Control Blood Sugar, Treat Sleep Apnea to Prevent Diabetes Complication

diabetes care, Type 2 diabetes, obstructive sleep apnea
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Diabetes complications present enormous health challenges. Having diabetes increases your risk for cardiovascular conditions such as heart attack and stroke, eye disease including cataracts and blindness, kidney failure, and nerve damage or neuropathy. These complications can be prevented or delayed if diabetics take extra efforts to better control blood sugar, which includes getting treatment for the condition known as obstructive sleep apnea (OSA).

Diabetic neuropathy is a disabling condition which affects up to half of all people with diabetes. This nerve damage, caused by decreased blood flow and high blood sugar levels affects not only the nerves in the feet and legs, making them feel tingly, numb, painful or weak, but also nerves in the skull, spinal cord, and those that lead to the vital organs including the heart, bladder, stomach and intestines.

Doctors know that those who control their blood sugar are less likely to develop neuropathy. New research suggests that the tighter the control, the better chance patients have to delay the onset of this complication. In a review of 17 clinical trials published in the June issue of the Cochrane Database of Systematic Reviews, patients who aggressively controlled their blood sugars had a lower risk of developing neuropathy, with the best benefit shown in those patients with Type 1 Diabetes.

However, warns Brian C. Callaghan MD of the University of Michigan, those with Type 1 diabetes did have a much greater risk of hypoglycemia with more aggressive treatment. "Although these results show clear benefits for preventing neuropathy in people with diabetes, they should be weighed against potential adverse effects," he said. "Future studies must establish target levels for glucose control that will balance benefits and side effects."

Dr. Callaghan also said, “The less dramatic effect of enhanced glucose control in type 2 diabetes may indicate that other factors, besides high glucose levels, may be important in causing nerve damage in these patients." One of these factors, interestingly enough, could be obstructive sleep apnea. Two new studies link this condition with complications in Type 2 Diabetics.

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OSA is a condition in which the flow of air pauses or decreases during breathing while you are asleep. The pause in breathing is called an apneic episode. Researchers at the University of Birmingham (UK) have found that obstructive sleep apnea is independently associated with diabetic peripheral neuropathy in patients with Type 2 diabetes. And those with more severe sleep apnea are at greater risk for developing severe neuropathy.

“OSA is known to be associated with inflammation and oxidative stress,” says lead author Abd Tahrani, MD, clinical lecturer in endocrinology and diabetes. In a study of 234 adults, sleep apnea was also associated with impaired microvascular blood flow regulation. “OSA may aggravate and amplify glucose toxicity, which has significant implications for tissues which are susceptible to the complications of diabetes,” Dr. Tahrani concludes.

The second study, conducted by researchers at the Robert Wood Johnson Medical School in New Jersey finds that diabetic patients with OSA have double the risk of carbohydrate cravings than non-diabetics. Excessive intake of high carbohydrate foods raises blood sugar levels, increasing the risk for all diabetic complications, including neuropathy. Study co-investigator Mahmood Siddique DO, a clinical associate professor, says that hormonal changes occur during sleep deprivation during apneic epsidose that then affect appetite and hunger regulation.

"The management of patients with diabetes and or metabolic syndrome based solely on pharmacotherapy, exercise and nutritional modifications without taking into account the risk of sleep apnea may not lead to optimal outcomes for patients suffering from these chronic diseases,” adds Dr. Anthony Cannon MD, American Diabetes Association regional president for central and southern Pennsylvania and southern New Jersey.

Clearly, blood sugar control is based on many factors, but tackling the following can put diabetic patients on the road to good health:
• Daily exercise, even if only for a short period of time
• A healthy, balanced diet of whole grains, legumes, fruits and non-starchy vegetables, and lean protein
• Monitoring blood sugar and taking prescribed medications as directed.
• Reducing stress and improving sleep quality.
Smoking cessation

Source references:
Callaghan BC, et al "Enhanced glucose control for preventing and treating diabetic neuropathy" Cochrane Database Syst Rev 2012; DOI:10.1002/14651858.CD007543.pub2.
Tahrani A, et al. Obstructive Sleep Apnea and Diabetic Neuropathy: a Novel Association in Patients with Type 2 Diabetes. American Journal of Respiratory and Critical Care Medicine (AJRCCM), June 2012.
"Association of sleep apnea and carbohydrate craving among diabetics" presented June 13, 2012 at SLEEP 2012, the 26th annual meeting of the Associated Professional Sleep Societies (APSS) in Boston.
National Institutes of Health

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