Diabetes Management

Can High Ozone Levels Cause Significant Lung Damage in Diabetics?

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By Apollo 24/7, Published on - 19 December 2020, Updated on - 11 December 2023

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Research has revealed that air pollution is responsible for 9% of deaths globally, while the range can vary from 2% to 15% in different countries. Air pollution is the combination of particulate matter present outdoor and indoor, along with ozone. Ozone is a gas that is naturally present in the stratosphere (second layer of the atmosphere), protecting the earth from the harmful rays of the sun.
However, when sunlight reacts with the nitrogen oxides and other volatile organic compounds (released by burning of fuels from motor vehicles, industrial facilities, electric utilities, and chemical solvents), ozone is produced at the ground level too. Various studies have concluded that exposure to high levels of ozone can increase the risk of morbidity and mortality. However, recent studies have shown that diabetics exposed to excessive ozone levels in polluted air could be at higher risk of suffering from permanent lung damage.

How is ozone gas harmful to the lungs?

Ozone and smog are often used interchangeably as smog is made up of ozone and other particulate matter, and both are known to exacerbate upper respiratory illnesses such as asthma, bronchitis, emphysema and rhinitis (inflammation of the mucous membrane inside the nose). Previous studies conducted on pre-diabetic rodents to determine the harmful effects of ozone concluded that ozone exposure can negatively affect the heart rate, blood pressure, and can result in adipose tissue (fat tissue) inflammation. Various experiments conducted on rodents and humans concluded that continuous exposure to ozone can result in:
  • Inflammation of the space between the lungs and its parenchyma (outer covering)

  • Increased production of inflammatory mediators in the lungs

  • Increased risk of asthma 

  • Change in the architecture of lungs

  • Scarring of the lungs resulting in idiopathic pulmonary fibrosis

Recent studies have concluded that high concentrations of ozone can cause lung restriction and stiffness, ultimately leading to severe complications.

How do high ozone levels affect the lungs of people with diabetes?

In a study published in the journal Environmental Health Perspective on 30th November 2020, scientists determined the effects of ozone gas on pre-diabetic and diabetic mice. In this study, researchers examined 24 mice and divided them into three categories: healthy, those with mild insulin resistance and the ones with extreme insulin resistance. The mice in different categories were further divided into experimental group and control group. The control group was exposed to filtered air, while the experimental group was exposed to ozone gas for 13 days, four hours each day.
The results of the study showed that:
  • There is a direct relationship between insulin resistance levels and the severity of inflammation and scarring in the lungs.

  • Diabetes prone subjects were more susceptible to inflammation and showed excessive changes in the lung tissues after getting exposed to ozone repeatedly.

  • Exposure to ozone can exacerbate scarring of lungs (pulmonary fibrosis) in diabetics.

What can be done to prevent lung damage?

While more research needs to be done to affirm similar patterns in humans, there are some simple easy things that can be done to make sure that people with blood sugar challenges stay protected from the harmful effects of air pollution.
  • People diagnosed with diabetes must keep their blood sugar levels under control. Those with a family history of diabetes must get their blood sugar levels checked every 3 months.

  • Diabetics and pre-diabetics must avoid high-fat, calorie-rich food as it can lead to obesity and insulin resistance in the body. They must take up some form of exercise to keep themselves active and healthy.

  • People with diabetes living in extremely polluted cities must avoid stepping out of their homes early in the morning as the pollution levels are at a peak during those hours. They must keep their windows closed during the mornings and evenings.

  • Before stepping out, affected people must use a good quality mask preferably N95, N99 or N100 mask as they can filter out the finest pollution particles.

  • People with diabetes or pre-diabetes can install air purifiers at their homes to filter out the pollutants from the indoor air.


Various studies have concluded that exposure to ozone gas can increase the risk of developing early pulmonary fibrosis and interstitial lung disease in people with diabetes and pre-diabetes. With proper precautions and careful planning, it is possible for people with impaired blood sugar levels to prevent respiratory complications and continue leading healthy lives.
Consult an endocrinologist or a diabetologist for any queries related to diabetes.

You can also try the Apollo 24|7 Diabetes Self-Management Tool to log your sugar values, track patterns, know all about food nutrition and more.


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