INS and Hyperglycemia: It seems to be a vicious-feedback loop in which hyperglycemia has increased levels of periodontal SASP response, and the increased gingival macrophage inflammation and/or senescence, in turn, induces alterations in the bacteria to make it more inflammatory.3 Additionally, oral-microbiome change fuels systemic inflammation (inflammaging)31 through intermittent interaction between bacteria and macrophage, which in turn enhances insulin resistance to promote hyperglycemia.