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Glial Cells: Neuroglia

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• First Online: 29 June 2022
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• Helmut Kettenmann 4 , 5 &
• Alexei Verkhratsky 6 , 7  

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In the human brain glial cells are as abundant as neurons. The relative number of glial cells has increased with increasing complexity of the central nervous system (CNS) during evolution. In vertebrates three types of glial cells can be distinguished in the CNS, namely, astrocytes, oligodendrocytes, and microglia. In the peripheral nervous system glial cells are represented by Schwann cells, satellite glial cells, enteric glial cells (EGCs), and olfactory ensheathing cells. Astroglia are a heterogeneous cell population that fulfill different supportive and homeostatic tasks such as providing guiding structures during development, controlling homeostasis of the extracellular space, providing energy substrate for neurons, controlling blood flow, and modulating synaptic transmission. Oligodendrocytes in the central and Schwann cells in the peripheral nervous system form myelin and thereby enable a high conduction velocity within the axons. Microglial cells are the immune competent cells of the brain and are activated during any pathologic process. The activated microglial cells can release many factors which influence the pathologic process. Taken together brain function is only possible by a concerted action of neurons and glial cells.

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Cellular Neurosciences, Max-Delbrück-Center for Molecular Medicine, Berlin, Germany

Helmut Kettenmann

Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China

Faculty of Biology, Medicine and Health, University of Manchester, Oxford, UK

Alexei Verkhratsky

Achucarro Centre for Neuroscience, IKERBASQUE, Basque Foundation for Science, Bilbao, Spain

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Rockefeller University Lab. Neurobiology & Behaviour, New York, NY, USA

Donald W. Pfaff

National Institutes of Health (NIH), National Institute of Drug Abuse (NIDA), Rockville, MD, USA

Nora D. Volkow

Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA

John Rubenstein

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Kettenmann, H., Verkhratsky, A. (2021). Glial Cells: Neuroglia. In: Pfaff, D.W., Volkow, N.D., Rubenstein, J. (eds) Neuroscience in the 21st Century. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6434-1_19-3

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DOI : https://doi.org/10.1007/978-1-4614-6434-1_19-3

Received : 16 February 2021

Accepted : 12 April 2021

Published : 29 June 2022

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Print ISBN : 978-1-4614-6434-1

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Neuroglia in ageing and disease

Affiliation.

• 1 Faculty of Life Sciences, The University of Manchester, Manchester, UK, [email protected].
• PMID: 24652503
• DOI: 10.1007/s00441-014-1814-z

The proper operation of the mammalian brain requires dynamic interactions between neurones and glial cells. Various types of glial cells are susceptible to morpho-functional changes in a variety of brain pathological states, including toxicity, neurodevelopmental, neurodegenerative and psychiatric disorders. Morphological modifications include a change in the glial cell size and shape; the latter is evident by changes of the appearance and number of peripheral processes. The most blatant morphological change is associated with the alteration of the sheer number of neuroglia cells in the brain. Functionally, glial cells can undergo various metabolic and biochemical changes, the majority of which reflect upon homeostasis of neurotransmitters, in particular that of glutamate, as well as on defence mechanisms provided by neuroglia. Not only glial cells exhibit changes associated with the pathology of the brain but they also change with brain aging.

Publication types

• Research Support, N.I.H., Extramural
• Research Support, Non-U.S. Gov't
• Brain / pathology
• Brain / physiology
• Brain / physiopathology
• Mental Disorders / pathology*
• Mental Disorders / physiopathology
• Neurodegenerative Diseases / pathology*
• Neurodegenerative Diseases / physiopathology
• Neuroglia / cytology
• Neuroglia / pathology*
• Neuroglia / physiology*
• Neuroglia / ultrastructure
• Neurons / metabolism
• Neurons / pathology

Grants and funding

• R21 HD078678/HD/NICHD NIH HHS/United States
• HD078678/HD/NICHD NIH HHS/United States

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10.2A: Neuroglia of the Central Nervous System

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Glia, named from the Greek word for “glue,” support and scaffold neurons while performing other unique functions.

Learning Objectives

• Identify the types of neuroglia in central nervous system
• Neuroglia in the CNS include astrocytes, microglial cells, ependymal cells and oligodendrocytes.
• Neuroglia in the PNS include Schwann cells and satellite cells.Astrocytes support and brace the neurons and anchor them to their nutrient supply lines. They also play an important role in making exchanges between capillaries and neurons.
• Microglial cells can transform into a special type of macrophage that can clear up the neuronal debris, while monitoring the health of the neuron.
• Ependymal cells are another glial subtype that line the ventricles of the CNS to help circulate the CSF.
• Oligodendrocytes are cells that wrap their process tightly around the fibers producing an insulating covering called myelin sheath.
• Schwann cells are similar in function to oligodendrocytes and microglial cells.
• Satellite cells perform a similar function to astrocytes,
• myelin : A white, fatty material, composed of lipids and lipoproteins, that surrounds the axons of nerves.
• glia : Non-neuronal cells that maintain homeostasis, form myelin, and provide support and protection for neurons in the brain, and for neurons in other parts of the nervous system such as in the autonomic nervous system.
• astrocyte : a neuroglial cell, in the shape of a star, in the brain

Neurogila or glial cells, are non-neuronal cells that maintain homeostasis, form myelin, and provide support and protection for neurons in the central (CNS) and peripheral nervous systems (PNS). It was long believed that neuroglia did not play any role in neuro-transmission, however recent advances have demonstrated that neuroglia play a key role in synapse formation and maintenance.

Neuroglia of the CNS

Neuroglia in the CNS include astrocytes, microglial cells, ependymal cells, and oligodendrocytes. In the human brain, it is estimated that the total number of glia roughly equals the number of neurons, although the proportions vary in different brain areas.

• Astrocytes are delicate, star-shaped branching glial cells. Their numerous radiating processes cling to neurons and their synaptic endings. These astrocytes cover nearly all the capillaries in the CNS. They support and brace the neurons and anchor them to their nutrient supply lines. They also play an important role in making exchanges between capillaries and neurons. Astrocytes also regulate the external chemical environment of neurons by removing excess ions and recycling neurotransmitters released during synaptic transmission.
• Microglial cells are small and have thorny processes that can touch the neighboring neurons. Microglial cells can transform into a special type of macrophage that can clear up the neuronal debris. They are also able to monitor the health of neurons by detecting injuries to the neuron.
• Ependymal cells are another glial subtype that line the ventricles of the CNS, forming a permeable barrier between the cerebrospinal fluid (CSF) and underlying cells, and also aid in the circulation of CSF through cilial beat.
• Oligodendrocytes are cells that have fewer processes compared to astrocytes. They line up along the nerve fibers in the CNS and wrap their process tightly around the fibers producing the insulating myelin sheath.

Oligodendrocyte : Oligodendrocytes form the electrical insulation around the axons of CNS nerve cells.

Neuroglia of the PNS

Neuroglia in the PNS include Schwann cells and satellite cells.

• Schwann cells are similar in function to oligodendrocytes and microglial cells, providing myelination to axons in the PNS. They also have phagocytotic activity and clear cellular debris that allows for regrowth of PNS neurons.
• Satellite cells are similar in function to astrocytes small cells that surround neurons in sensory, sympathetic, and parasympathetic ganglia, helping to regulate the external chemical environment. They are highly sensitive to injury and inflammation, and appear to contribute to pathological states, such as chronic pain.

Neuroglia : Types of neuroglia found in the CNS and PNS.

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8.3 Neurons and Neuroglia

Created by CK-12 Foundation/Adapted by Christine Miller

Life as Art

This colourful picture (Figure 8.3.1) could be an abstract work of modern art. You might imagine it hanging in an art museum or art gallery. In fact, the picture illustrates real life — not artistic creation. It is a micrograph of human nervous tissue . The neon green structures in the picture are neurons . The neuron is one of two basic types of cells in the nervous system. The other type is the neuroglial cell.

Neurons  —   also called nerve cells — are electrically excitable cells that are the main functional units of the  nervous system . Their function is to transmit  nerve impulses , and they are the only type of human cells that can carry out this function.

Neuron Structure

Figure 8.3.2 shows the structure of a typical neuron. Click on each of the main parts to learn about their functions.

Figure 8.3.2 The structure of a typical neuron. 

Neurogenesis

Fully differentiated neurons, with all their special structures, cannot divide and form new daughter neurons. Until recently, scientists thought that new neurons could no longer be formed after the brain developed prenatally. In other words, they thought that people were born with all the brain neurons they would ever have, and as neurons died, they would not be replaced. However, new evidence shows that additional neurons can form in the brain, even in adults, from the division of undifferentiated neural stem cells found throughout the brain. The production of new neurons is called  neurogenesis .  The extent to which it can occur is not known, but it is not likely to be very great in humans.

Neurons in Nervous Tissues

The nervous tissue in the brain and spinal cord consists of gray matter and white matter.  Gray matter contains mainly non-myelinated structures, including the cell bodies and dendrites of neurons. It is gray only in cadavers. Living gray matter is actually more pink than gray (see Figure 8.3.3) White matter consists mainly of axons covered with a myelin sheath , which gives them their white colour. White matter also makes up the nerves of the peripheral nervous system . Nerves consist of long bundles of myelinated axons that extend to muscles, organs, or glands throughout the body. The axons in each nerve are bundled together like wires in a cable. Axons in nerves may be more than a metre long in an adult. The longest nerve runs from the base of the spine to the toes.

