Diabetes is one of the most common chronic conditions in the United States. According to the CDC's National Diabetes Statistics Report, around 40 million Americans have diabetes — about 12% of the population — and roughly one in four of them doesn't yet know it. A further 115 million adults have prediabetes.
This article covers what actually drives type 2 diabetes, the day-to-day factors that move your blood sugar, how diabetes affects your lungs and breathing, and where breathing practice genuinely fits in. It also covers where it doesn't — because there is a lot of overstated information about oxygen and diabetes online, and you deserve a straight answer.
What Causes Diabetes?
The two main types have very different causes:
- Type 1 diabetes is an autoimmune condition. The immune system destroys the insulin-producing beta cells in the pancreas. It is not caused by diet or lifestyle, and it requires insulin.
- Type 2 diabetes has multiple contributing causes: genetic predisposition, body composition, physical activity levels, sleep, chronic stress and long-term dietary patterns.
Why Prediabetes Matters as Much as Diabetes
In type 2 diabetes, insulin resistance usually develops years before blood sugar rises enough to trigger a diagnosis. High blood sugar is the measurable result of that process rather than its starting point — which is why prediabetes is not a mild warning, and why a normal glucose reading doesn't mean nothing is happening.
Here's the mechanism in plain terms:
- After you eat, food is broken down into glucose and the pancreas releases insulin.
- Glucose is stored in the liver and muscles as fuel — but these have limited storage space. Think of them as bags that fill up.
- Once they're full, insulin escorts the excess glucose to fat cells, where it's stored as fat.
- When fat cells also stop accepting it, glucose stays in the bloodstream. That's when blood sugar readings start to climb.
Two things worth knowing:
- The liver loses insulin sensitivity first, followed by muscle and then fat tissue. By the time a glucose test flags a problem, insulin resistance is usually well established.
- Being thin doesn't rule it out. A significant minority of people with insulin resistance are not overweight — sometimes described as "skinny fat", where fat is stored around the organs rather than visibly.
What Affects Your Blood Sugar Day to Day
Artificial sweeteners can alter your glucose response
Non-caloric artificial sweeteners are often chosen to avoid the glucose spike that comes with sugar. The picture is more complicated than that.
- Research published in Nature found that commonly used artificial sweeteners can drive glucose intolerance by altering the composition and function of gut bacteria (Suez et al., 2014).
- A 2013 study in Diabetes Care found that when obese, non-insulin-resistant participants drank a sucralose-sweetened beverage before a standard glucose load, their blood sugar and insulin peaked higher than when they drank water.
- Gut bacterial profiles differ measurably between people with and without type 2 diabetes, and between those with and without impaired glucose tolerance.
There is also an ongoing debate about whether intense sweeteners increase appetite for sweet food. If you'd rather avoid synthetic sweeteners, stevia and monk fruit are widely available alternatives.
Dehydration concentrates your blood sugar
When you're dehydrated, the glucose in your circulation becomes more concentrated, which raises blood sugar readings. High blood sugar then increases urination, which worsens the dehydration. Staying properly hydrated is one of the simplest things you can control.
Some medications affect glucose control
Both prescription and over-the-counter medicines can move your numbers:
- Raise blood sugar: corticosteroids (used for inflammatory conditions, autoimmune disease and asthma), some birth control pills, certain antidepressants and antipsychotics, diuretics, and nasal decongestants.
- Lower blood sugar: some medications can push glucose low enough to cause hypoglycaemia.
Never stop or change a prescribed medication on your own. Raise it with your doctor or pharmacist instead.
Irregular sleep disrupts glucose control
Short or broken sleep does more than affect your mood. Insufficient sleep is associated with impaired glucose control and reduced insulin sensitivity, and it acts on the body as a form of chronic stress — which itself raises blood sugar. A consistent sleep schedule is one of the higher-leverage changes available to most people.
Caffeine: the picture is mixed
- Some research associates regular coffee drinking (three to four cups a day) with a reduced risk of developing type 2 diabetes in healthy people.
- In people who already have diabetes, caffeine can affect how insulin behaves and may produce swings in either direction.
- The Mayo Clinic notes that up to 400 mg of caffeine daily is safe for most adults — but if you have diabetes, you may notice changes in your readings after as little as two 8-ounce cups of brewed coffee.
The practical advice: test around your usual coffee intake and see what your own numbers do.
How Diabetes Affects Your Breathing and Lungs
Breathing difficulty is not a typical symptom of diabetes, but the risk of respiratory problems is higher in people with diabetes than in the general population. Four connections are worth understanding.
