Diabetes And Sleep

What is diabetes?

Diabetes is a chronic disorder in which the body is unable to control blood sugar levels, either because the pancreas is unable to produce enough insulin or because the action of the insulin is ineffective. Hyperglycemia, or high blood sugar levels, is caused by malfunctioning regulatory mechanisms that prevent glucose from entering the cells. Additionally, uncontrolled blood sugar has been linked to a number of micro and macrovascular issues, such as damage to the heart, kidneys, nerves, and eyes.1

An individual is more likely to develop type 2 diabetes if they have a family history of the disease, have an unhealthy diet, lead a sedentary lifestyle, are overweight, or have a polycystic ovarian syndrome or high blood pressure. But did you know that getting insufficient sleep can also increase your risk of type 2 diabetes?

Getting enough sleep can make the management of diabetes easier

The absence of sufficient and restorative sleep has been linked to an increased occurrence of hyperglycemic episodes in individuals with type 2 diabetes and prediabetes.2,3 Even though the precise mechanism underlying the relationship between sleep and diabetes control is uncertain, subject matter experts and researchers suggest that insufficient sleep raises the body's level of the stress hormone cortisol, which puts the body at risk for developing an oxidative stress state that interferes with the insulin regulation system and, ultimately, raises blood sugar levels.4 

Studies have shown that reduced total sleep time in individuals on either insulin or oral glucose-lowering therapy was also linked to greater risks of complications and cardiovascular disease mortality and that diabetics who slept for less than seven hours had an elevated risk of dying prematurely than those who slept for the full seven hours.5

How does getting enough sleep help manage diabetes?

An important strategy for effective diabetes care includes physical activity, healthy dietary habits, and adherence to prescribed therapy, whether it be oral medication or injectable therapy. Moreover, healthy lifestyle choices, including getting enough sleep, will help you control your diabetes (a good sleep cycle is associated with maintaining glycemic control).

Improves response to insulin

Blood sugar is not only caused by decreased insulin production, but it is also frequently caused by impaired insulin sensitivity, which happens when insulin is present but inefficient in lowering blood sugar levels. Without enough sleep, the body produces excessive amounts of the stress hormone cortisol, which causes the body to go into flight or fight mode, impairing pancreatic insulin production and decreasing insulin sensitivity to maintain glucose availability, causing blood sugar levels to rise.6

Adequate sleep helps improve the body's insulin response by lowering circulating cortisol levels, bringing the body out of flight or fight mode, and stabilizing blood sugar levels in all people, especially diabetics.

Improves regulation of appetite hormones

It has frequently been observed that people who do not get enough sleep end up having unhealthy food choices, especially at midnight, which increases their risk of developing high blood glucose in the short term and obesity in the long run (the appetite hormones ghrelin and leptin also plays a major role).7,8 Ghrelin is associated with hunger, whereas leptin is associated with satiety, and both levels fluctuate throughout the day. Sleep deprivation affects hormones that control appetite, causing lower levels of leptin and higher levels of ghrelin.9 These changes increase hunger and decrease satiety, which encourages overeating of calorie-dense meals. Similarly, a balanced appetite and sensation of satiety are induced by getting sufficient sleep, which in turn curbs temptation and helps individuals make healthier food decisions.

Blood sugar fluctuations disrupt sleep

Blood sugar fluctuations also have an impact on the quality of sleep, much like insufficient sleep causes blood sugar levels to alter. Research has shown that people with type 2 diabetes frequently experience poor sleep quality, which is consistent with the frequent complaints of diabetics about their restless sleep.10 Even if we ignore nocturnal blood sugar fluctuations, frequent urination, discomfort, and blood sugar changes can have a direct negative impact on the sleep cycle and lead to sleep disturbances. Diabetes patients are also more likely to experience sleep disturbances, including restless legs syndrome and obstructive sleep apnoea.

Adequate lifestyle changes, such as following a low glycemic index diet, taking regular medication, and adhering to immaculate sleep hygiene, can help minimize the sleep disruption caused by blood sugar variations.

