Ask D’Mine: How Does Sleep Impact Blood Sugar Control?

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Got questions about life with diabetes? You can always Ask D’Mine — our weekly Q&A column, hosted by longtime type 1 and diabetes author Wil Dubois.

Today, we’re addressing sleep, that essential component impacting all aspects of health.

{ Got your own questions? Email us at AskDMine@diabetesmine.com }

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Joe, type 2 from New Jersey, asks: What’s the big deal with sleep and diabetes? What impact does it actually have on your blood sugar levels? 

Wil@Ask D’Mine answers: Oh, man, you would not believe the ways that short-changing yourself on sleep will harm with your blood sugar levels, and, in fact, your entire diabetes health. I kid you not, a lack of sleep is worse for people with diabetes than having a job at the Gummy Bear Factory. Try this number on for size: Insufficient sleep can raise A1C by a whopping 1.9 points!

Allow me take you through each of the major ways that not getting enough sleep messes with your diabetes health. Bear in mind that all of these mechanisms overlap, and in many cases feed on each other—each making the other worse, in a descending spiral of diabetes chaos.

According to the National Sleep Foundation, not getting enough sleep screws with the hormones in your body that regulate and metabolize glucose. First up, naturally, is insulin. One study linked peak nocturnal insulin release with REM sleep, suggesting that people who don’t sleep enough to get into this deepest sleep cycle will have high morning sugars largely due to the fact that there was simply not enough insulin in play. And on the flip side of that coin, insufficient sleep significantly raises insulin resistance, partly through changes in the thyroid stimulating hormone and testosterone. So not only is there not enough insulin in play, what is present isn’t as effective.

Meanwhile, along with “garden variety” insulin resistance, a lack of proper sleep causes the stress hormone cortisol to be released. Cortisol raises blood sugar directly and depresses beta cell activity. But that’s not all on the hormone front. In addition to impacts on insulin, thyroid, testosterone, and cortisol, studies on sleep “curtailment” show that lack of sleep reduces the satiety hormone leptin and increases the appetite-stimulating hormone ghrelin. That’s a nasty double-whammy. It means that you run hungry, and this powerful hunger is harder to satisfy. Even a single night of sleep deprivation results in measurable changes in the levels of this pair of hormones. The end result is that you overeat during the day and start putting on weight.

And, of course, we all know that our old friend insulin resistance increases as weight increases. Meanwhile, the more tired people get, simply from not getting enough sleep, the less active they are. That means along with eating more, they are burning less energy, again adding to weight. Oh, and speaking of weight, people with high BMI (body mass index) are at risk for sleep apnea, a condition linked to poor sleep quality. And, of course, fatigue from lack of sleep can lead straight into depression, which can fuel poor eating choices and gets in the way of good diabetes management, making everything even worse.

I think by now you’re starting to get the idea. These interlinked sleep issues snowball into an avalanche. And we’re not done yet. Lack of sleep also increases fatty acids in the blood, which in turn can block the action of insulin. Other studies show how various levels of sleep deprivation can affect growth hormone, driving glucose upward. And I’m not even getting iinto the arcane subject of sympathovagal balance and the relationship between it, sleep, and sugar. Bottom line, there are a lot of chefs in the kitchen when it comes to ways in which not getting enough sleep raises blood glucose.

Meanwhile, the worse the blood sugar control, the worse the sleep. And as we’ve seen, the worse the sleep, the worse the blood sugar control, and on it goes. Then, when the blood sugar gets significantly out of control, hyperglycemia-triggered polyuria jumps in to become a serious sleep interrupter. Sugar levels in the 300s can have PWDs (people with diabetes) dashing for the bathroom to pee every hour, all night long, wrecking any possibility of proper sleep, further upping the ante on all the hormone cascades we’ve talked about.

And if high sugars remain unchecked, they will lead to sleep-interrupting complications like restless leg syndrome or painful peripheral neuropathies.

While all of this sounds incredibly depressing, an opposite takeaway is possible: While lack of sleep throws a monkey wrench into the machinery of diabetes control, getting the right amount of sleep can actually be therapeutic.

Diabetes advocate and technology expert Adam Brown, over at DiaTribe, has spent a lot of time looking at blood sugar and all the things that impact it, and he calls sleep “a highly underrated diabetes tool.” In fact, Adam’s evidence-based study of blood glucose and sleep made such an impact on him that he devoted an entire section to sleep in his four-section book Bright Spots & Landmines. 

Sleep is a big part of his book, because sleep is a “big deal” when it comes to diabetes.

Will Dubois lives with type 1 diabetes and is the author of five books on the illness, including “Taming The Tiger” and “Beyond Fingersticks.” He spent many years helping treat patients at a rural medical center in New Mexico. An aviation enthusiast, Wil lives in Las Vegas, NM, with his wife and son, and one too many cats.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. Bottom Line: You still need the guidance and care of a licensed medical professional.