The Sleep-Diabetes Connection

Not sleeping? Check your blood sugar levels. 

Whenever diabetes patients enter Lynn Maarouf’s office with out-of-control blood sugar levels, she immediately asks them how they are sleeping at night. All too often, the answer is the same: not well.

“Any time your blood sugar is really high, your kidneys try to get rid of it by urinating,” says Maarouf, RD, the diabetes education director of the Stark Diabetes Center at the University of Texas Medical Branch in Galveston. “So you are probably getting up and going to bathroom all night long -- and not sleeping well.”

Diabetes and sleep problems often go hand in hand. Diabetes can cause sleep loss, and there’s evidence that not sleeping well can increase your risk of developing diabetes.

Low Sleep, High Blood Sugar

Maarouf says high blood sugar is a red flag for sleep problems among people with diabetes for another reason. “People who are tired will eat more because they want to get energy from somewhere,” she says. “That can mean consuming sugar or other foods that can spike blood sugar levels.”

“I really push people to eat properly throughout the day and get their blood sugars under control so they sleep better at night,” Maarouf says. “If you get your blood sugar under control, you will get a good night sleep and wake up feeling fabulous with lots of energy.”

The Connection Between Lack of Sleep and Diabetes

“There is some evidence that sleep deprivation could lead to pre-diabetic state,” says Mark Mahowald, MD, director of the Minnesota Regional Sleep Disorders Center in Hennepin County.

According to Mahowald, the body's reaction to sleep loss can resemble insulin resistance, a precursor to diabetes. Insulin’s job is to help the body use glucose for energy. In insulin resistance, cells fail to use the hormone efficiently, resulting in high blood sugar.

Diabetes occurs when the body does not produce enough insulin or the cells do not properly use the insulin. When insulin is not doing its job, high blood sugar levels build in the body to the point where they can harm the eyes, kidneys, nerves, or heart.

The Link Between Lack of Sleep and Weight

Some studies show that people who get less sleep tend to be heavier than those who sleep well, Mahowald says.  Being overweight or obese is a risk factor for the development of diabetes.

There is also a link between diabetes and sleep apnea, a sleep disorder marked by loud snoring and pauses in breathing while you sleep. The culprit may be excess weight, which can cause fat deposits around the upper airway that obstruct breathing. So being overweight or obese is a risk factor for sleep apnea as well as diabetes.

“If you have diabetes, are overweight, and snore, tell your doctor,” says Susan Zafarlotfi, PhD, clinical director of the Institute for Sleep and Wake Disorders at Hackensack University Medical Center in New Jersey. “You may need a sleep study.”

Sleep apnea can prevent a person from getting a good night sleep, which can worsen diabetes or perhaps increase the risk of developing diabetes. In sleep studies, you are monitored while you sleep for sleep disorders such sleep apnea.

There are many effective treatments for sleep apnea. These include lifestyle changes such as weight loss for mild cases and devices to open up blocked airways for more significant cases.

Sleep Is as Important as What You Eat

“In general, people with diabetes have to be very careful about sleep because anything that throws off their routine can make them feel a lack of energy and fatigue,” says Zafarlotfi. “The more fatigued they feel, the more their motor is running, and the more likely they are to develop insulin deficiencies.

“Proper sleep is as important as diet for people with diabetes,” she says.

Determining How Much Sleep You Need

“There is no formula for how much sleep you need,” Zafarlotfi says.  “It depends on you.”

Mahowald agrees. “On average, we need 7.5 hours per night, but your sleep requirement is genetically determined and varies,” he says. “It can be about four hours on the short end to 10 or 11 on the long end.”

Want to know if you are sleep-deprived? The answer is simple, Mahowald says: “If you use an alarm clock, you are. If you were getting adequate sleep, your brain would awaken you before the alarm goes off.”