Getting adequate sleep appears to help insulin functioning and blood sugar control

There was an interesting, I think, study published this week in which the association between sleep habits and certain metabolic processes were assessed in diabetics and non-diabetics [1]. The study assessed sleep habits by self reports and something known as ‘actigraphy’ (the measuring of sleep through a device worn on the wrist). Health markers assessed included blood sugar levels, insulin levels and extent of ‘insulin resistance’.

Insulin resistance, describes a state where some of the body’s tissues are not responding to insulin, which causes, among other things, generally elevated levels of sugar in the bloodstream. Insulin levels will tend to be high too. Higher levels of insulin may predispose to fat gain. However, if sugar is not making its way efficiently into, say, the muscles and brain, we can end up tired and hungry. In general terms, insulin resistance is not a good thing, and neither is generally elevated levels of sugar and insulin.

In the study in question, in non-diabetics, there was no association found between sleep habits and levels of sugar and insulin and insulin sensitivity.

The situation, however, was very different in diabetics.

Poor sleep in this group was associated with raised levels of blood sugar and insulin. Insulin resistance was significantly greater too. In short, in diabetics, poor sleep habits were associated with worsened blood sugar control and, in all likelihood, enhanced risk of diabetic complications and disease in time.

Now, so-called epidemiological studies of this nature can only tell us that poor sleep and worse health markers are associated. It does not prove that sleeping poorly causes these issues. However, there is other evidence in the scientific literature that supports the idea that sleep problems can actually lead directly to the sort of issues we’re talking about here.

In one study, nine health adults were tested to see what effect sleep deprivation has on insulin resistance [2].

On one night, individuals were allowed to sleep for up to 8.5 hours (23.00 – 7.30 hrs). On another night, sleep was only permitted for four hours (01.00 – 05.00 hrs). The actual average sleep times were 7 hours 34 minutes and 3 hours 46 minutes respectively.

The results show that in the sleep-deprived state there was evidence of insulin resistance. ‘Endogenous’ sugar production (internal production of sugar, say, from the liver) was higher, and clearance of glucose (say, into muscle cells) was lower in the sleep-deprived state.

Now, less than four hours sleep is not much sleep. But then again, increased insulin resistance was seen in individuals after just one night of sleep deprivation. It’s possible that less extreme sleep deprivation over long periods of time also poses hazards for the body. In fact, lower sleep durations has previously been linked with an increased risk of type 2 diabetes.

I don’t know how well any underlying mechanisms here are understood. However, it is known that sleep deprivation can cause increases in the ‘stress’ hormone cortisol. And cortisol is known to have the capacity to induce insulin resistance.

References:

1. Knutson KL, Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes: The Coronary Artery Risk Development in Young Adults (CARDIA) Sleep Study. Diabetes Care. 2011;34(5):1171-6.

2. Donga E, et al. A single night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways in healthy subjects. J Clin Endocrinol Metab. 2010;95(6):2963-8

17 Responses to Getting adequate sleep appears to help insulin functioning and blood sugar control

  1. liza 5 May 2011 at 2:12 pm #

    title is missing a word (Sleep). getting enough sleep?

  2. Margaret Wilde 5 May 2011 at 2:41 pm #

    That’s very interesting, especially the paragraph: “The results show that in the sleep-deprived state there was evidence of insulin resistance. ‘Endogenous’ sugar production (internal production of sugar, say, from the liver) was higher, and clearance of glucose (say, into muscle cells) was lower in the sleep-deprived state.” It explains a lot to me.

    Thank you very much.

  3. John Briffa 5 May 2011 at 3:10 pm #

    Thanks Liza – corrected now.

  4. Jessica Macbeth 5 May 2011 at 5:33 pm #

    This is very helpful. I guess I need to set the alarm to go to sleep on time instead of staying up late… It all makes perfect sense with my own observations. Both lack of sleep *and* stress, together or separately, send my blood glucose up.

  5. Chmee 5 May 2011 at 10:48 pm #

    Interesting, and supports what I found when I tracked my BG levels. Less / interrupted sleep – and with two young children this was guaranteed most nights ! :) ) and I noted the increased BG level in the morning. Anecdotal / n=1 I know, but it is supported by studies. I also found that if I dozed off again – say at weekends – and got up an hour later than normal, disturbing normal rhythms, levels were similarly raised. There is evidence for this; see ‘Roles of Circadian Rhythmicity and Sleep in Human Glucose Regulation — Van Cauter et al_ 18 (5) 716′. (link is http://edrv.endojournals.org/cgi/content/full/18/5/716#top ) It supports what Dr Briffa has said: good quality sleep is important, as is regular rising etc. But is there anything to beat that delicious feeling of just saying ‘Ah, sod it !’ on a Sunday morning and drifting off back to sleep leaving the wife to handle things ? No, I thought not…. :) And yes, I do get up on saturday mornings and let her have a lie in. And take her breakfast in bed, before you ask.

