the incidence of diabetes is increasing in india with > 62 million indians currently diagnosed with diabetes mellitus . poor adherence to diabetes medications and treatment and lack of awareness in identifying disease complications and its management are the prime reason for the increasing morbidity due to diabetes . it was only in the middle of 19 century that the vestibular system was recognized as a separate entity . fibers from all five sense organs travel to the brain stem and terminate in the vestibular nuclei . the vestibular apparatus is a membranous structure consisting of three semicircular canals connected at their base to the utricle , saccule and endo - lymphatic duct . autonomic nervous system ( ans ) is one of the important regulators of the endocrine system . stimulation of the parasympathetic system stimulates insulin secretion , whereas sympathetic stimulation inhibits insulin secretion . several studies have demonstrated the synaptic connections between vestibular otolith organs and ans and its contribution to the control of blood pressure during movement and changes in posture . synaptic connections in the vestibule - sympathetic reflex are functional at birth and require the involvement of the ventrolateral medulla in adult mammals . further caloric stimulation of the vestibular apparatus can inhibit noradrenergic neuronal activity in the locus coeruleus ( lc ) , thus supporting the concept of the ability to modulate the vestibular and ans synaptic connections . one such event is the central regulation of decrease in insulin secretion following stimulation of the sympathetic system . interestingly cholinergic neurons are associated with noradrenergic neuronal inhibition during the vestibulo - autonomic reflex , independent of the histaminergic neuron system . of interest caudal medial vestibular nucleus and inferior vestibular nucleus ( ivn ) is connected bilaterally to nucleus tractussolitarius ( nts ) and dorsal motor nucleus of the vagus nerve ( dmx ) . the nts and dorsal motor nucleus of the vagus nerve ( dmv ) constitute sensory and motor nuclei of the dorsal vagal complex , respectively . stimulation of the vagus nerve can cause a considerable increase in insulin secretion and a decrease in c - peptide secretion with no significant change in glucagon secretion . here we review the possible mechanisms by which vestibular stimulation may affect diabetes , and suggest necessary translational research in this area , for the benefit of diabetic patients and to the society in general . a detailed review of published literature from http://www.google.com , http://www.pubmed.com , british medical http://www.journal.com , medline , eric , http://www.frontiersin.org and other online journals was performed and analyzed . patients with peripheral and central vestibular abnormalities manifest both symptoms and signs of autonomic dysfunction presumably via compromised vestibulo - autonomic connections . hence , vestibular - autonomic connections may form the basis for an association between vestibular dysfunction and panic attacks . nevertheless autonomic dysfunction are suggested to be an underlying mechanism in the development of vertigo . . the solitary tractus nucleus ( sn ) neurons , where the vagal nerve ( vn ) cell bodies exist , fired spikes with short latencies , following electrical stimulation of peripheral labrynth . electrophysiological and histological studies indicates existence of ( i ) vestibular organs - vn - sn - stomach , ( ii ) posterior semicircular canal solitary tractus nuclear neurons ( ) stomach , associated with the vestibulo - autonomic reflex . the neurons of the vestibular system that involves in cardiovascular and respiratory control integrates a variety of sensory signals and receive direct inputs from visual , muscle , skin and visceral receptors . neuro - anatomical studies in the rabbit and in the cat have identified descending vestibulo - autonomic pathways from the caudal portion of the medial vestibular nucleus and the ivn to the dorsal motor nucleus of the vagus nerve , the nucleus of the solitary tract , and some brain stem medullary sympathetic regions . branches of right vagus nerve innervates the pancreatic islets , and stimulation of this parasympathetic pathways causes increased insulin secretion via m4 receptors ( atropine blocks the response and acetylcholine stimulates insulin secretion ) . the effect of acetylcholine like that of glucose activates phospholipase c , with the released ip3 releasing the ca from the endoplasmic reticulum , which facilitates the insulin release process . vestibular sensory inputs to the vestibulo - sympathetic pathway terminates on cells in the vestibular nuclear complex , which project to brainstem sites involved in the regulation of cardiovascular activity , including the rostral and caudal ventrolateral medullary regions . noisy vestibular stimulation increases release of gamma - aminobutyric acid ( gaba ) from substansia nigra and gaba inhibits lc nor - adrenergic neurons . however , if alpha adrenergic receptors are blocked , stimulation of sympathetic nerves causes increased insulin secretion , which is mediated by beta-2 adrenergic receptors . obesity of nongenetic origin is a consequence to the dis - regulation of food intake , energy balance and overall nutrition . this combination of findings is commonly called the metabolic syndrome or syndrome x. some of the patients with the syndrome are prediabetic , whereas others have frank type 2 diabetes . single shock vestibular stimulation evokes response from the ipsilateral vagus nerve and long term vn stimulation decreased food intake and body weight . the onset of diabetes was linked with prolonged sorrow by english physician in 17 century . stress activates hypothalamo - pituitary - adrenal ( hpa ) axis , leading to various endocrine disorders such as high cortisol and low sex steroid levels , which antagonize the actions of insulin . controlled vestibular stimulation inhibits hpa axis , which further supports the role of vestibular stimulation in the regulation of diabetes . although these are only association , it would be necessary to explore such associations for further therapeutic development . adequate sleep and good sleep hygiene should be included among the goals of a healthy lifestyle , especially