Types of Neurons

There are hundreds of different types of neurons in the human nervous system that exhibit a variety of structures and functions. Nonetheless, many neurons can be classified functionally based on the direction in which they carry nerve impulses.

• Sensory  (also called afferent)  neurons  carry nerve impulses from sensory receptors  in tissues  and organs  to the  central nervous system . They change physical stimuli (such as touch, light, and sound) into nerve impulses.
• Motor  (also called efferent)  neurons , like the one in the diagram below (Figure 8.3.4), carry nerve impulses from the central nervous system to muscles and glands. They change nerve signals into the activation of these structures.
• Within the spinal cord or brain,  interneurons carry nerve impulses back and forth, often between sensory and motor neurons.

In addition to neurons, nervous tissues also consist of neuroglia , also called glial cells . The root of the word glial comes from a Greek word meaning “glue,” which reflects earlier ideas about the role of neuroglia in nervous tissues. Neuroglia were thought to be little more than “glue” holding together the all-important neurons, but this is no longer the case. They are now known to play many vital roles in the nervous system. There are several different types of neuroglia, each with a different function. You can see six types of neuroglia in Figure 8.3.5.

In general, neuroglia provide support for neurons and help them carry out the basic function of nervous tissues, which is to transmit nerve impulses. For example, oligodendrocyte s in the central nervous system and Schwann cell s in the peripheral nervous system generate the lipids that make up myelin sheaths , which increase the speed of nerve impulses’ transmission. Functions of other neuroglia cells include holding neurons in place, supplying neurons with nutrients, regulating the repair of neurons, destroying pathogens, removing dead neurons, and directing axons to their targets. Neuroglia may also play a role in the transmission of nerve impulses, but this is still under study. Unlike mature neurons, mature glial cells retain the ability to divide by undergoing mitosis.

In the human brain, there are generally roughly equal numbers of neurons and neuroglia. If you think intelligence depends on how many neurons you have, think again. Having a relatively high number of neuroglia is actually associated with higher intelligence. When Einstein’s brain was analyzed, researchers discovered a significantly higher-than-normal ratio of neuroglia to neurons in areas of the brain associated with mathematical processing and language. On an evolutionary scale, as well, an increase in the ratio of neuroglia to neurons is associated with greater intelligence in species.

Feature: My Human Body

Would you like your brain to make new neurons that could help you become a better learner? When it comes to learning new things, what college student  wouldn’t  want a little more brain power? If research about rats applies to humans, then sustained aerobic exercise (such as running) can increase neurogenesis in the adult brain, and specifically in the hippocampus, a brain structure important for learning temporally and/or spatially complex tasks, as well as memory. Although the research is still at the beginning stages, it suggests that exercise may actually lead to a “smarter” brain. Even if the research results are not ultimately confirmed for humans, though, it can’t hurt to get more aerobic exercise. It is certainly beneficial for your body, if not your brain!

8.3 Summary

• Neurons  are one of two major types of nervous system cells. They are electrically excitable cells that transmit nerve impulses.
• Neuroglia are the other major type of nervous system cells. There are many types of neuroglia and they have many specific functions. In general, neuroglia function to support, protect, and nourish neurons.
• The main parts of a neuron include the cell body , dendrites , and axon . The cell body contains the  nucleus . Dendrites receive nerve impulses from other cells, and the axon transmits nerve impulses to other cells at axon terminals. A  synapse  is a complex membrane junction at the end of an axon terminal that transmits signals to another cell.
• Axons are often wrapped in an electrically-insulating myelin sheath , which is produced by neuroglia. Electrical signals occur at gaps in the myelin sheath, called nodes of Ranvier , which speeds the conduction of nerve impulses down the axon.
• Neurogenesis , or the formation of new neurons by cell division, may occur in a mature human brain, but only to a limited extent.
• The nervous tissue in the brain and spinal cord consists of gray matter (which contains unmyelinated cell bodies and dendrites of neurons) and white matter (which contains mainly myelinated axons of neurons). Nerves of the peripheral nervous system consist of long bundles of myelinated axons that extend throughout the body.
• There are hundreds of types of neurons in the human nervous system, but many can be classified on the basis of the direction in which they carry nerve impulses. Sensory neurons  carry nerve impulses away from the body and toward the central nervous system, motor neurons  carry them away from the central nervous system and toward the body, and interneurons  often carry them between sensory and motor neurons.

8.3 Review Questions

• Describe the myelin sheath and nodes of Ranvier. How does their arrangement allow nerve impulses to travel very rapidly along axons?
• Define neurogenesis. What is the potential for neurogenesis in the human brain?
• Relate neurons to different types of nervous tissues.
• Compare and contrast sensory and motor neurons.
• Identify the role of interneurons.
• Identify four specific functions of neuroglia.
• What is the relationship between the proportion of neuroglia to neurons and intelligence?

8.3 Explore More

Thriving in the Face of Adversity | Stephanie Buxhoeveden | TEDxHerndon, TEDx Talks, 2015.

You can grow new brain cells. Here’s how | Sandrine Thuret, TED, 2015.

Attributions

Figure 8.3.1

Nervous Tissue Confocal Microscopy/ Mouse brain, confocal microscopy by ZEISS Microscopy on Flickr is used under a CC BY-NC-ND 2.0  (https://creativecommons.org/licenses/by-nc-nd/2.0/) license.

Figure 8.3.2

Parts of a Neuron  by Open Stax on Wikimedia Commons is used and adapted by Christine Miller under the CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/) license.

Figure 8.3.3

White_and_Gray_Matter  by OpenStax   on Wikimedia Commons is used under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/) license.

Figure 8.3.4

Neuromuscular Junction  by CK-12 Foundation is used under a CC BY-NC 3.0 (https://creativecommons.org/licenses/by-nc/3.0/) license.

Figure 8.3.5

TypesofNeuroglia by BruceBlaus on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0/deed.en) license.

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2016, May 18). Figure 12.3   Gray matter and white matter [digital image].  In Anatomy and Physiology (Section 12.1). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/12-1-basic-structure-and-function-of-the-nervous-system

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2016, May 18). Figure  12.8   Parts of a neuron [digital image].  In Anatomy and Physiology (Section 12.2). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/12-2-nervous-tissue

Blausen.com staff. (2014). Types of neuroglia cells [digital image]. Medical gallery of Blausen Medical 2014. WikiJournal of Medicine, 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. Wikiversity.org. https://en.wikiversity.org/wiki/WikiJournal_of_Medicine/Medical_gallery_of_Blausen_Medical_2014

Brainard, J/ CK-12 Foundation. (2016). Figure 3 The axon in this diagram is part of a motor neuron.  [digital image]. In CK-12 College Human Biology (Section 10.3) [online Flexbook]. CK12.org. https://www.ck12.org/book/ck-12-college-human-biology/section/10.3/

TED. (2015, October 30). You can grow new brain cells. Here’s how | Sandrine Thuret. YouTube. https://www.youtube.com/watch?v=B_tjKYvEziI&feature=youtu.be

TEDx Talks. (2015, April 3). Thriving in the face of adversity | Stephanie Buxhoeveden | TEDxHerndon. YouTube. https://www.youtube.com/watch?v=zuLOT6GsAxw&feature=youtu.be

A specialized tissue found in the central nervous system and the peripheral nervous system. It consists of neurons and supporting cells called neuroglia. The nervous system is responsible for the control of the body and the communication among its parts.

A functional unit of the nervous system that transmits nerve impulses; also called a nerve cell.

A class of nervous system cell that provides support for neurons and helps them transmit nerve impulses.

The highly complex body system of an animal that coordinates its actions and sensory information by transmitting signals to and from different parts of its body. The nervous system detects environmental changes that impact the body, then works in tandem with the endocrine system to respond to such events.

A signal transmitted along a nerve fiber.

The formation of new neurons by cell division.

The central nervous system organ inside the skull that is the control center of the nervous system.

A thin, tubular bundle of central nervous system tissue that extends from the brainstem down the back to the pelvis and connects the brain with the peripheral nervous system.

A type of nervous tissue that is found only in the brain and spinal cord and consists mainly of un-myelinated cell bodies and dendrites of neurons.

A type of nervous tissue that consists mainly of the myelinated axons of neurons.

The lipid layer around the axon of a neuron that allows nerve impulses to travel more rapidly down the axon.

A structure in the nervous system that consists of cable-like bundles of axons and makes up the majority of the peripheral nervous system.

One of two major divisions of the nervous system that consists of all the nervous tissue that lies outside the central nervous system.

A long extension of the cell body of a neuron that transmits nerve impulses to other cells.

Type of neuron that carries nerve impulses from sensory receptors in tissues and organs to the central nervous system; also called afferent neuron.

Specialized nerve cell that responds to a particular type of stimulus such as light or chemicals by generating a nerve impulse.

A cellular organizational level between cells and a complete organ. A tissue is an ensemble of similar cells and their extracellular matrix from the same origin that together carry out a specific function. Organs are then formed by the functional grouping together of multiple tissues.

