Diabetes is a very common disease nowadays. It is called a civilization disease or a non-communicable epidemic of the 21st century. About 3 million people suffer from the disease in Poland, and approximately 440 million in the world, which translates into 1.6 million deaths annually due to it. The disease increases mortality but also deteriorates the quality of life. Diabetes that is improperly treated and poorly controlled causes very serious complications, mainly cardiac ones - more frequent heart attacks, strokes, atherosclerosis of arterial vessels, and, as a consequence of these changes, an increase in the number of lower limb amputations, cases of kidney failure, and diabetic retinopathy. Peripheral polyneuropathy is a very painful symptom, affecting mainly the feet and significantly worsening the patient's quality of life. Currently, an individual approach to a patient with diabetes is emphasized, because each case is different. Each patient struggles with diabetes at different stages and degrees of advancement, uses different antidiabetic drugs or insulin therapy, has a different lifestyle, work pattern, ability to perform physical activity or follow an appropriate diet, which is so important in diabetes.
Despite increasingly better treatment methods, modern drugs and insulins, new insulin pumps and continuous glucose monitoring (CGM) systems, good diabetes control and avoiding hyper- or hypoglycemia are still influenced by many elements of the patient's daily life. Regularity, repetition, consistency of eating, working and resting times, avoiding excessive stress, worrying, living in a hurry, as well as the ability to get good and healthy sleep are very important. The latest diabetes recommendations of the PTD emphasize the role of sleep, its duration and quality on the course of diabetes.
Sleep disorders affect diabetes in two ways. On the one hand, they worsen its balance, causing morning hyperglycemia, increased insulin resistance, and certain neurological disorders that persist during the day regarding concentration, memory, and emotion. On the other hand, diabetes, especially insulin therapy or traditional, older drugs such as sulfonylurea derivatives, generate glycemic disturbances at night and impair the quality of sleep.
Sleep disorders in patients with diabetes and their adverse impact on health parameters
The journal Diabetologia conducted a meta-analysis on the incidence of sleep disorders in type 2 diabetes and their impact on factors such as glycemic control, micro and macrovascular complications, depression, mortality and quality of life. The authors, based on the available literature in the PubMed database, asked the extent to which the treatment of sleep disorders in patients with type 2 diabetes can improve the mentioned health factors. The review included both observational and experimental studies. The results showed that insomnia (39%), obstructive sleep apnea (55-86%), and restless legs syndrome (8-45%) occurred more often than in the general population without diabetes. Moreover, it has been shown that sleep disorders have a significantly negative impact on glycemic control and increase the percentage of glycated hemoglobin HbA1c. The reason for the increase in glycemia after a bad night's sleep is believed to be an increase in the amount of stress hormones, mainly cortisol, which causes metabolic disorders, insulin resistance, slower metabolism, difficulty maintaining optimal body weight, and additional snacking at night or in the morning. Repeated sleepless nights increase your cardiovascular risk. It has been proven that people who sleep little have higher levels of CRP (acute phase protein), which causes a greater risk of inflammation, weakened immunity, a greater risk of obesity, diabetes, hypertension, depression, and cancer. Already the first sleepless night causes memory and concentration disorders, weakened reflexes and the ability to react, anticipate, make decisions and various emotional disorders. Each additional one increases the risk and intensity of the above-mentioned disorders. Such a person may have impaired driving skills, limited assessment of the consequences of actions and reduced foresight, which may contribute to an increased risk of road accidents or accidents at work. The body returns to full balance only after three consecutive nights of sleep.
Treating sleep disorders may therefore play an important role in preventing the progression of diabetes. Conventional therapies such as weight loss, education, and cognitive behavioral therapy appear to be effective in improving sleep and health outcomes in patients with diabetes. Sleeping medications should only be used in more severe cases and for short periods of time. For this purpose, you can use herbal medicines that have a relaxing and sleep-inducing effect, as well as melatonin. In conclusion, it can be stated that because the treatment of sleep disorders can prevent deterioration of diabetes control, sleep disorders should be recognized and treated in patients with diabetes in order to ultimately improve health and quality of life.
Diabetes and drug therapy as factors worsening sleep quality
A diabetic patient using insulin therapy, especially intensive 3-4 injections a day, and also treated with an insulin pump or older generation drugs, such as sulfonylurea derivatives, is more exposed to fluctuations in glycemia at night, which may manifest as:
- Hyperglycemia, i.e. too high blood glucose level >180 mg, with symptoms of difficulty falling asleep, more frequent urination - nocturia and large amounts of urine excreted (polyuria),
- Hypoglycemia, i.e. too low glycemia level <70 mg/dl. It may cause waking up at night or waking up with heavy sweats, deterioration of sleep quality, problems with waking up, feeling tired, dull, and irritable during the day.
To avoid these problems, you should choose the appropriate meal for dinner, especially the amount of carbohydrates in the meal, and adjust the appropriate dose of insulin depending on the glycemia before the meal, e.g. around 6:00 p.m., and basal insulin, usually administered around 10:00 p.m. Currently, with advanced devices for measuring CGM (Continuous glucose monitoring system), new insulin pumps with a hybrid system and closed loop, significant nocturnal hypo- or hyperglycemia is becoming less common, and patients have a better quality of life and avoid dangerous complications of diabetes. .
To ensure comfortable sleep, remember the basic rules, such as the appropriate temperature in the bedroom (about 18 degrees Celsius), airing the room, properly selecting a sleeping pillow and mattress, and using headbands or earplugs. In the evening, it is important to turn off multimedia and avoid intense exercise late at night. It is worth remembering about fixed sleep times and avoiding shift work at night.
To sum up, detecting and treating sleep disorders is not usually part of standard patient care in a diabetes office, which is often due to the time limit of such a visit, but drawing attention to this problem in the doctor's office and ensuring the patient's good sleep contributes significantly to improving diabetes control. , and sometimes to prevent it and reduce the risk of other diseases and health problems mentioned in this article.
Krzysztof Chabros
Diabetologist specialist
Literature:
- Urszula Cieślik-Guerra, Sleep disorders as a risk factor for type 2 diabetes, " Fam Med Prim Care Rev11.3 (2009), pp. 574-576.
- Clinical recommendations for the management of patients with diabetes 2022. Position of the Polish Diabetes Association. Current Topics in Diabetes, 2022;2 (1) p. 26.