for patients with diabetes . vestibular system has extensive interactions with hypothalamus , dorsal raphe nucleus , nts , locus coeruleus and hippocampal formation all of which promotes sleep . the current evidence suggests the role for vestibular stimulation as a potential intervention to prevent or delay the development of diabetes mellitus in at - risk population and may also used as supplementary therapy in management of diabetic patients . the benefits from vestibular stimulation are achieved through many well - established physiological pathways nevertheless well - designed translational studies are necessary to rigorously establish these findings into evidence - based clinical practice . nevertheless , we urge clinicians to recommend vestibular stimulation as a simple means to maintain a healthy lifestyle . patients with peripheral and central vestibular abnormalities manifest both symptoms and signs of autonomic dysfunction presumably via compromised vestibulo - autonomic connections . hence , vestibular - autonomic connections may form the basis for an association between vestibular dysfunction and panic attacks . nevertheless autonomic dysfunction are suggested to be an underlying mechanism in the development of vertigo . interestingly constriction of the stomach is observed following stimulation of peripheral labyrinth . the solitary tractus nucleus ( sn ) neurons , where the vagal nerve ( vn ) cell bodies exist , fired spikes with short latencies , following electrical stimulation of peripheral labrynth . electrophysiological and histological studies indicates existence of ( i ) vestibular organs - vn - sn - stomach , ( ii ) posterior semicircular canal solitary tractus nuclear neurons ( ) stomach , associated with the vestibulo - autonomic reflex . the neurons of the vestibular system that involves in cardiovascular and respiratory control integrates a variety of sensory signals and receive direct inputs from visual , muscle , skin and visceral receptors . neuro - anatomical studies in the rabbit and in the cat have identified descending vestibulo - autonomic pathways from the caudal portion of the medial vestibular nucleus and the ivn to the dorsal motor nucleus of the vagus nerve , the nucleus of the solitary tract , and some brain stem medullary sympathetic regions . branches of right vagus nerve innervates the pancreatic islets , and stimulation of this parasympathetic pathways causes increased insulin secretion via m4 receptors ( atropine blocks the response and acetylcholine stimulates insulin secretion ) . the effect of acetylcholine like that of glucose activates phospholipase c , with the released ip3 releasing the ca from the endoplasmic reticulum , which facilitates the insulin release process vestibular sensory inputs to the vestibulo - sympathetic pathway terminates on cells in the vestibular nuclear complex , which project to brainstem sites involved in the regulation of cardiovascular activity , including the rostral and caudal ventrolateral medullary regions . noisy vestibular stimulation increases release of gamma - aminobutyric acid ( gaba ) from substansia nigra and gaba inhibits lc nor - adrenergic neurons . this inhibition is produced by released norepinephrine acting on alpha - adrenergic receptors . however , if alpha adrenergic receptors are blocked , stimulation of sympathetic nerves causes increased insulin secretion , which is mediated by beta-2 adrenergic receptors . obesity of nongenetic origin is a consequence to the dis - regulation of food intake , energy balance and overall nutrition . hence , hyperinsulilinemia and dyslipidemia and accelerated development of atherosclerosis are associated with obesity . this combination of findings is commonly called the metabolic syndrome or syndrome x. some of the patients with the syndrome are prediabetic , whereas others have frank type 2 diabetes . single shock vestibular stimulation evokes response from the ipsilateral vagus nerve and long term vn stimulation decreased food intake and body weight . the onset of diabetes was linked with prolonged sorrow by english physician in 17 century . stress activates hypothalamo - pituitary - adrenal ( hpa ) axis , leading to various endocrine disorders such as high cortisol and low sex steroid levels , which antagonize the actions of insulin . controlled vestibular stimulation inhibits hpa axis , which further supports the role of vestibular stimulation in the regulation of diabetes . although these are only association , it would be necessary to explore such associations for further therapeutic development . adequate sleep and good sleep hygiene should be included among the goals of a healthy lifestyle , especially for patients with diabetes . vestibular system has extensive interactions with hypothalamus , dorsal raphe nucleus , nts , locus coeruleus and hippocampal formation all of which promotes sleep . the current evidence suggests the role for vestibular stimulation as a potential intervention to prevent or delay the development of diabetes mellitus in at - risk population and may also used as supplementary therapy in management of diabetic patients . the benefits from vestibular stimulation are achieved through many well - established physiological pathways nevertheless well - designed translational studies are necessary to rigorously establish these findings into evidence - based clinical practice . nevertheless , we urge clinicians to recommend vestibular stimulation as a simple means to maintain a healthy lifestyle .
despite the complexities of the relationship between vestibular stimulation and endocrine disorders being well known , research efforts to understand these complexities are lacking . 
 interestingly vestibular stimulation may potentially prevent / delay development / progression of diabetes . here 
 we review the science behind this concept and highlight the need for necessary translational research in this area . 
 current evidence supports the use of vestibular stimulation not only as a potential intervention to prevent or delay the development of diabetes mellitus in at - risk population , but also to use it as supplementary therapy for diabetic patients management . 
 we urge clinicians to recommend vestibular stimulation by simple means like swing as a goal in maintaining a healthy lifestyle .