A group of tissues in a living organism that have been adapted to perform a specific function. In higher animals, organs are grouped into organ systems; e.g., the esophagus, stomach, and liver are organs of the digestive system.

One of two main divisions of the nervous system that includes the brain and spinal cord.

A type of neuron that carries nerve impulses from the central nervous system to muscles and glands; also called efferent neuron.

A type of neuron that carries nerve impulses between other neurons, often between sensory and motor neurons.

A nervous system cell that provides support for neurons and helps them transmit nerve impulses.

A type of neuroglia whose main functions are to provide support and insulation to axons in the central nervous system of some vertebrates, equivalent to the function performed by Schwann cells in the peripheral nervous system.

A variety of neuroglia that keep peripheral nerve fibres (both myelinated and unmyelinated) alive. In myelinated axons, Schwann cells form the myelin sheath.

The central part of a neuron that contains the nucleus and other cell organelles.

An extension of the cell body of a neuron that receives nerve impulses from other neurons.  A neuron will have several dendrites extending from the cell body.

A central organelle containing hereditary material.

The place where the axon terminal of a neuron transmits a chemical or electrical signal to another cell.

One of the regularly spaced gaps in the myelin sheath along an axon that allows the action potential (electrical signal) to travel very rapidly.

Human Biology Copyright © 2020 by Christine Miller is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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What Are Glial Cells and What Do They Do?

These cells have an important role in supporting the brain

Glial cells are a type of cell that provides physical and chemical support to neurons and maintain their environment. Located in the central nervous system and peripheral nervous system, glial cells are sometimes called the "glue" of the nervous system, as well as neuroglia or just glia.

This article will go over what glial cells do in the brain and nerves in the body. You'll also learn about conditions that are related to glial cells.

Types of Glial Cells

Glial cells' main job is to support another type of brain cell called neurons. Glial cells are like a secretarial pool for your nervous system and its janitorial and maintenance staff.

Glial cells may not do the "big jobs," in the brain, but without them, those big jobs would never get done.

There are different types of glial cells and each one has a specific role in helping your central nervous system (CNS)—which is made up of your brain and the nerves of your spinal column—work right.

There are five types of glial cells in your CNS:

Oligodendrocytes

• Ependymal cells
• Radial glia

You also have glial cells in your peripheral nervous system (PNS), which is made up of all the nerves in your body that are away from your spine (like your arms and legs).

The two types of glial cells in the PNS are:

• Schwann cells
• Satellite cells

The most common type of glial cell in the CNS is the astrocyte or astroglia . The "astro" part of the name is because the cells have projections that make them look star-shaped.

There are different kinds of astrocytes. For example, protoplasmic astrocytes have thick projections with lots of branches. Fibrous astrocytes have long, slender arms with few branches.

Protoplasmic astrocytes are generally found among neurons in the gray matter of the brain while the fibrous ones are typically found in white matter.

While they're found in different places, they do similar jobs, including:

• Forming the blood-brain barrier (BBB) : The BBB is like a strict security system for the brain. It only lets in substances that are supposed to be in your brain while keeping out things that could be harmful. This filtering system is essential for keeping your brain healthy.
• Regulating neurotransmitters : Neurons communicate using chemical messengers called neurotransmitters. Once the message is delivered, neurotransmitters hang around until an astrocyte recycles them. This reuptake process is the target of many medications, including antidepressants.
• Cleaning up : Astrocytes also clean up what's left behind when a neuron dies, as well as excess potassium ions (chemicals that play an important role in nerve function).
• Regulating blood flow to the brain : For your brain to process information properly, it needs a certain amount of blood going to all of its different regions. An active region gets more blood than an inactive one.
• Synchronizing the activity of axons : Axons are long, thread-like parts of neurons and nerve cells that conduct electricity to send messages between cells.
• Brain energy metabolism and homeostasis : One of the most important roles of astrocytes is to regulate metabolism in the brain by storing sugar (glucose) from the blood and providing it as fuel for neurons.

What Happens If Astrocytes Don't Work?

Astrocyte dysfunction has been linked to neurodegenerative diseases, including:

• Amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease)
• Huntington's chorea
• Parkinson's disease

Animal models of astrocyte-related diseases are helping researchers learn more about them with the hope of discovering new treatment possibilities for them in humans.

Oligodendrocytes come from neural stem cells. The word is made up of a few Greek terms that mean "cells with several branches."

The main purpose of oligodendrocytes is to help information move faster along axons in the brain.

Oligodendrocytes look like spikey balls. On the tips of their spikes are white, shiny membranes that wrap around the axons of nerve cells and form a protective layer, like the plastic insulation on electrical wires. This protective layer is called the myelin sheath .

The sheath is not continuous, though. There's a gap between each membrane that's called the "node of Ranvier." This node helps electrical signals spread efficiently along nerve cells.

The signal actually hops from one node to the next and increases the velocity of the nerve conduction while also reducing how much energy it takes to transmit it.

Signals along myelinated nerves can travel as fast as 200 miles per second.

At birth, you only have a few myelinated axons, but the number keeps growing until you're about 25 to 30 years old. Myelination is believed to play an important role in intelligence.

Oligodendrocytes also provide stability and carry energy from blood cells to the axons.

The term "myelin sheath" is often used when talking about multiple sclerosis (MS) because this part gets damaged in the disease.

In people with MS, it's thought that the body's immune system attacks the myelin sheaths, which leads to dysfunction of the neurons and impaired brain function. Spinal cord injuries can also damage myelin sheaths.

Other diseases associated with oligodendrocyte dysfunction include:

• Leukodystrophies
• Tumors called oligodendrogliomas
• Schizophrenia
• Bipolar disorder

Glutamate Damage

Oligodendrocytes can be damaged by the neurotransmitter glutamate . Its job is to stimulate areas of your brain so you can focus and learn new information.

However, glutamate is considered an "excitotoxin" at high levels, which means that it can overstimulate cells until they die.

Microglia are tiny glial cells ("micro" means small). They act as the brain's own dedicated immune system. The brain needs its own immune system because the blood-brain barrier isolates the brain from the rest of your body.

Microglia are alert to signs of injury and disease. When they detect a problem, they charge in and take care of it—whether it means clearing away dead cells or getting rid of a toxin or pathogen.

When microglia respond to an injury, it causes inflammation as part of the healing process.

Sometimes, the response causes problems. For example, in Alzheimer's disease , microglia are hyperactivated and cause too much inflammation. The response may lead to amyloid plaques and other brain changes related to Alzheimer's.

Along with Alzheimer's, other conditions linked to microglial dysfunction include:

• Fibromyalgia
• Chronic neuropathic pain
• Autism spectrum disorders

Microglia are believed to have many jobs, including playing a "housekeeping" role in learning-associated brain plasticity and guiding the development of the brain.

Our brains create a lot of connections between neurons that allow them to pass information back and forth. In fact, the brain creates a lot more of them than we need, which is not very efficient.

Microglia detect unnecessary synapses and "prune" them, just as a gardener prunes a rose bush to keep it healthy.

Ependymal Cells

Ependymal cells make up the thin membrane lining the central canal of the spinal cord and the passageways ( ventricles ) of the brain ( ependyma ). They also make cerebrospinal fluid and have an important role in the blood-brain barrier.

Ependymal cells are very small and line up tightly to form the membrane. Inside the ventricles, they have little hairlike projections ( cilia ) that wave back and forth to keep the cerebrospinal fluid circulating.

Cerebrospinal fluid delivers nutrients to and eliminates waste products from the brain and spinal column. It also serves as a cushion and shock absorber between your brain and skull.

The fluid is also necessary to maintain homeostasis of your brain, which means regulating its temperature and other features that keep it operating as well as possible.

Radial Glia

Radial glia is believed to be a type of stem cell. This type of cell can create other cells. In the developing brain, stem cells are the "parents" of neurons, astrocytes, and oligodendrocytes.

When you were an embryo, these cells also provided the "scaffolding" for developing neurons. They provide the long fibers that guide young brain cells into place as your brain forms.

Since they have an important role as stem cells, especially as creators of neurons, researchers have looked at radial glia to learn more about how to repair brain damage from illness or injury.

Later in life, these cells contribute to your brain's ability to change and adapt ( neuroplasticity ).       

Schwann Cells

Schwann cells are named for Theodor Schwann, the physiologist who discovered them.

They function a lot like oligodendrocytes by providing myelin sheaths for axons. However, Schwann cells are found in the peripheral nervous system (PNS) rather than the CNS.

Instead of being a central cell with membrane-tipped arms, Schwann cells form spirals directly around the axon. The nodes of Ranvier sit between them, just as they do with oligodendrocytes, and assist in nerve transmission in the same way.

Schwann cells are also part of the PNS's immune system. When a nerve cell is damaged, it can "eat" the nerve's axons and provide a protected path for a new axon to form.

There are a few diseases that involve the Schwann cells, such as:

• Guillain-Barre' syndrome
• Charcot-Marie-Tooth disease
• Schwannomatosis
• Chronic inflammatory demyelinating polyneuropathy

Schwann cells might also be involved in some forms of chronic pain . The activation of the cells after nerve damage might contribute to dysfunction in a type of nerve fibers called nociceptors , which sense environmental factors such as heat and cold.

