Diabetes Type 1 And Sleep

What is diabetes type 1?

Type 1 diabetes is caused by elevated blood glucose (sugar) levels occurring because the body cannot produce enough insulin. Insulin is the hormone that controls blood glucose levels in the body. This condition is autoimmune in nature since an individual’s immune system attacks and destroys the insulin-producing cells in their pancreas, so they cannot make sufficient amounts of insulin anymore.

Insulin is vital for us all and essential for the normal physiological function of our bodies. Typically, when we eat and drink our bodies break down the carbohydrates from what we have consumed into a type of sugar called glucose which serves to fuel our cells. With this rise in blood glucose levels, the body alerts the pancreas to release insulin to help break down the glucose in our bloodstream so that it can be absorbed by the body’s cells or alternatively stored by the liver for later use.

In non-diabetic individuals, this cycle regulates itself to maintain a relatively stable blood glucose level, however, in those with type 1 diabetes this cycle is altered since the pancreas is unable to produce enough insulin to break down all the glucose in the blood. In turn, their blood sugar levels continue to rise which further damages the pancreas and contributes towards atherosclerosis (hardening of the blood vessels), which consequently has a cascade of implications for the body as a whole. Therefore, it is vital that those with this condition get treatment and supplement their insulin, often using injections or pumps, to live a functioning lifestyle and help prevent longer, more damaging, later life health conditions.

Unlike type 2 diabetes which typically originates from lifestyle-related developments over time and affects 90% of the diabetic population, type 1 diabetes is a genetic condition that manifests during early life and affects 8% of diabetics.1 Regardless of their type, diabetics can suffer episodes of hyperglycaemia when blood sugar levels are elevated, and hypoglycaemia when blood sugar levels are deficient. Again, because of such extremes and ongoing glucose variability, it is crucial those with diabetes manage their condition, especially considering that failure to do so results in further complications, health deterioration and lifestyle difficulties.

The importance of sleep

Sleep is a fundamental process that enables the body and mind to recharge, as well as the brain to cognitively and behaviourally function optimally. Fundamentally, sleep is essential for the maintenance of cardiovascular and metabolic health throughout one’s life.2 For such reasons, adults are required to have between seven and nine hours of nightly sleep whilst children and teenagers should have more due to their ongoing development.3 Insufficient sleep in the form of disturbances, fragmentation, restrictions and architecture amongst other things has been linked to increased risk for certain diseases and medical conditions,4 and overally has detrimental impact on all of us so getting enough sleep is paramount.

Sleep complications when living with diabetes type 1

Type 1 diabetics have a complicated relationship with sleep. On the one hand, glucose variability and subsequent episodes of hyperglycaemia or hypoglycaemia may affect how diabetics sleep. On the other hand, the nature of sleep itself and how that differs compared to non-diabetic individuals also contributes towards the worsening of one’s diabetic condition, the management of their condition and their general lifestyle.

More specifically, in type 1 diabetics sleep is disrupted due to both behavioural and physiological aspects of the condition and its management. Much research has reported significantly elevated blood sugar levels in type 1 diabetics over time with sleep disturbances in the form of sleep initiation problems,5 sleeping difficulties, and full awakenings from sleep.6 Moreover, in terms of sleep architecture (i.e. the different stages of sleep reflecting how deeply someone is sleeping), greater ongoing hyperglycaemia is observed in type 1 diabetics sleeping less than 6.5 hours per night.7 Similarly, compared to non-diabetics, type 1 diabetics commonly spent a greater percentage of time in the lighter stages of sleep and less time in the deeper stages which consequently affects sleep quality.8

Overall deficient sleep in people with type 1 diabetes negatively affects disease progression, makes their condition harder to manage, and contributes towards the development of other complications.

Nocturnal hypoglycaemia

Nocturnal hypoglycaemia refers to when blood glucose levels severely dip while sleeping at night. This condition is a common occurrence in type 1 diabetics regardless of age,9 and is relatively dangerous due to difficulty recognising symptoms or awakening during such episodes.

Causes

Nocturnal hypoglycaemia is typically caused by:

  • Skipping meals or not eating enough before going to sleep.
  • Exercising or drinking alcohol before bed.
  • Low blood glucose levels before bed.
  • Daytime hypoglycaemia.
  • Having infections or feeling ill.
  • Menstruation or puberty (for children/adolescents).

What happens if you sleep through an episode of nocturnal hypoglycaemia?

Following an episode of nocturnal hypoglycaemia, after awakening a type 1 diabetic may experience the following morning symptoms:

  • Feeling fatigued and lethargic the following day.
  • Having a higher than usual morning glucose level.
  • Signs of excessive sweating, such as damp bedding and clothes.
  • Ongoing sleep disturbances and restlessness.
  • Suffering from a headache or experiencing confusion and irritability.