  6. Reijo Laatikainen 6 May 2011 at 10:54 am #

    You mention that cortisol may lay behind the decreased insulin sensitivity. Nedeltcheva et al have also documented that decreased insulin sensitivy may be caused (at least partly) by high adrenalin levels observed during sleep curtailment

    http://1.usa.gov/k4eztw

  7. JohnBenson Anyanwu 7 May 2011 at 5:44 am #

    IT is true, sleep does a lot in body functions,especially in the night. The digestive functions are mostly done by the liver in the hours of 12 mid-night and 4 am while asleep and this function stops while awake. Elimination functions according to experts starts by 4am if proper digestion has taken place. Brain functions are greatly enhanced by proper sleep. toxins are easily eliminated by the liver while asleep. Etc

  8. Chris Brown 7 May 2011 at 12:07 pm #

    Wondering if there is a connection also with sleep apneoa and weight gain ? With people who have this disorder, they are obviously not getting enough ood quality sleep so prone to insulin resistance.

    Most people with sleep apneoa are overweight – but is this a “chicken and egg” situation? They have gained weight due to insulin resistance, thus have a propensity to develop sleep apneoa which in turn increases the insulin resistance which in turn then causes further weight gain……………..so a true vicious cycle.

  9. Jean Barlow 7 May 2011 at 1:57 pm #

    This sleep stuff is all very well – but what if it isn’t easy to get it? I’d love to drift naturally off to sleep like I used to but can’t any more. No hope for Type 2′s like me then!

  10. carter 7 May 2011 at 7:51 pm #

    Hi, I enjoy your work immensely, thanks.

    Just wondering if you have run across anything that supports the fact that meditation can replace sleep? thanks very much, richard carter

  11. Chris 8 May 2011 at 9:44 am #

    Some fifteen years ago I observed I had a tendency to over-eat and such tendency seemed to be associated with degrees of sleep deprivation and accumulated degrees of fatigue. The more tired I was the more I craved food, snacks, and perhaps by distinction, food that tended to be higher in carbohydrate and/or sugar. Beer featured as a common component of my relaxation time before retiring.

    It seemed to be a vicious circle because I recall experiencing episodes of muscle lethargy particularly in the thigh muscles. Sometime later the doctor had cause to ‘do some bloods’ and the fasting BG turned up to be high but not a complete disaster.

    Since then I have lived with being identified as type 2 diabetic but I resist accepting the prescriptive route to treatment. In ten years I have come to interpret how I feel with the management of my condition.

    I agree entirely that satisfactory levels of sleep, and quality of sleep, influence how I get on.

    Plus there are other factors, particularly aspects related to diet, that determine my success or otherwise.

  12. MrWeetabix 8 May 2011 at 12:38 pm #

    @CHRIS

    Being overweight causes sleep apnea not sleep apnea causes weight gain! lol

  13. John Briffa 8 May 2011 at 12:45 pm #

    MrWeetabix

    Being overweight causes sleep apnea not sleep apnea causes weight gain! lol

    Can you provide the evidence for this?

  14. katydogcrazy 10 May 2011 at 9:11 pm #

    My sleep specialist told me plainly that there was virtually no hope of losing weight with untreated sleep disturbance disorders. Encouraging folk with sleep apnea (whether obstuctive or central)to lose weight is known as fruitless among the board certified specialists – treat the apnea and generally the weight will start falling off. Years back he said that the effect was generally assumed to be that better sleep meant feeling better which led to more activity, but he believed there were firm ties to deeper physiologic roots which were yet to be elucidated.

  15. Lynette Ellison 12 May 2011 at 3:31 am #

    Especially for Jean – investigate a low dose melatonin ie 300mcg to start with. You will possibly need to get it from the USA. This can help with getting to sleep and staying asleep for many people.

  16. business daily 21 May 2011 at 8:06 am #

    Several studies have indicated that we are getting less sleep and that there are significant health effects that can occur as a result. A new study from the Leiden University Medical Center in the Netherlands adds to prior evidence that insomnia is linked to insulin resistance and also finds that it takes just one sleepless night to cause problems..Using the hyperinsulinemic euglycemic clamp method the researchers measured insulin sensitivity nine health people once after a night of eight hours of sleep and once after a night of just four hours. This method uses catheters to infuse glucose and insulin into the bloodstream and then determines insulin sensitivity by measuring the amount of glucose necessary to compensate for an increased insulin level without causing hypoglycemia..The partial sleep restriction during a single night reduced some types of insulin sensitivity by 19 to 25 ..Insulin is a hormone produced by the pancreas that controls the amount of glucose is present in the bloodstream.

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