There has been exciting research on transplanting Schwann cells for spinal cord injury and other types of peripheral nerve damage.

Satellite Cells

Satellite cells get their name from the way they surround certain neurons, with several "satellites" forming a sheath around the cellular surface.

We're just beginning to learn about satellite cells but many researchers believe they're similar to astrocytes. However, they're found in the PNS, not the CNS.

Satellite cells' main purpose appears to be regulating the environment around the neurons, keeping chemicals in balance.

The neurons with satellite cells make up clusters of nerve cells in the autonomic nervous system and the sensory system called ganglia .

The autonomic nervous system regulates your internal organs, while your sensory system is what allows you to see, hear, smell, touch, feel, and taste.

Satellite cells deliver nutrition to the neuron and absorb heavy metal toxins, such as mercury and lead, to keep them from damaging the neurons.

Like microglia, satellite cells detect and respond to injury and inflammation, but their role in repairing cell damage is not yet understood.

It's also thought that satellite cells help transport several neurotransmitters and other substances, including:

• Norepinephrine
• Adenosine triphosphate
• Substance P
• Acetylcholine

Satellite cells are linked to chronic pain involving peripheral tissue injury, nerve damage, and a systemic heightening of pain (hyperalgesia) that can result from chemotherapy.

There are several kinds of glial cells in your brain and the nerves throughout your body. Each type has a special—and important—job in keeping your brain working at its best.

If these cells get damaged or are affected by a disease, it can cause problems in your nervous system.

We have a sense of what glial cells do in the body, but still have a lot left to learn.

Frequently Asked Questions

Researchers believe that there are anywhere from 40 to 130 billion glial cells in the brain.

Some glial cells help transmit information in the brain. For example, astrocytes and oligodendrocytes both play important roles in helping neurons "talk" to each other.

Glial cells that are damaged won't be able to do their jobs well—if at all. The effects of glial cell dysfunction depend on what role they play in the brain.

For example, if Schwann cells are not working correctly, it can contribute to chronic pain. The overactivation of microglia may cause inflammation that's possibly linked to Alzheimer's brain changes.

University of Queensland. Queensland Brain Institute. Types of glia .

Chung WS, Allen NJ, Eroglu C. Astrocytes Control Synapse Formation, Function, and Elimination . Cold Spring Harb Perspect Biol . 2015;7(9):a020370. doi:10.1101/cshperspect.a020370

Barbeito L. Astrocyte-based cell therapy: new hope for amyotrophic lateral sclerosis patients? . Stem Cell Res Ther . 2018;9(1):241. doi:10.1186/s13287-018-1006-y

Nickel M, Gu C. Regulation of central nervous system myelination in higher brain functions . Neural Plast . 2018;2018:6436453. doi:10.1155/2018/6436453

Duncan ID, Radcliff AB. Inherited and acquired disorders of myelin: The underlying myelin pathology . Exp Neurol . 2016;283(Pt B):452-75. doi:10.1016/j.expneurol.2016.04.002

Briançon-marjollet A, Balenci L, Fernandez M, et al. NG2-expressing glial precursor cells are a new potential oligodendroglioma cell initiating population in N-ethyl-N-nitrosourea-induced gliomagenesis . Carcinogenesis . 2010;31(10):1718-25. doi:10.1093/carcin/bgq154

Takahashi N, Sakurai T, Davis KL, Buxbaum JD. Linking oligodendrocyte and myelin dysfunction to neurocircuitry abnormalities in schizophrenia . Prog Neurobiol . 2011;93(1):13-24. doi:10.1016/j.pneurobio.2010.09.004

Konradi C, Sillivan SE, Clay HB. Mitochondria, oligodendrocytes and inflammation in bipolar disorder: evidence from transcriptome studies points to intriguing parallels with multiple sclerosis . Neurobiol Dis . 2012;45(1):37-47. doi:10.1016/j.nbd.2011.01.025

Dong YX, Zhang HY, Li HY, Liu PH, Sui Y, Sun XH. Association between Alzheimer's disease pathogenesis and early demyelination and oligodendrocyte dysfunction . Neural Regen Res . 2018;13(5):908-914. doi:10.4103/1673-5374.232486

Kanno H, Pearse DD, Ozawa H, Itoi E, Bunge MB. Schwann cell transplantation for spinal cord injury repair: its significant therapeutic potential and prospectus . Rev Neurosci . 2015;26(2):121-8. doi:10.1515/revneuro-2014-0068

von Bartheld CS, Bahney J, Herculano-Houzel S. The search for true numbers of neurons and glial cells in the human brain: A review of 150 years of cell counting . J Comp Neurol. 2016 Dec 15;524(18):3865-3895. doi: 10.1002/cne.24040. Epub 2016 Jun 16. PMID: 27187682; PMCID: PMC5063692.

Gosselin RD, Suter MR, Ji RR, Decosterd I.  Glial cells and chronic pain.   Neuroscientist . 2010 Oct;16(5):519-31. 

Kriegstein A, Alvarez-Buylla A. The glial nature of embryonic and adult neural stem cells . Annu Rev Neurosci . 2009;32:149-84. doi:10.1146/annurev.neuro.051508.135600

Ohara PT, Vit JP, Bhargava A, Jasmin L. Evidence for a role of connexin 43 in trigeminal pain using RNA interference in vivo . J Neurophysiol . 2008 Dec;100(6):3064-73. doi:10.1152/jn.90722.2008

By Adrienne Dellwo Dellwo was diagnosed with fibromyalgia in 2006 and has over 25 years of experience in health research and writing.

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Editorial: Physiology and pathology of neuroglia

Daniel reyes-haro.

1 Universidad Nacional Autónoma de México, Instituto de Neurobiología - UNAM, Campus Juriquilla, Juriquilla, QRO, Mexico

Alejandro López-Juárez

2 Department of Health and Biomedical Sciences, The University of Texas Rio Grande Valley, Brownsville, TX, United States

Adrián Rodríguez-Contreras

3 The Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, United States

Neuroglia is the largest population of cells in the brain and participates in formation, maintenance, and modulation of synaptic circuits. This heterogenous group includes macroglia (astroglia and oligodendroglia) and microglia. Neurons and neuroglia form assemblies that potentiate the cognitive capability of the brain. In this topic, nine articles highlight structural and functional roles of neuroglia in brain physiology, which is fundamental to better understand the biology of neurodevelopmental and neurodegenerative diseases.

Our understanding of brain connectivity evolves rapidly and the cytoarchitecture of underexplored brain regions such as the cerebellum need to be revisited (De Zeeuw et al., 2021 ). Hence, Gómez-González et al. reviewed the organization of a peculiar cerebellar glial niche located at the subventricular zone of the fourth ventricle. In addition to neurons and ependymal cells, this region is rich in microglia as well as macroglia including astrocytes, Bergmann glia, and oligodendrocyte lineage cells. Further transcriptional and functional heterogeneity within these glial populations is discussed. Despite scarce to non-proliferative activity, this region shares similarity with adult neurogenic niches throughout the brain and various stimulating questions remain to be explored. Furthermore, glial organization is adapted to this highly vascularized niche and contribute to the glioneurovascular unit, a structural and functional element where glial cells respond to stimulation by coupling to increased sensory activity through development (Biesecker et al., 2016 ; Koehler, 2021 ). In a perspective contributed by Konecny et al. , they hypothesize that augmented neuronal activity is associated with angiogenic factor production and creates an environment of intermittent hypoxia, promoting the expression of hypoxia-inducible transcription factors (HIFs) by the glioneurovascular unit. However, mechanisms triggering glioneurovascular coupling during early sensory neurodevelopment are unknown; therefore, further research using non-invasive approaches is proposed.

Neuron-glia coupling is physiologically tied to volume regulation. Ionic gradients permit neurons to communicate electrically, and glial cells help them to regulate volume. Astrocytes express a variety of cotransport systems and ion channels to maintain brain homeostasis through mobilization of osmolytes (Walch and Fiacco, 2022 ). Ochoa-de la Paz and Gulias-Cañizo identify glial cells as master regulators of the tripartite synapse volume, a property that gives them an important role in maintaining homeostasis. Dysfunction of volume regulation leads to pathology in conditions such as edema, uremia, and diabetes, in which solute imbalances occur.

Neuron-glia communication is mediated by neurotransmitters including glutamate, the main excitatory neurotransmitter of the brain. This signaling occurs through ionotropic and metabotropic receptors expressed by neurons and glial cells. Particularly, astrocytes modulate neuronal activity through release of gliotransmitters like glutamate and D-serine (Reyes-Haro et al., 2010 ). Additionally, astrocytes express glutamate transporters to regulate the glutamatergic tone at the synaptic cleft and supply glutamine to neurons that convert it into glutamate or GABA to refill synaptic vesicles (Martínez-Lozada and Ortega, 2023 ). Dysfunction of the glutamate-glutamine shuttle results in excitotoxicity that has been linked to Alzheimer's and Huntington's diseases. Thus, Cuellar-Santoyo et al. summarize the astrocyte's contribution to glutamatergic neurotransmission in physiological and pathological conditions.

