Treatment

The First Step to Take for Managing Blood Sugar

David Mendosa Health Guide June 05, 2013
  • The usual ways we have to bring our blood sugar levels down to normal work well. But they may not be the best means for about half of us who have diabetes and pre-diabetes.


    The usual ways are diet, exercise, and reducing stress. These are the cornerstones of diabetes management, but anyone who has sleep apnea has to do more.



    A great many of us who have diabetes also have sleep apnea, and a new study indicates that when we start to manage sleep apnea, we manage our diabetes better at the same time.


    But most of us who have sleep apnea don’t even know that we have it. Ten years ago I was one of them, as I wrote then for Diabetes Wellness News at “Sleep Apnea Goes with Diabetes.”


    About 40 percent of all men who have type 2 diabetes also have sleep apnea, according to research that Daniel Einhorn, the director of the Sharp Diabetes Treatment and Research Center in San Diego, and three associates presented at the 65th Scientific Sessions of the American Diabetes Association. They found that the proportion went up to 61 percent among men older than 65.


    But 93 percent of women and 82 percent of men with moderate to severe sleep apnea haven’t been diagnosed, according to a study in the journal Sleep.“Apnea” is a Greek word meaning “without breath.” The clinical definition is a cessation of breath that lasts at least ten seconds. I didn’t have a clue that I had sleep apnea until I learned from a test that I had 82 apneas per hour, averaging about 24 seconds each.


    A study that doctors from McGill University in Montreal and the University of Chicago presented a few days ago at the annual conference of the American Thoracic Society indicates that the standard treatment option for sleep apnea results in reduced blood sugar levels among people with pre-diabetes. The abstract of the study is available online at, “Effective Treatment Of Obstructive Sleep Apnea Improves Glucose Tolerance In Prediabetes.”


    The study included 39 adults with sleep apnea and prediabetes who were randomized to two weeks of either standard sleep apnea treatment or a placebo tablet. Both before and after the treatment period the study participants took an oral glucose tolerance test, which measures how well they use blood sugar. A unique aspect of the study was that subjects slept each night in the research laboratory, which made sure that they adhered to the treatment. In addition to glucose tolerance, the researchers also measured the insulin secretion and the insulin sensitivity of the participants.


    The results were a dramatic difference between those treated and those who took only a placebo. “We found that optimal treatment of sleep apnea for two weeks led to significant improvements in glucose levels following an oral glucose challenge without affecting insulin secretion,” says lead author Sushmita Pamidi, MD, of the Department of Medicine at McGill University in Montreal, Canada. This suggests “an improvement in insulin sensitivity."


  • People who have type 2 diabetes already secrete too much insulin from the beta cells of their pancreas. The problem is that our bodies aren’t sensitive enough to the insulin that their bodies produce. To be able to reduce blood sugar levels without pumping out more insulin is therefore even better than the way diabetes drugs work.


    The standard treatment of sleep apnea is to use a continuous positive airway pressure device called a CPAP. These machines deliver air at a specific pressure through a breathing tube connect to a facemask. This opens the upper airway and prevents breathing disturbances when we sleep.


    I used a CPAP every night for several years until a second sleep study showed that I didn’t have sleep apnea any more. While some people might think that getting used to wearing a face mask would be a problem, 70 percent of people who use a CPAP stay the course.


    We do that in part because the alternative is so bad. It is immediately obvious that you sleep much better. But untreated sleep apnea is also a potentially life-threatening condition. It can cause high blood pressure and heart disease, memory problems, weight gain, impotency, and headaches. Untreated sleep apnea can also lead to automobile and other accidents.

     

    Based on my experience, a type of CPAP called an APAP could be an even better solution, as I wrote here at “Treating Sleep Apnea for Diabetics.” A mask that fits your face is equally important as I wrote at “Successful Sleep Apnea Therapy.”


    If you have type 2 diabetes or pre-diabetes, you probably need to take a test to see if you have sleep apnea. If you do, a CPAP could be the good news in your future.