More broadly, such hypoglycaemia contributes towards anxiety, poorer physiological health , reduced life quality,10 and even neurocognitive deficits.11

How to avoid low blood sugar at night

In turn, it is vital to prevent nocturnal hypoglycaemia, which can be achieved through consulting a healthcare professional, as well as creating good habits regarding:

  • Regularly test blood glucose levels before going to bed.
  • Adhering to regular meals and snacks at similar timings each day.
  • Eating a meal/snack when consuming alcohol.
  • Adjusting insulin doses when required before going to sleep, especially following exercise.
  • Being prepared by having rapid-acting carbohydrates, such as glucose tablets, at your bedside.

Generally, nocturnal hypoglycaemic episodes often vary in severity so whilst minor episodes may be self-corrected, severe episodes often require third-party intervention.12 

Summary

Type 1 diabetes is caused by elevated glucose levels in the blood due to insufficient insulin production. Such a condition has the potential to drastically compromise how an individual may lead their life, although consistent management of the condition improves overall quality of life, physical health, and ultimately disease progression.

A key area that is often compromised is sleep and given the complicated relationship between sleep and type 1 diabetes, it is vital for diabetics to regulate their glucose levels. More specifically, whilst sleep is affected in various ways in diabetics, the consequent repercussions of episodes of nocturnal hypoglycaemia in particular demonstrate why management is key. Overall, sleep is vital for us all but especially for type 1 diabetics, it is critical to be prepared and get into good habits to ensure they achieve a good night’s sleep.

References

  1. Differences between type 1 and type 2 diabetes [Internet]. Diabetes UK. [cited 2022 Oct 13]. Available from: https://www.diabetes.org.uk/diabetes-the-basics/differences-between-type-1-and-type-2-diabetes
  2. Farabi SS. Type 1 diabetes and sleep. Diabetes Spectrum [Internet]. 2016 Feb 1 [cited 2022 Oct 13];29(1):10–3. Available from: https://diabetesjournals.org/spectrum/article/29/1/10/32164/Type-1-Diabetes-and-Sleep
  3. How sleep works - how much sleep is enough? | nhlbi, nih [Internet]. [cited 2022 Oct 13]. Available from: https://www.nhlbi.nih.gov/health/sleep/how-much-sleep
  4. Why do we need sleep? [Internet]. Sleep Foundation. 2014 [cited 2022 Oct 13]. Available from: https://www.sleepfoundation.org/how-sleep-works/why-do-we-need-sleep
  5. Happe S, Treptau N, Ziegler R, Harms E. Restless legs syndrome and sleep problems in children and adolescents with insulin-dependent diabetes mellitus type 1. Neuropediatrics [Internet]. 2005 Apr [cited 2022 Oct 13];36(2):98–103. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-2005-837685
  6. Barone MTU, Wey D, Schorr F, Franco DR, Carra MK, Lorenzi Filho G, et al. Sleep and glycemic control in type 1 diabetes. Arch Endocrinol Metab [Internet]. 2015 Feb [cited 2022 Oct 13];59:71–8. Available from: http://www.scielo.br/j/aem/a/wvWJqQSwjRd8Kc8sxhW8Nyb/?lang=en
  7. Borel AL, Pépin JL, Nasse L, Baguet JP, Netter S, Benhamou PY. Short sleep duration measured by wrist actimetry is associated with deteriorated glycemic control in type 1 diabetes. Diabetes Care [Internet]. 2013 Oct [cited 2022 Oct 13];36(10):2902–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3781526/
  8. Perfect MM. Sleep-related disorders in patients with type 1 diabetes mellitus: current insights. Nat Sci Sleep [Internet]. 2020 Feb 11 [cited 2022 Oct 13];12:101–23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023878/
  9. Prolonged nocturnal hypoglycemia is common during 12 months of continuous glucose monitoring in children and adults with type 1 diabetes. Diabetes Care [Internet]. 2010 May [cited 2022 Oct 13];33(5):1004–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2858162/
  10. Nordfeldt S, Ludvigsson J. Fear and other disturbances of severe hypoglycaemia in children and adolescents with type 1 diabetes mellitus. Journal of Pediatric Endocrinology and Metabolism [Internet]. 2005 Jan [cited 2022 Oct 13];18(1). Available from: https://www.degruyter.com/document/doi/10.1515/JPEM.2005.18.1.83/html
  11. Matyka KA. Nocturnal hypoglycaemia in children: the effects on cognitive function. Diabetes, nutrition & metabolism. [Internet] 2002 Dec; [cited 2022 Oct 13] 15(6):390-5. Available from: https://pubmed.ncbi.nlm.nih.gov/12678456/
  12. Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care [Internet]. 2003 Jun 1 [cited 2022 Oct 13];26(6):1902–12. Available from: https://diabetesjournals.org/care/article/26/6/1902/26493/Hypoglycemia-in-Diabetes

Jaskirat Kanwal

Bachelor of Science - BSc, Psychology. University of Leicester, UK
Jaskirat currently works in pharmaceutical care and is currently working towards their data analytics certification. They hope to study further, and continue in academia and research, with hopes to ultimately become an HCPC registered clinical neuropsychologist.

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