Diabetic ketoacidosis and Kussmaul breathing
Deep, rapid, laboured breathing — Kussmaul breathing — is a sign of diabetic ketoacidosis (DKA). DKA happens when very high blood glucose combines with high levels of ketones in the blood, usually because there isn't enough insulin. Without insulin, the body breaks down fat for fuel and acidic ketones accumulate.
DKA is a medical emergency. Symptoms can escalate within 24 hours, and untreated DKA can be fatal. If you or someone you're with has diabetes and develops rapid deep breathing, fruity-smelling breath, vomiting or confusion, seek emergency care immediately.
Breathlessness and kidney disease
Kidney disease is one of the most common complications of diabetes, affecting a large proportion of people with the condition. New breathlessness — for instance on climbing stairs — can be a sign of declining kidney function. Chronic kidney disease also causes anaemia, which means fewer red blood cells to carry oxygen, and that shows up as shortness of breath on exertion.
Obstructive sleep apnoea
People with type 2 diabetes have a substantially higher rate of obstructive sleep apnoea, and excess body weight is a major driver of both. The relationship runs both ways: disrupted sleep and interrupted breathing affect circadian rhythm and glucose regulation, while poor glucose control and weight gain worsen apnoea. If you snore heavily, wake unrefreshed or have been told you stop breathing in your sleep, a sleep study is worth asking about.
Flu and chest infections
People with diabetes are at higher risk of developing pneumonia as a complication of influenza. Viral infections also raise blood glucose and increase the short-term risk of DKA and hyperosmolar hyperglycaemic state (HHS). Annual flu vaccination is standard advice for people with diabetes for exactly this reason.
What Research Says About Oxygen and Insulin-Producing Cells
There is a genuine and active line of research into how oxygen availability affects the cells involved in diabetes.
Laboratory studies have shown that oxygen levels influence how pancreatic beta cells and fat cells behave, largely through a protein called hypoxia-inducible factor 1-alpha (HIF-1α). This work spans beta cell differentiation, insulin signalling in adipocytes, and islet cell survival (Moritz et al. 2002; Carroll & Ashcroft 2006; Regazzetti et al. 2009; Halberg et al. 2009; Heinis et al. 2010; Cheng et al. 2010 — full references below).
Important context: this is cell culture and animal research. It does not show that low cellular oxygen causes diabetes in people, and it does not mean that breathing more oxygen treats diabetes. It is a mechanism worth following, not a therapy.
A related area is transplantation. When insulin-producing cells are transplanted, many die in the early stages before the body builds a blood supply to them, and pancreatic cells need a lot of oxygen to survive. Biomaterials designed to supply oxygen directly to grafted cells are in testing, and if they work they could improve transplant success for people with type 1 diabetes. That research is at an early stage.
Oxygen Therapy and Diabetes: What's Established and What Isn't
This is where online information about oxygen and diabetes goes badly wrong, so here is the honest position.
What is established: hyperbaric oxygen therapy is used in hospitals as an add-on treatment for some non-healing diabetic foot ulcers. That is a pressurised, prescribed treatment delivered under medical supervision, and the evidence supporting it is specific to that setting and that indication.
What is not established:
- Breathing supplemental oxygen is not a treatment for diabetes.
- Exercise With Oxygen Therapy (EWOT) is not a treatment for diabetes or for any diabetes complication, and we don't sell it as one.
- There is no good evidence that supplemental oxygen prevents glaucoma, regenerates damaged nerves, or reverses diabetic neuropathy.
In a healthy person at rest, blood is already around 97–98% saturated with oxygen. That's why "more oxygen" is not the lever it's often presented as. If you have diabetes, your blood sugar management belongs with your medical team.
Can Breathing Exercises Help With Diabetes?
Breathing exercises are not a blood-sugar treatment. What the research points to is indirect — and indirect doesn't mean worthless, because the pathways involved are real ones.
Stress and the nervous system
Chronic activation of the sympathetic ("fight or flight") nervous system is associated with worse insulin sensitivity, and stress hormones raise blood glucose directly. Slow, diaphragmatic breathing shifts the balance towards parasympathetic activity, which is the measurable physiological basis for its calming effect. Whether that translates into better insulin sensitivity over months has not been established.
What one study actually found
A small 2011 study is often cited on this topic, and it's worth reporting accurately. Martarelli and colleagues had 16 healthy volunteers eat a 900-calorie, high-carbohydrate breakfast. Eight then performed 40 minutes of diaphragmatic breathing; the other eight sat quietly and read. The breathing group showed a lower heart rate and less oxidative stress afterwards (Martarelli et al., 2011).
Two caveats matter: none of the participants had diabetes, and the study measured the hours after a single meal rather than long-term glucose control. It's a reason to find slow breathing interesting. It isn't evidence that breathing manages diabetes.