Astrocytes also respond to neuronal activity with calcium transients, a signaling mechanism that seems involved in pain and nociception (Prokhorenko and Smyth, 2023 ). Here, Higinio-Rodríguez et al. present an experimentally supported perspective in which coherent activity of astrocytes in pain-related brain areas plays critical roles in binding sensory, affective, and cognitive information, on a slow time scale. As astrocytes respond to noxious stimuli via calcium modulation likely independent of neuronal activation, this could represent the mechanism by which pain is created from nociception with the participation of astrocytes.

Glial cell responses in pathology involve inflammasomes, multi-protein intracellular signaling complexes which orchestrate inflammatory responses to a diverse range of pathogens and host-derived signals (Jewell et al., 2022 ). In their review article, Mata-Martínez et al. , discuss aspects of the inflammatory process, focusing on accumulating evidence of multiprotein complexes that sense and respond in the context of inflammation. The authors argue that acute and chronic inflammation will engage a coordinated molecular response in various organs, involving glial cells in the brain. Interestingly, Down syndrome (DS) and Alzheimer's disease (AD) are characterized by chronic neuroinflammation, peripheral inflammation, astrogliosis, imbalanced excitatory/inhibitory neuronal function, and cognitive deficits in both humans and mouse models (Ahmed et al., 2022 ). Little is known about the causes of these pathologies, but patients with DS are suspected to be predisposed to developing AD late in life. García and Flores-Aguilar summarize data about glial cells in the context of DS-AD and inflammation.

Links for inflammation and glial cells could also exist in anorexia; food intake is reduced during acute and chronic inflammatory states in human and research models (Gautron and Layé, 2010 ). Reyes-Haro reviews features of physiological anorexia in research models in comparison with human pathological anorexia, emphasizing valid precautions when extrapolating results. Moreover, he discusses studies in murine models of anorexia in which glial cells putatively play central roles in classical hypothalamic mechanisms, as well as in systemic machineries including the prefrontal cortex. Specifically, the pro-inflammatory environment associated with microglia reactivity, the impact of astrocyte manipulation on food intake associated with purinergic gliotransmission, and the roles of Oligodendrocyte Precursor Cells (OPCs) mediating the anorexigenic action of leptin in mice, are presented.

Another pathology associated with glial cell dysfunction is alcohol exposure during pregnancy. Fetal Alcohol Syndrome (FAS) is a public health problem with a prevalence of 2–5% in the USA. FAS disturbs the structure and function of the brain, but the underlying mechanisms remain elusive (Holloway et al., 2023 ). Zheng et al. , observed loss of the tubulin-binding cofactor B resulting in disorganized microtubules and shortening of astrocytic processes in a model of chronic alcohol exposure. Developmental pathological implications to consider include abnormal migration of neuronal precursors through aberrant radial glial processes and defective synaptic coverage by astrocytes.

Overall, articles in this topic cover diverse aspects of research on glial cells and serve as introductory information to several subfields of glial biology. Ideas presented encourage others to design studies to clarify the roles of physiological and pathological factors with potential use in therapeutic applications and engineering.

Author contributions

DR-H, AL-J, and AR-C wrote the original draft and edited the final version of the manuscript. All authors contributed to the article and approved the submitted version.

Acknowledgments

The editors of this topic are grateful to Bruce Ransom, Alfonso Araque, and Axel Nimmerjahn for participating and promoting the organization of the Symposium on Physiology and Pathology of Neuroglia, a biannual event that is becoming a referent in the field. We are grateful to Teresa Morales and Mauricio Díaz (INb-UNAM), Raúl Paredes and Aurea Orozco (ENES-Juriquilla), and Gerardo Piloni and Yolanda Chirino (Posgrado-UNAM, PAEP-UNAM) for their support. We also appreciate the support of the technical and administrative staff.

Funding Statement

This work was supported by CONAHCYT 319209 and UNAM-DGAPA-PAPIIT (IN209121) to DR-H. NU start-up funds to AR-C.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

• Ahmed M. M., Wang A. C., Elos M., Chial H. J., Sillau S., Solano D. A., et al.. (2022). The innate immune system stimulating cytokine GM-CSF improves learning/memory and interneuron and astrocyte brain pathology in Dp16 Down syndrome mice and improves learning/memory in wild-type mice . Neurobiol. Dis . 15, 105694. 10.1016/j.nbd.2022.105694 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
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Insulin, Medicines, & Other Diabetes Treatments

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What medicines might I take for diabetes?

What type of diabetes do i have, what are the different types of insulin, what are the different ways to take insulin, what oral medicines treat type 2 diabetes, what other injectable medicines treat diabetes, what should i know about side effects of diabetes medicines.

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Taking insulin  or other diabetes medicines is often part of treating diabetes. In addition to making healthy food and beverage choices, getting physical activity, getting enough sleep, and managing stress, medicines can help you manage the disease. Some other treatment options are also available.

The medicine you take depends on the type of diabetes you have and how well the medicine controls your blood glucose  levels, also called blood sugar levels. Other factors, such as any other health conditions you may have, medication costs, your insurance coverage and copays, access to care, and your lifestyle, may affect what diabetes medicine you take.

Type 1 diabetes

If you have type 1 diabetes , you must take insulin because your pancreas  does not make it. You will need to take insulin several times during the day, including when you eat and drink, to control your blood glucose level.

There are different ways to take insulin . You can use a needle and syringe , an insulin pen , or an insulin pump . An artificial pancreas —also called an automated insulin delivery system—may be another option for some people.

Type 2 diabetes

Some people with type 2 diabetes  can control their blood glucose level by making lifestyle changes. These lifestyle changes include consuming healthy meals and beverages, limiting calories if they have overweight  or obesity , and getting physical activity.

Many people with type 2 diabetes need to take diabetes medicines as well. These medicines may include diabetes pills or medicines you inject, such as insulin. Over time, you may need more than one diabetes medicine to control your blood glucose level. Even if you do not take insulin, you may need it at special times, such as if you are pregnant or if you are in the hospital for treatment.

Gestational diabetes

If you have gestational diabetes , you can manage your blood glucose level by following a healthy eating plan and doing a moderate-intensity physical activity, such as brisk walking for 150 minutes, each week. If consuming healthy food and beverages and getting regular physical activity aren’t enough to keep your blood glucose level in your target range, a doctor will work with you and may recommend you take insulin. Insulin is safe to take while you are pregnant.

No matter what type of diabetes you have, taking diabetes medicines every day can feel like a burden sometimes. New medications and improved delivery systems can help make it easier to manage your blood glucose levels. Talk with your doctor to find out which medications and delivery systems will work best for you and fit into your lifestyle.

Several types of insulin are available. Each type starts to work at a different speed, known as “onset,” and its effects last a different length of time, known as “duration.” Most types of insulin reach a peak, which is when they have the strongest effect. After the peak, the effects of the insulin wear off over the next few hours or so. Table 1 lists the different types of insulin, how fast they start to work, when they peak, and how long they last.

Table 1. Types of insulin and how they work 1,2

Another type of insulin, called premixed insulin, is a combination of insulins listed in Table 1. Premixed insulin starts to work in 15 to 60 minutes and can last from 10 to 16 hours. The peak time varies depending on which insulins are mixed.

Your doctor will work with you to review your medication options. Talk with your doctor about your activity level, what you eat and drink, how well you manage your blood glucose levels, your age and lifestyle, and how long your body takes to absorb insulin.

Follow your doctor’s advice on when and how to take your insulin. If you're worried about the cost, talk with your doctor. Some types of insulin cost more than others. You can also find resources to get financial help for diabetes care .

The way you take insulin may depend on your lifestyle, insurance plan, and preferences. Talk with your doctor about the options and which one is best for you. Most people with diabetes take insulin using a needle and syringe, insulin pen, or insulin pump. Inhalers and insulin jet injectors  are less common ways to take insulin. Artificial pancreas systems are now approved by the U.S. Food and Drug Administration (FDA). Talk with your doctor to see if an artificial pancreas is an option for you.

Needle and syringe

You can give yourself insulin shots using a needle and syringe . You draw up your dose of insulin from the vial—or bottle—through the needle into the syringe. Insulin works fastest when you inject it in your belly, but your doctor may recommend alternating the spot where you inject it. Injecting insulin in the same spot repeatedly could cause the tissue to harden, making it harder to take shots in that area over time. Other spots you can inject insulin include your thigh, buttocks, or upper arm, but it may take longer for the insulin to work from those areas. Some people with diabetes who take insulin need 2 to 4 shots a day to reach their blood glucose targets. Others can take a single shot. Injection aids can help you give yourself the shots.

An insulin pen looks like a writing pen but has a needle for its point. Some insulin pens come filled with insulin and are disposable. Others have room for an insulin cartridge that you insert and replace after use. Many people find insulin pens easier to use, but they cost more than needles and syringes. You may want to consider using an insulin pen if you find it hard to fill the syringe while holding the vial or cannot read the markings on the syringe. Different pen types have features that can help with your injections. Some reusable pens have a memory function, which can recall dose amounts and timing. Other types of “connected” insulin pens can be programmed to calculate insulin doses and provide downloadable data reports, which can help you and your doctor adjust your insulin doses.

