, concluded that this form of hair loss is associated with hormones called androgens. In particular, an androgen called dihydrotestosterone (also called DHT) (6). Androgens have functions including the following:
• Regulating hair growth
• Sex drive control
• Sexual development in boys, before birth, and during puberty
Studies have shown that DHT can affect hair follicles by causing shrinkage of the hair follicle. This leads to problems like hair thinning and can lead to signs of male pattern baldness too.
The hair growth cycle and diabetes
Hair growth begins under the skin within hair follicles. During the process, the following happens (6):
• Each strand of hair grows, usually for 2 to 6 years
• They then go into a ‘resting phase’ for several months, after which time, they fall out
• This cycle restarts when the follicle starts to grow a new hair
When increased levels of androgens in hair follicles are present, the following can happen:
• The cycle of hair growth can be shorter
• The hair that does grow can be shorter, with thinner strands
• There can be a delay in the growth of new hair to replace lost strands
For those living with diabetes, the following can contribute to an interruption in the hair growth cycle:
- Thyroid disorders. The two types of thyroid disorder, hypothyroidism, and hyperthyroidism, are common among people with diabetes, particularly type 1 diabetes. Thyroid disorders in type 1 diabetes are related to autoimmunity, whereas the cause in type 2 diabetes is unknown (though the association is less common). Thyroid disorders can be treated with tablets, although it does have side effects. One of these is a hard loss. The Thyroid UK charity website contains lots of information about how to manage hair loss as a result of hypo or hyperthyroidism. For example, they recommend considering if your diet may be deficient in certain nutrients, and always consulting a healthcare professional if you are not sure. See the next section of this article for information about what you can do to treat hair loss in diabetes.
- High blood sugar levels. As we have mentioned, when blood vessels are damaged, they cannot deliver nutrients that your hair needs to stay healthy and complete the growth cycle.
- Anaemia. Iron deficiency anemia can cause hair loss. When you aren’t consuming enough iron in your diet, your body can’t produce adequate hemoglobin in your blood. Hemoglobin carries oxygen, which is required for the growth and repair of cells in your body. This includes the cells that stimulate hair growth (7). Iron deficiency may not necessarily be linked to diabetes. Good iron sources in your diet include red meat, poultry, pulses, beans and lentils, green leafy veg, and dried fruit and fortified grains. Rich sources of vitamin C can help you to absorb iron from non-meat sources (if eaten alongside them).
There have been other vitamins and mineral deficiencies linked to the incidence of hair loss, including vitamin B12 and vitamin C, and fat-soluble vitamins D and E. Biotin deficiency and since deficiency have also been linked to hair loss. (8,9,10).
What can I do about my hair loss?
Firstly, if you have uncontrolled diabetes in the form of persistent high blood sugars, this should be addressed. This may include making dietary or lifestyle changes or adjusting your diabetes medication. Speak with your diabetes specialist team if you are concerned about your blood sugar levels.
Addressing any nutrient deficiencies can be a way to try and prevent or treat hair loss. You can do this with your diet, although it is recommended that you speak with a registered nutrition professional if you are concerned about your diet’s adequacy. If you have been identified as having a specific nutrient deficiency, supplements may help (8,9,10).
However, it is more important that you address the underlying cause of hair loss, so if this is uncontrolled blood sugar levels, then consider focusing on this before you supplement as excess amounts of some vitamins can be toxic. As always, speak with your diabetes team before you make any changes to your treatment.
Finally, there are practical steps you can take to maintain the health of your hair. These include limiting treatments such as bleaching or coloring with other harsh chemicals or tying it back with tight bands. Aim to brush, wash, and dry your hair gently and limit heat treatments.
Conclusion
Hair loss can be common among some populations with diabetes, and can also occur among those who do not have the condition. The causes are not fully known, but research has shown a link between hair loss and high blood sugar levels, as well as nutrient deficiencies.
Speak with your diabetes healthcare team if you are interested in finding out more about treatments that may include a medication review, dietary changes, or vitamin supplementation.
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