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Here are my thoughts on relating Blood sugar to sleep apnea. There may be two ways, I think, that sleep apnea might affect blood glucose. First, I have read elsewhere that if your sugar goes too low(hypoglycemia), your body responds by sending a shot of adrenaline through your system which causes, among other things, glucose to be released into the bloodstream. Now what if you suffer from sleep apnea and are not using your mask, and you have these apneatic (a made-up word) events. Might the partial wake up that the body goes through as a defense mechanism also release adrenaline and therefore glucose into the bloodstream? If you are not diabetic the body would quickly counteract this, but if you ARE diabetic the sugar might remain in the bloodstream, giving you a higher glucose reading in the morning when you get up.
The other way has to do with eating too much to stay awake, as a previous post has it, and possibly too much fat in the area around the back of the mouth. I remember a doctor saying that there isn't that strong a correlation between weight loss and relief of sleep apnea, so it may require a lot of weight loss to see any improvement. My father in his 40's, 50's and 60's was a BIG apneatic (there were no treatments available then,) but by the time he reached his late seventies he no longer snored, and was also more frail at that time.

This is also one of the rare cases where correlation DOES equate to causation.

Sleep Apnea has been proven to cause weight gain if untreated. Obesity has been linked to forms of diabetes. So untreated sleep apnea has a casual link to diabetes by helping contribute to one of the causes of diabetes.

This is fascinating to me because "post hoc ergo proctor hoc" is nearly never true in the medical world, but thanks to secondary factors it ends up being true here =)

My RT explained the correlation to me, but to try to reiterate the conversation would probably result in something that sounds like a Weird Al song

So, after a little searching, this is the closest I could find that sounds like what she told me:

http://www.battlediabetes.com/obstructi ... 2-diabetes

I wad Dxed with Diabetes (type 2) one week after being Dxed with Sleep Apnea. I later found out that diabetes runs in my family on my mothers side and sleep seems to run in the family on my fathers side ( and maybe on my mothers side as well but not sure).
But since I am only 39 I can't help think that, even though I probably would of got diabetes anyway, OSA has caused the diease to come early. But this is just my opnion and not based on sceintifc fact.

john_dozer wrote:Here's my rationale on the matter.

The weak die first.

I'm not talking about people, I'm talking about cells in your body. The insulin producing cells are relatively fragile. The are easy to kill or damage. I believe apnea degrades the number of your insulin producing cells and degrades the remaining cells ability to function. This puts pressure on your remaining insulin producing cells which may not be quite up to the task. Also your insulin release is tied to past performance of the last insulin release and the varying health of your insulin producing cells probably leads to inconsistent self-regulation.

John,
Type II diabetes has nothing to do with beta cells. It involves transportation problems with glucose getting into muscle cells to be metabolized. I've had Type I for almost 40 years, and it had nothing to do with sleep apnea. However, there is a not to difficult correlation that can be made between severity of OSA and diabetic control, as referenced in previous posts.

Stephen

welki, I like your reference to sounding like a Weird Al song. In my case, I think if I tried to explain what I know I'd come off sounding like Cliff Clavin.

What I know is, diabetes is a silent, complex disease. It affects every part of your body though you will not be aware of most of it, and everything that happens to your body has the potential to affect your diabetes. That is by no means an explanation but it is what I know, and I respect it. Even those of us with Type I can experience an improvement with CPAP therapy because we are prone to decreased insulin sensitivity over time, which is much like developing Type II diabetes even while you already have Type I.

My understanding is that OSD does negatively impact the ability of the body to efficiently metabolize sugar, which may lead to somewhat higher blood sugar numbers. In my non doctor view, beta cell production does impact insulin, and if the pancreas is never allowed to "rest" by good sleep cycles, it will wear out quicker. My type 2 is very well controlled after 20+ years with oral meds, exercise and diet. I doubt, absent any other variables such as genetics, weight, diet, exercise levels, that OSD alone CAUSES diabetes. Cell receptors are just one of the factors for type 2s, the other is inadequate insulin production, hence the reason for certain meds which stimulate the pancreas to kick out insulin, such as glyburide. Other drugs such as metformin address the receptor cells processing.

As Yogi Berra said "you can look it up".

I have been a type 1 diabetic since the age of 11 (and am now 49) and I use an insulin pump. Before my CPAP and sleep apnea diagnosis, I was running really high morning sugars. The reason? Sleep apnea causes stress on the body which results in the release of a hormone called cortisol which directly elevates blood sugar. If my AHI is even up to 5, I have a problem with morning glucose levels. Now it is running about .7 to .4 and my fasting sugars are golden. So does sleep apnea cause diabetes? I'm not sure. Does it make diagnosed diabetes worse? I know that it does.