An insulin pump is a small machine that gives you steady doses of insulin throughout the day. You wear one type of pump outside your body on a belt or in a pocket or pouch. The insulin pump connects to a small plastic tube and a very small needle. You insert the plastic tube with a needle under your skin, then take out the needle. The plastic tube will stay inserted for several days while attached to the insulin pump. The machine pumps insulin through the tube into your body 24 hours a day and can be programmed to give you more or less insulin based on your needs. You can also give yourself doses of insulin through the pump at mealtimes.

Another type of pump has no tubes. This pump attaches directly to your skin with a self-adhesive pad and is controlled by a hand-held device. The plastic tube and pump device are changed every several days.

Another way to take insulin is by breathing powdered insulin into your mouth from an inhaler device. The insulin goes into your lungs and moves quickly into your blood. You may want to use an insulin inhaler to avoid using needles. Inhaled insulin is only for adults with type 1 or type 2 diabetes. Taking insulin with an inhaler is less common than using a needle and syringe.

Jet injector

A jet injector is a device that sends a fine spray of insulin into the skin at high pressure instead of using a needle to deliver the insulin. It is used less commonly than a needle and syringe or a pen.

Artificial pancreas

An artificial pancreas is a system of three devices that work together to mimic how a healthy pancreas controls blood glucose in the body. A continuous glucose monitor (CGM)  tracks blood glucose levels every few minutes using a small sensor inserted under the skin that is held in place with an adhesive pad. The CGM wirelessly sends the information to a program on a smartphone or an insulin infusion pump. The program calculates how much insulin you need. The insulin infusion pump will adjust how much insulin is given from minute to minute to help keep your blood glucose level in your target range. An artificial pancreas is mainly used to help people with type 1 diabetes.

You may need to take medicines to manage your type 2 diabetes, in addition to consuming healthy foods and beverages and being physically active. You can take many diabetes medicines by mouth. These medicines are called oral medicines.

Most people with type 2 diabetes start with metformin pills. Metformin also comes as a liquid. Metformin helps your liver make less glucose and helps your body use insulin better. This drug may help you lose a small amount of weight.

Other oral medicines act in different ways to lower blood glucose levels. Combining two or three kinds of diabetes medicines can lower blood glucose levels better than taking just one medicine.

Read about different kinds of diabetes medicines (PDF, 2.8 MB) from the FDA.

If you have type 1 diabetes, your doctor may recommend you take other medicines, in addition to insulin, to help control your blood glucose. Some of these medicines work to slow how fast food and beverages move through your stomach . These medicines also slow down how quickly and how high your blood glucose levels rise after eating. Other medicines work to block certain hormones  in your digestive system  that raise blood glucose levels after meals or help the kidneys to remove more glucose from your blood.

Besides insulin, other types of injected medicines (PDF, 2.8 MB) are available that will keep your blood glucose level from rising too high after you eat or drink. These medicines, known as glucagon-like peptide-1 (GLP-1) receptor agonists, 3 may make you feel less hungry and help you lose some weight. GLP-1 medicines are not substitutes for insulin.

Side effects are problems that result from taking a medicine. Some diabetes medicines can cause hypoglycemia , also called low blood glucose, if you don’t balance your medicines with food and activity.

Ask your doctor whether your diabetes medicine can cause hypoglycemia or other side effects, such as upset stomach and weight gain. Aim to take your diabetes medicines as your doctor instructs you, to help prevent side effects and diabetes problems.

If medicines and lifestyle changes are not enough to manage your diabetes, there are other treatments that might help you. These treatments include weight-loss (bariatric) surgery  for certain people with type 1 or type 2 diabetes, or pancreatic islet transplantation  for some people with type 1 diabetes.

Weight-loss surgery

Weight-loss surgery  are operations that help you lose weight by making changes to your digestive system. Weight-loss surgery is also called bariatric or metabolic surgery.

This type of surgery may help some people who have obesity and type 2 diabetes lose a large amount of weight and bring their blood glucose levels back to a healthy range. How long the improved response lasts can vary by patient, type of weight-loss surgery, and the amount of weight the person lost. Other factors include how long a person had diabetes and whether the person used insulin. Some people with type 2 diabetes may no longer need to use diabetes medicines after weight-loss surgery . 4

Researchers are studying whether weight-loss surgery can help control blood glucose levels in people with type 1 diabetes who have obesity. 5

Pancreatic islet transplantation

Pancreatic islet transplantation is an experimental treatment for people with type 1 diabetes who have trouble controlling their blood glucose levels. Pancreatic islets  are clusters of cells in the pancreas that make the hormone insulin. In type 1 diabetes, the body’s immune system attacks these cells. A pancreatic islet transplantation replaces destroyed islets with new islets from organ donors. The new islets make and release insulin. Because researchers are still studying pancreatic islet transplantation , the procedure is only available to people enrolled in research studies.

The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for insulin, medicines, and other diabetes treatments?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Find out if clinical trials are right for you .

Researchers are studying many aspects of diabetes medicines, including

• new types of insulin
• the most effective times to take diabetes medicines
• new types of monitoring devices and delivery systems

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for insulin, medicines, and other diabetes treatments are looking for participants?

You can view a filtered list of clinical studies on insulin, medicines, and other diabetes treatments covered in this health topic that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank Stuart A. Weinzimer, M.D., Yale University School of Medicine

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How can we reduce the risk of firearm suicide among LGBTQ+ youth? The Trevor Project and Everytown explore this urgent topic.

The Relationship Between Firearms, Mass Shootings and Suicide Risk among LGBTQ+ Young People

Learn more:.

• Impact of Gun Violence on Historically Marginalized Communities
• Mass Shootings

This research brief is the product of a collaboration between The Trevor Project and the Everytown for Gun Safety Support Fund .

Deaths due to firearm violence occur in alarming numbers in the United States (U.S.) each year. In 2023, over 43,000 people died from a firearm-related injury, and the majority (55%) of these deaths were from suicide. 1 Gun Violence Archive. (2024). Past Summary Ledgers. https://www.gunviolencearchive.org/past-tolls. Young people are at heightened risk, with firearms being the leading cause of death for youth ages 13-24, and the cause of half of all suicide deaths in this age group as well. 2 Centers for Disease Control and Prevention. (2024). CDC Wonder. https://wonder.cdc.gov/controller/saved/D158/D392F588. 3 National Violent Death Reporting System. (2024). NVDRS Violent Deaths Report. https://wisqars.cdc.gov/nvdrs/. Only in the last five years did Congress allocate federal resources for firearm violence research, and the prior decades-long ban on this research has stymied information that could have been used to prevent these deaths. 4 Hellman, J. (2019). Congress reaches deal to fund gun violence research for first time in decades. https://thehill.com/policy/healthcare/474740-25m-set-aside-for-gun-violence-research-in-spending-agreement-in-win-for/. This lack of research has had wide-reaching effects, including the limited understanding of how firearm violence impacts specific vulnerable populations, such as LGBTQ+ individuals. Although much progress has been made, systematic data collection efforts that assess LGBTQ+ identity and experiences have long been a challenge in the U.S., similarly limiting available research on LGBTQ+ health and wellness. 5 Healthy People 2030. (2023). LGBT – Overview and Objectives. https://health.gov/healthypeople/objectives-and-data/browse-objectives/lgbt. One of the most consistent findings we do know from available research, however, is that LGBTQ+ young people experience higher rates of considering and attempting suicide compared to their peers.

The Trevor Project’s 2024 U.S. National Survey on the Mental Health of LGBTQ+ Young People found that 39% of all LGBTQ+ young people seriously considered attempting suicide in the past year. This finding is important in the context of what we know about firearms: they are the most lethal means used in suicide attempts; nearly 9 in 10 (89.6%) suicide attempts with a firearm result in death. 6 Conner, A., Azrael, D., & Miller, M. (2019). Suicide case-fatality rates in the United States, 2007 to 2014: a nationwide population-based study. Annals of Internal Medicine, 171(12), 885-895. Furthermore, though mass shootings constitute a small fraction (1.5%) of firearm deaths in the U.S., the public nature of this violence, often targeted toward members of oppressed groups, still have noteworthy impact. Mass shootings are defined by The Federal Bureau of Investigation (FBI) as any incident in which four or more people are shot and wounded or killed, excluding the shooter. Many LGBTQ+ people across the country identified with the victims of two widely publicized mass shootings that occurred at LGBTQ+ nightclubs in recent years: the Pulse shooting in 2016, and the shooting at Club Q in 2022. The mental health of survivors and directly impacted geographic communities are adversely affected by mass shootings, 7 Lowe, S. R., & Galea, S. (2017). The mental health consequences of mass shootings. Trauma, Violence, & Abuse, 18(1), 62-82. and individuals not directly affected by mass shooting events can also experience post-traumatic stress through media exposure. 8 Thompson, R. R., Jones, N. M., Holman, E. A., & Silver, R. C. (2019). Media exposure to mass violence events can fuel a cycle of distress. Science Advances, 5(4), eaav3502. In the instance of the Pulse shooting, those who identified as LGBTQ+ responded more strongly to media coverage and, in turn, experienced more post-traumatic stress. 9 First, J. M., Shin, H., Figueroa-Caballero, A., Okker-Edging, K., Spialek, M. L., & Houston, J. B. (2023). Posttraumatic Stress Related to Orlando Nightclub Shooting: LGBTQ Identity and Media Use. Journal of Loss and Trauma, 28(4), 298-314.

