By DR. MANOHAR K NAGESHAPPA, MD, DNB, FRCP (Edinburgh, & Glasgow UK), CONSULTANT, PHYSICIAN, INTERNAL MEDICINE, MANIPAL HOSPITAL, BANGALORE
Approximately 425 million people in the world were suffering from Diabetes as per a 2016 report of the WHO, of which 70 million live in India. This number is growing steadily in most emerging economies, as they achieve greater success in battling poverty and hunger. Further, people of Asian origin who are living in industrialized countries exhibit a higher frequency of diabetes and heart disease that Caucasians living in those countries.
Diabetes is of two main types, Type-1 which is seen from a very young age and can only be treated with insulin injections, and Type-2, which can occur at any age. A few decades ago, it used to be believed that only middle aged, affluent people would suffer from diabetes. Now we know that even teenagers at times have abnormally high blood sugar levels. This is also seen in middle class, working class and even rural folk.
Lifestyle factors such as growing urbanization, sedentary nature of work and unhealthy dietary habits have traditionally been blamed for causing diabetes in an increasing section of the population.
World Diabetes Day is observed on November 14 each year to draw attention to the growing problem. One goal is to educate people that a healthy lifestyle is mostly in the hands of individual people.
While an unhealthy lifestyle is an important factor in causation, there are others at play as well. One is genetics and inheritance, because of which doctors always enquire about family history of the disease. However, medical scientists now believe that almost 100 genes act together to determine who gets Diabetes and who doesn’t. Besides, the disease progresses at a different pace in different levels, particularly in the matter of complications of Diabetes such as kidney failure, heart disease, retinal disorders in the eyes, delayed healing of wounds, etc. This is because of genetic variations, though the details are still sketchy.
Other important determinants are stress and anxiety as well as poor quality of sleep. Stress provokes the body to generate hormones such as cortisol and adrenaline, which gears up the human body to meet any challenges that it faces. Once the threat or challenge fades out, these hormones are also gradually removed from the blood. However, if the stress lasts for much longer, the supply of glucose and oxygen generated by the hormones remains. This is the link between stress and the causation of diabetes.
Similarly, when we sleep, our body winds down, and the need for oxygen and glucose is also lower than the waking hours. Hence the generation of glucose through chemical reactions in the liver, the heart-beat and blood pressure, the depth and pace of breathing also tend to slow down. It is the time the human body recovers from the strains of the day time. Now if sleep is continuously interrupted, either due to a breathing disorder or the need to visit the toilet at night (on account of prostate enlargement), your body doesn’t get a chance to recuperate. The result is constantly high blood sugar, which fails to respond to usual therapeutic measures such as medication, diet control, exercise, etc.
One of the commonest reasons of continuous interruptions in sleep with all its attendant complications is Obstructive Sleep Apnea or OSA. In fact, while OSA is a severe form of the disease, even milder forms such as snoring which most people tend to ignore, are also as dangerous as full-blown OSA.
This is why endocrinologists (specialists in hormonal disorders including Diabetes) should give due attention to the role of sleep disorders in Diabetes patients, particularly if those who do not show the expected response to standard forms of therapy.
Fortunately, sleep disorders can be quite diagnosed with the help of a Sleep Test, either at home or in a Sleep Laboratory. The most preferred form of treatment is CPAP (Continuous Positive Airway Pressure) for which a number of well-designed devices are available.