Sleep
Slow breathing before bed is a well-established way to make falling asleep easier, and better sleep is independently linked to better glucose control. For anyone with sleep apnoea, breathing exercises are not a substitute for CPAP or for medical assessment.
Weight
Breathing exercises don't burn fat by themselves. Where they help is indirectly: lower stress and better sleep both make weight management easier, and weight loss is one of the most reliable ways to improve insulin sensitivity.
What's Actually Worth Doing
If you have prediabetes or diabetes, the levers you control day to day are unglamorous and effective:
- Take your prescribed treatment as directed, and talk to your doctor before changing anything.
- Monitor your glucose and learn your own patterns — including how your readings respond to coffee, poor sleep and stressful days. Note that HbA1c alone doesn't capture everything about your risk.
- Build regular physical activity into your week. Muscle is where a large share of glucose gets used.
- Protect your sleep schedule. Consistency matters more than perfection.
- Get assessed for sleep apnoea if you snore heavily or wake unrefreshed.
- Use breathing practice for what it's good at — managing stress and winding down before sleep — alongside your care, not instead of it.
- Have the flu vaccination conversation with your doctor.
Frequently Asked Questions
Does breathing exercise lower blood sugar?
Not directly, and it shouldn't be relied on to. Breathing exercises can reduce stress and improve sleep, and both of those support glucose control indirectly. They are not a replacement for prescribed treatment.
Does EWOT treat diabetes?
No. Exercise With Oxygen Therapy is not a treatment for diabetes or for any diabetes complication. If you have diabetes and want to start any new exercise programme, including EWOT, talk to your doctor first.
Can low oxygen cause diabetes?
Laboratory research shows that oxygen levels affect how insulin-producing cells and fat cells behave, but this has not been shown to cause diabetes in people. Type 2 diabetes develops through insulin resistance driven by genetics, body composition, activity, sleep and diet.
Why am I short of breath if I have diabetes?
There are several possible reasons, including kidney disease and associated anaemia, sleep apnoea, heart problems, or — as an emergency — diabetic ketoacidosis. New or worsening breathlessness in someone with diabetes should be assessed by a doctor rather than self-managed.
Is diabetes reversible?
Type 1 diabetes is not. For type 2, some people achieve sustained remission — normal blood sugar without medication — most often through significant weight loss. That is a goal to pursue with a medical team, not something to attempt by stopping treatment.
A Note on Medical Advice
This article is for general education. It is not medical advice, it is not a diagnosis, and it is not a treatment plan. Diabetes is a serious condition that needs professional management. Please don't change your medication, insulin or monitoring routine based on anything you read here — talk to your doctor or diabetes care team.
References
- Centers for Disease Control and Prevention. National Diabetes Statistics Report. cdc.gov
- Suez J, Korem T, Zeevi D, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014;514(7521):181–186. Link
- Martarelli D, Cocchioni M, Scuri S, Pompei P. Diaphragmatic breathing reduces postprandial oxidative stress. Journal of Alternative and Complementary Medicine. 2011. Link
- Moritz W, Meier F, Stroka DM, et al. Apoptosis in hypoxic human pancreatic islets correlates with HIF-1alpha expression. FASEB J. 2002;16(7):745–747.
- Carroll VA, Ashcroft M. Role of hypoxia-inducible factor (HIF)-1alpha versus HIF-2alpha in the regulation of HIF target genes. Cancer Res. 2006;66(12):6264–6270.
- Chen B, Lam KS, Wang Y, et al. Hypoxia dysregulates the production of adiponectin and plasminogen activator inhibitor-1 independent of reactive oxygen species in adipocytes. Biochem Biophys Res Commun. 2006;341(2):549–556.
- Glassford AJ, Yue P, Sheikh AY, et al. HIF-1 regulates hypoxia- and insulin-induced expression of apelin in adipocytes. Am J Physiol Endocrinol Metab. 2007;293(6):E1590–E1596.
- Halberg N, Khan T, Trujillo ME, et al. Hypoxia-inducible factor 1alpha induces fibrosis and insulin resistance in white adipose tissue. Mol Cell Biol. 2009;29(16):4467–4483.
- Regazzetti C, Peraldi P, Grémeaux T, et al. Hypoxia decreases insulin signaling pathways in adipocytes. Diabetes. 2009;58(1):95–103.
- Heinis M, Simon MT, Ilc K, et al. Oxygen tension regulates pancreatic beta-cell differentiation through hypoxia-inducible factor 1alpha. Diabetes. 2010;59(3):662–669.
- Cheng K, Ho K, Stokes R, et al. Hypoxia-inducible factor-1alpha regulates beta cell function in mouse and human islets. J Clin Invest. 2010;120(6):2171–2183.