Everytown for Gun Safety states that not only is addressing firearms essential to any strategy to reduce suicide, but also that the effect of mass shootings extends to survivors, families, and communities. Despite the elevated risk of suicide attempts among LGBTQ+ young people, the fact that the majority of firearm deaths in the U.S. are suicides, and the high lethality of suicide attempts involving firearms, little is known about how many LGBTQ+ young people own or have access to firearms, or how experiences of mass shooting events impact suicide risk. Using data from the 2024 U.S. National Survey on the Mental Health of LGBTQ+ Young people, this brief examines relationships between access to firearms, the impact of mass shootings, and suicide risk among LGBTQ+ young people.

Access to Firearms

Overall, 40% of LGBTQ+ young people reported that there was a firearm in their home . The majority (92%) of those with a firearm in the home reported that it was not theirs. Additionally, of those who reported the presence of a firearm in their home, 63% reported that the firearm was kept in a locked place, 22% reported that it was not kept in a locked place, and 15% reported that they did not know whether it was kept in a locked place.

Demographics

LGBTQ+ young people ages 13-17 reported higher rates of having a firearm in their home (44%), compared to their LGBTQ+ young people ages 18-24 (36%). LGBTQ+ young people living in the South reported the highest rates of having a firearm in their home (48%) , followed by LGBTQ+ young people living in the Midwest (43%), West (37%), and Northeast (25%). Cisgender boys and men reported the highest rates of living in a home with a firearm (46%), followed by transgender girls and women (43%), transgender boys and men (42%), nonbinary youth (38%), youth questioning their gender identity (38%), and cisgender girls and women (36%). Native and Indigenous LGBTQ+ young people reported the highest rates of living in a home with a firearm (58%), followed by White LGBTQ+ young people (45%), Multiracial LGBTQ+ young people (38%), Black LGBTQ+ young people (31%), Latinx LGBTQ+ young people (29%), Middle Eastern and North African LGBTQ+ young people (22%), and Asian American and Pacific Islander LGBTQ+ young people (21%). No significant differences were found in rates of having a firearm in the home when comparing LGBTQ+ youth based on their socioeconomic status.

Associations with Suicide Risk

LGBTQ+ young people who reported the presence of a firearm in their home reported higher rates of having seriously considered suicide in the past year (43%) , compared to their LGBTQ+ peers who did not report a firearm in their home (37%). Reporting the presence of a firearm in the home was associated with 19% higher odds of seriously considering suicide in the past year (adjusted odds ratio [aOR] = 1.19, 95% Confidence Interval [CI] = 1.11-1.28, p < 0.001), compared to LGBTQ+ young people who did not report the presence of a firearm in the home.

LGBTQ+ young people who reported having a firearm in their home had higher rates of attempting suicide in the past year (13%) , compared to their LGBTQ+ peers who did not report having a firearm in their home (11%). The presence of a firearm in the home was associated with 17% higher odds of reporting a suicide attempt in the past year (aOR = 1.17, 95% CI = 1.05-1.30, p < 0.01).

Among LGBTQ+ young people who reported having a firearm in their home, 48% of those who did not keep it in a locked place and 46% of those who did not know if it was kept in a locked place seriously considered suicide in the last year, compared to the 40% who said the firearms were kept in a locked place (p<.001). Similarly, among those LGBTQ+ young people who reported the presence of a firearm in their home, 14% of those who did not keep it in a locked place and 15% of those who did not know if it was kept in a locked place attempted suicide in the last year, compared to the 12% who said the firearms were kept in a locked place (p<.001).

Experiences with and Fears about Mass Shootings

Overall, 21% of LGBTQ+ young people reported that they or someone they know had been personally impacted by a mass shooting. LGBTQ+ young people ages 18-24 reported significantly higher rates of being impacted or knowing someone impacted by a mass shooting (23%), compared to their LGBTQ+ peers ages 13-17 (18%). LGBTQ+ young people living in the South and West reported the highest rates of being impacted or knowing someone impacted by a mass shooting (22%), followed by those living in the Midwest (21%) and the Northeast (17%). LGBTQ+ young people who reported only just meeting their basic economic needs reported higher rates of being impacted or knowing someone impacted by a mass shooting (26%), compared to their LGBTQ+ peers who had more than enough to meet their basic needs (20%). Transgender, nonbinary, and gender-questioning young people reported higher rates of being impacted or knowing someone impacted by a mass shooting (22%), compared to their cisgender LGBQ+ peers (19%). Nonbinary young people reported the highest rates of being impacted or knowing someone impacted by a mass shooting (24%), followed by transgender boys and men (22%), cisgender women and girls (20%), transgender girls and women (20%), gender-questioning youth (17%) and cisgender men and boys (17%). Native and Indigenous LGBTQ+ young people reported the highest rates of being impacted or knowing someone impacted by a mass shooting (24%), followed by Multiracial LGBTQ+ young people (23%), White LGBTQ+ young people (22%), Middle Eastern and North African LGBTQ+ young people (22%), Black LGBTQ+ young people (18%), Latinx LGBTQ+ young people (18%), and Asian American and Pacific Islander LGBTQ+ young people (17%).

A majority of LGBTQ+ young people also reported frequently worrying that a mass shooting could happen in their community (87%) , with 33% worrying “a lot” in the past year and 54% worrying “sometimes” that a mass shooting could happen in their community.

LGBTQ+ young people living in the South reported the highest rates of worrying about a mass shooting happening in their community (90%) , followed by LGBTQ+ young people living in the Midwest (88%), West (87%), and Northeast (85%). LGBTQ+ young people who reported only just meeting their basic economic needs reported higher rates of worrying about a mass shooting happening in their community (90%), compared to their LGBTQ+ peers who had more than enough to meet their basic needs (87%). Transgender, nonbinary, and gender-questioning young people reported higher rates of worrying about a mass shooting happening in their community (90%) , compared to their cisgender LGBQ+ peers (85%). Transgender boys and men reported the highest rates of worrying about a mass shooting happening in their community (93%), followed by nonbinary young people (91%), gender-questioning young people (90%), cisgender girls and women (90%), transgender girls and women (80%) and cisgender boys and men (75%). Multiracial LGBTQ+ young people reported the highest rates of worrying about a mass shooting happening in their community (90%), followed by White LGBTQ+ young people (88%), Latinx LGBTQ+ young people (88%), Native and Indigenous LGBTQ+ young people (88%), Middle Eastern and North African LGBTQ+ young people (87%), Black LGBTQ+ young people (85%), and Asian American and Pacific Islander LGBTQ+ young people (84%).

LGBTQ+ young people who reported being impacted or knowing someone impacted by a mass shooting reported higher rates of having seriously considered suicide in the past year (45%) , compared to their LGBTQ+ peers who did not report being impacted or knowing someone impacted by a mass shooting (37%). LGBTQ+ young people who reported being impacted or knowing someone impacted by a mass shooting also reported 38% higher odds of seriously considering suicide in the past year (aOR = 1.38, CI = 1.30-1.46, p < 0.001), compared to LGBTQ+ peers who did not report being impacted or knowing someone impacted by a mass shooting.

LGBTQ+ young people who reported being impacted or knowing someone impacted by a mass shooting reported higher rates of having attempted suicide in the past year (16%) , compared to their LGBTQ+ peers who did not report being impacted or knowing someone impacted by a mass shooting (10%). Being impacted or knowing someone impacted by a mass shooting was associated with 32% higher odds of reporting a suicide attempt in the past year (aOR = 1.32, CI = 1.21-1.44, p < 0.001), compared to LGBTQ+ peers who did not report being impacted or knowing someone impacted by a mass shooting.

LGBTQ+ young people who reported frequently worrying about a mass shooting in their community reported higher rates of having seriously considered suicide in the past year (40%) , compared to their LGBTQ+ peers who did not report frequently worrying about a mass shooting in their community (29%). LGBTQ+ young people who reported frequently worrying about a mass shooting in their community also reported 53% higher odds of seriously considering suicide in the past year (aOR = 1.53, CI = 1.37-1.72, p < 0.001), compared to LGBTQ+ peers who did not report frequently worrying about a mass shooting in their community.

LGBTQ+ young people who reported frequently worrying about a mass shooting in their community reported higher rates of having attempted suicide in the past year (12%) , compared to their LGBTQ+ peers who did not report frequently worrying about a mass shooting in their community (9%). LGBTQ+ young people who reported frequently worrying about a mass shooting in their community also reported 38% higher odds of having attempted suicide in the past year (aOR = 1.38, CI = 1.15-1.66, p < 0.001), compared to LGBTQ+ peers who did not report frequently worrying about a mass shooting in their community.

Data were collected through The Trevor Project’s 2024 U.S. National Survey on the Mental Health of LGBTQ+ Young People . In total, 18,663 LGBTQ+ young people between the ages of 13 to 24 were recruited via targeted ads on social media.

