6 Summary, conclusions, and perspectives is considered the watchdog of the brain and a proper insulin response is needed to control the glucose exposure to the brain. Carotid body insulin resistance falls within the general concept of insulin resistance in T2DM. However, the hyperexcitability of the carotid body in T2DM is an important observation that may be linked to health outcome measures such as hypertension, cardiac arrhythmias, and heart failure.15 Carotid body denervation or destruction has earlier been suggested as a treatment of a hyperexcitable carotid body related diseases, such as treatment-resistant hypertension, heart failure, myocardial infarction, and ventricular tachycardia.16,17 Hence, our data suggest that patients with T2DM might be at an increased risk for such adverse health issues. While carotid sinus nerve denervation in T2DM may be a bridge too far due to adverse effects, electronic modulation has been shown to restore metabolic homeostasis in animal models.18 Given the high prevalence of T2DM, further studies are warranted to determine the risks of a hyperexcitable carotid body in T2DM, determine how this is associated with alterations in ventilatory control, and evaluate preclinical therapeutic approaches. In conclusion, the research conducted in this thesis has expanded our knowledge of pharmacology and pathophysiology on the control of breathing, both in health and disease. We anticipate that these findings will contribute to improved health outcomes and enhanced safety in pain management and foster further research. 125
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