Lack of sleep is associated with insulin resistance

Even though the effects of sleep deprivation on diabetics are well established, it was found that sleep deprivation is one of the major risk factors for the onset of type 2 diabetes because it lowers insulin sensitivity and raises insulin resistance. Prediabetes, the period prior to the onset of diabetes in which blood sugar levels are high but not high enough to be classified as diabetes, is marked by insulin resistance. Type 2 diabetes will eventually develop from persistently poor sleep patterns following insulin resistance.

Conclusion

It is crucial to get enough sleep, especially when it comes to managing diabetes-related blood glucose levels. A lack of sleep affects the body's ability to regulate hormones and blood sugar, increases oxidative stress, and leads to a rise in inflammatory markers, all of which significantly raises the likelihood of diabetic complications. It also increases the risk of developing diabetes and pre-diabetes in healthy individuals. So, getting adequate sleep is critical if you want to effectively control your diabetes. For adults, at least 7 uninterrupted hours of restorative sleep accompanied by good sleep hygiene are deemed sufficient.

References

  1. Cade WT. Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting. Physical Therapy [Internet]. 2008 [cited 2022 Nov 13]; 88(11):1322–35. Available from: https://academic.oup.com/ptj/article/88/11/1322/2858152.
  2. Yoda K, Inaba M, Hamamoto K, Yoda M, Tsuda A, Mori K, et al. Association between Poor Glycemic Control, Impaired Sleep Quality, and Increased Arterial Thickening in Type 2 Diabetic Patients. PLoS One [Internet]. 2015 [cited 2022 Nov 17]; 10(4):e0122521. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396841/.
  3. Iyegha ID, Chieh AY, Bryant BM, Li L. Associations between poor sleep and glucose intolerance in prediabetes. Psychoneuroendocrinology [Internet]. 2019 [cited 2022 Nov 13]; 110:104444. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0306453019304858.
  4. Rains JL, Jain SK. Oxidative stress, insulin signaling, and diabetes. Free Radic Biol Med. 2011; 50(5):567–75.
  5. Wang Y, Huang W, O’Neil A, Lan Y, Aune D, Wang W, et al. Association between sleep duration and mortality risk among adults with type 2 diabetes: a prospective cohort study. Diabetologia [Internet]. 2020 [cited 2022 Nov 13]; 63(11):2292–304. Available from: https://link.springer.com/10.1007/s00125-020-05214-4.
  6. Adam TC, Hasson RE, Ventura EE, Toledo-Corral C, Le K-A, Mahurkar S, et al. Cortisol Is Negatively Associated with Insulin Sensitivity in Overweight Latino Youth. The Journal of Clinical Endocrinology & Metabolism [Internet]. 2010 [cited 2022 Nov 13]; 95(10):4729–35. Available from: https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2010-0322.
  7. Greer SM, Goldstein AN, Walker MP. The impact of sleep deprivation on food desire in the human brain. Nat Commun [Internet]. 2013 [cited 2022 Nov 13]; 4(1):2259. Available from: http://www.nature.com/articles/ncomms3259.
  8. Markwald RR, Melanson EL, Smith MR, Higgins J, Perreault L, Eckel RH, et al. Impact of insufficient sleep on total daily energy expenditure, food intake, and weight gain. Proc Natl Acad Sci U S A [Internet]. 2013 Apr 2 [cited 2022 Nov 13];110(14):5695–700. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3619301/ 
  9.  Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLOS Medicine [Internet]. 2004 Dec 7 [cited 2022 Nov 13];1(3):e62. Available from: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0010062 
  10. Yoda K, Inaba M, Hamamoto K, Yoda M, Tsuda A, Mori K, et al. Association between poor glycemic control, impaired sleep quality, and increased arterial thickening in type 2 diabetic patients. PLoS ONE [Internet]. 2015 Apr 14;10(4). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396841/ 

Sidra Irfan

Bachelors of Dental Surgery, Dentistry, Lahore Medical & Dental College, Pakistan

Sidra is a general dentist who enjoys writing in general but particularly enjoys compiling health tech innovation and patient awareness material. She is an equal healthcare access advocate who is currently engaged in research and public health. She also works as a medical, health, and wellness SEO content writer.

Klarity is a citizen-centric health data management platform that enables citizens to securely access, control and share their own health data. Klarity Health Library aims to provide clear and evidence-based health and wellness related informative articles.