The presence of a firearm in the home was assessed via a question which asked, “Are there any firearms in your home?” Response options included: “No,” “Yes, but it’s not mine,” and “Yes, and it’s mine.” Both “Yes” options were coded together to indicate the presence of a firearm in the home. Whether or not the firearm was stored in a secure location was assessed via the question, “Are firearms in your home kept in a locked place?” Response options included: “No,” “Yes,” and “I don’t know.” Being impacted by a mass shooting was assessed via the question, “Have you or someone you know been personally impacted by a mass shooting?” Response options included: “No” and “Yes.” Worrying about a mass shooting was assessed via the question, “In the past year, how often have you worried that a mass shooting could happen in your community?” Response options included: “Never,” “Sometimes,” and “A lot.” The responses “Sometimes” and “A lot” were coded together to indicate worry about a mass shooting.

Chi-square tests were run to examine differences in rates between groups. After checking assumptions, adjusted logistic regression models were run to examine the association between firearm variables and suicide risk, controlling for age, race/ethnicity, sexual orientation, gender identity, socioeconomic status, and Census region. All reported comparisons and odds ratios are statistically significant at least at p < 0.05. This means there is less than a 5% likelihood these results occurred by chance.

Looking Ahead

We found that 40% of LGBTQ+ young people reported that there was a firearm in their home, although the vast majority (92%) of those firearms were owned by other people. Having a firearm in the home was associated with higher rates of both seriously considering and attempting suicide in the past year, but these rates were lower when respondents reported that firearms were kept in a locked place. We also explored the role of mass shootings on suicide risk of LGBTQ+ young people, and found that being impacted by or knowing someone who was impacted by a mass shooting was associated with higher risk of considering and attempting suicide in the past year. This relationship was also demonstrated for LGBTQ+ young people who expressed worry about a mass shooting in their community. We urge caution when interpreting the causal nature of these relationships, as our data are cross-sectional. Furthermore, though we document associations between the presence of a firearm in the home and suicide attempts among LGBTQ+ young people, we do not assess the means used in any reported suicide attempts. Individuals who attempt suicide using firearms are unlikely to be represented in survey research, due to the highly lethal nature of these attempts. Nevertheless, it is important to highlight that LGBTQ+ young people who have considered or attempted suicide in the past year are more likely to be the ones who have access to firearms.

The 2024 National Strategy for Suicide Prevention provides several recommendations for reducing risk of firearm suicide related to access, including storing firearms separately from ammunition in a locked and safe location, providing information about temporary out-of-home storage of firearms, and implementing extreme risk protection orders (ERPOs, also known as red flag laws), which allow for firearms to be temporarily removed from the home of someone at high risk of attempting suicide. 10 U.S. Department of Health and Human Services (HHS), National Strategy for Suicide Prevention. Washington, DC: HHS, April 2024. For young people who died by suicide using a firearm, over 40% used one that belonged to a family member, suggesting that different policy approaches may need to be employed for legal minors, many of whom live in homes with firearms that they can easily access. 11 Simonetti, J. A., Mackelprang, J. L., Rowhani-Rahbar, A., Zatzick, D., & Rivara, F. P. (2015). Psychiatric comorbidity, suicidality, and in-home firearm access among a nationally representative sample of adolescents. JAMA Psychiatry, 72(2), 152-159. The 2024 National Strategy for Suicide Prevention also has a goal designed around community-based approaches that put both distance and time between a person in crisis and lethal means. 12 U.S. Department of Health and Human Services (HHS), National Strategy for Suicide Prevention. Washington, DC: HHS, April 2024. Adapting such a strategy for LGBTQ+ communities may be an important way to reduce firearm-related suicide attempts for LGBTQ+ young people, as policies that encourage safe firearm storage have been proven to lead to reductions in firearm suicides. 13 Schell, T. L., Cefalu, M., Griffin, B. A., Smart, R., & Morral, A. R. (2020). Changes in firearm mortality following the implementation of state laws regulating firearm access and use. Proceedings of the National Academy of Sciences, 117(26), 14906-14910. These findings have implications for counselors and other mental health professionals, as assessing access to lethal means among people at risk of suicide may help provide more tailored care and reduce risk of suicide attempts and death. 14 Boggs, J. M., Beck, A., Ritzwoller, D. P., Battaglia, C., Anderson, H. D., & Lindrooth, R. C. (2020). A quasi-experimental analysis of lethal means assessment and risk for subsequent suicide attempts and deaths. Journal of General Internal Medicine, 35, 1709-1714.

Firearms may play another role in suicide risk among LGBTQ+ young people beyond individual access to lethal means. The vast majority (87%) of LGBTQ+ young people reported being worried either sometimes or a lot about a mass shooting happening in their community. These worries may be rooted in rising amounts of protests, threats, and violence directed at LGBTQ+ community events like drag shows, or other visible displays of inclusivity at places such as schools. 15 Margolin, J., & Grant, T. (2023). Threats against the LGBTQIA+ community intensifying: Department of Homeland Security. https://abcnews.go.com/US/threats-lgbtqia-community-intensifying-department-homeland-security/story?id=99338137. 16 Martiny, C., & Lawrence, S. (2023). A Year of Hate: Anti-Drag Mobilization Efforts Targeting LGBTQ+ People in the US. Our findings are consistent with prior literature which show adverse mental health outcomes among those exposed to mass shootings, 17 Lowe, S. R., & Galea, S. (2017). The mental health consequences of mass shootings. Trauma, Violence, & Abuse, 18(1), 62-82. although our data also suggest that worrying about these shootings is similarly associated with heightened suicide risk. Following the 2016 mass shooting that occurred at Pulse nightclub in Orlando, Florida, researchers have hypothesized how the collective trauma from this targeted mass shooting may have had a sustained effect on LGBTQ+ people, with evidence pointing to severe psychological distress and increases concerns about safety, 18 Gavulic, K. A., & Gonzales, G. (2021). Did the Orlando shooting at Pulse nightclub affect sexual minority mental health? Results and challenges using population-based data. Journal of Gay & Lesbian Mental Health, 25(3), 252-264. 19 Stults, C. B., Kupprat, S. A., Krause, K. D., Kapadia, F., & Halkitis, P. N. (2017). Perceptions of safety among LGBTQ people following the 2016 Pulse nightclub shooting. Psychology of Sexual Orientation and Gender Diversity, 4(3), 251. both of which may in part be reflected in our findings. Resources to support LGBTQ+ young people in the immediate aftermath of targeted shooting events, and likely some time beyond, may be necessary to mitigate any associated increase with suicide risk.

While this analysis is a step forward, there remain large gaps in research on the use of firearms in suicide attempts among LGBTQ+ young people. The lack of systematic data collection efforts on sexual orientation and gender identity in the event of a violent death means that we often have little to no information about those LGBTQ+ young people who die by suicide. The little information we do have suggests there are critical differences in precipitating circumstances and mental health that need to be explored. 20 Lyons, B. H., Walters, M. L., Jack, S. P., Petrosky, E., Blair, J. M., & Ivey-Stephenson, A. Z. (2019). Suicides among lesbian and gay male individuals: findings from the National Violent Death Reporting System. American Journal of Preventive Medicine, 56(4), 512-521. As LGBTQ+ youth are already a population with an alarmingly high risk of considering, planning, and attempting suicide compared to their peers, 21 Gaylor EM, Krause KH, Welder LE, et al. Suicidal Thoughts and Behaviors Among High School Students — Youth Risk Behavior Survey, United States, 2021.(2023). MMWR Supplements, 72(1):45–54. information about who may be the most likely to use firearms in suicide attempts could help in targeted prevention and treatment efforts.

Everytown Research & Policy is a program of Everytown for Gun Safety Support Fund, an independent, non-partisan organization dedicated to understanding and reducing gun violence. Everytown Research & Policy works to do so by conducting methodologically rigorous research, supporting evidence-based policies, and communicating this knowledge to the American public.

In partnership with

The trevor project.

At The Trevor Project, our Crisis Intervention team works 24/7 to help LGBTQ+ young people in crisis. We also focus on prevention efforts in order to limit the need for crisis resources in the future and reduce the risk of suicide for LGBTQ+ young people. We provide training to youth-facing adults, including professionals who work with LGBTQ+ young people (e.g., counselors, educators, nurses, social workers) to increase understanding of LGBTQ+ young people’s identities and provide guidance on trauma-informed suicide prevention efforts. Additionally, Trevor’s Research team is committed to the ongoing dissemination of research that explores the experiences of LGBTQ+ young people to prevent suicide, as well as improve their life experiences.

Damming the Iron River

Gun thefts from cars: the largest source of stolen guns, hospital-based violence intervention programs: a guide to implementation and costing, freedom from fear of hate-fueled violence: preventing transgender homicides.

The statistics make it clear: violence against transgender people is a gun violence issue.

Did you know?

Every day, more than 120 people in the United States are killed with guns, twice as many are shot and wounded and countless others are impacted by acts of gun violence.

Everytown Research analysis of CDC, WONDER, Underlying Cause of Death , 2018–2022; Healthcare Cost and Utilization Project (HCUP) nonfatal firearm injury data, 2020; and SurveyUSA Market Research Study #26602 , 2022.

Last updated: 5.7.2024

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