LaCansada wrote:I have been a type 1 diabetic since the age of 11 (and am now 49) and I use an insulin pump. Before my CPAP and sleep apnea diagnosis, I was running really high morning sugars. The reason? Sleep apnea causes stress on the body which results in the release of a hormone called cortisol which directly elevates blood sugar. If my AHI is even up to 5, I have a problem with morning glucose levels. Now it is running about .7 to .4 and my fasting sugars are golden. So does sleep apnea cause diabetes? I'm not sure. Does it make diagnosed diabetes worse? I know that it does.

I concur. It is only logical that apnea events mimic "dawn phenomenon", which is the release of cortisol shortly before waking. This is a major problem in control of morning glucose readings. It would be interesting to see a study addressing this aspect of OSA connection to diabetes.

Stephen

Uh, Some here do not seem to understand Diabetes very well. This is my experience, please feel free to tell me what I have wrong. I have multiple problems, sleep apnea, non-insulin dependent type 2 diabetes, controlled hypertension, hyperlipidemia, arthritis, and have had a four way bypass. Worse, I am old.

I have been told that most type 2 diabetics typically produce more insulin than most people, problem is their bodies do not use it as efficiently. At least they produce more insulin until their over burdened pancreas burns out. The issue seems to be the insulin does not get through the cell walls very well so the cells can use the insulin as part of the change of usually-glucose to energy in the cells of the body.

When a person has a stomach stapling operation, doctors have noticed that their diabetes goes away (unless their pancreas is already gone.) Surgeon who noted the effect has hypothesized that it somehow has to do with the size of the stomach itself. Smaller stomach somehow changes how the body chemistry works. Some folks have suggested that using a Sleep Apnea machine can push air into the stomach, expanding it and causing some diabetic problems to either manifest or get worse. I dunno.

I personally suspect that my diabetes is related to not only being a natural pre-diabetic, but a relationship with hypertension drugs and a person becoming a diabetic. Explained another way, much of this nations epidemic of diabetes is not because of obesity, but the high use of hypertension drugs. Question I ask is which drug? Can I live without that drug? Personally I suspect the Beta Blocker, others have suggested it is the ACE inhibitors. As they are often used in a complex cocktail of several drugs, it is a bit hard to tell. There are some rumors on the internet of the relationship between use of hypertension drugs and diabetes. I usually believe what my doc says, and not the internet, and medical authorities have little to say on the subject.

Losing weight as a diabetic is extremely difficult. For a normal person they can eat a bit less, exercise a bit more, and their body usually responds by losing weight. As one doc told me, before I was a diabetic, it is simple formula, take in fewer calories than your body consumes and the body loses weight.

For a diabetic though, it is not quite that way. Each day we all go through cycles of increasing and decreasing blood sugar and insulin levels. As measuring insulin levels is extremely difficult, and requires the use of very expensive machines and lab techs, we ordinary people measure sugar levels. When the body has low sugar, it has a chemical system that tells the individual that it needs more sugar. Without high insulin levels, the type 2 Diabetic will not utilize whatever glucose the body has, as not enough insulin get through the cell walls. On the other hand, high insulin levels tell the body to store whatever glucose is in the blood stream as fat. So we have a perfect contradiction. We need high insulin levels for the body to function, which we also measure as controlled blood sugars, and having the high insulin levels try to grab up all the glucose and store it as fat. While the body is starts screaming, send in more calories.

The State of Utah once ran a public service TV commercial of an attractive young woman who described how when she was in high school she was desperate to be thin and used to skip injecting insulin for days at a time. Low insulin levels, her body dumped blood sugar through her kidneys, (blood sugar through the kidneys is really bad, and damages the kidneys). Now a young woman said she was really sorry that she did that, it was not worth it, others should not try what she did, she became blind as a result.

I could not get the diabetes educators or my MD to ever define a means for me to determine exactly how much to eat, of what to eat, or when to eat and how much to exercise, when - to lose weight. Most people with my host of medical issues do not lose much weight. One can not starve ones body without creating high insulin levels, which mean no weight loss, or cut back on the diabetes meds as it will cause high sugar levels. High sugar levels are believed to cause of, blindess, kidney damage, Neuropathy, Paresis and of course blood circulation problems which lead to amputations.

While the trademark of treated diabetics is a large abdomen, it is not true all diabetics look fat. Untreated diabetics often dump their blood sugar through the kidneys. Some youthful untreated diabetic women can be quite thin, which is of course, pleasing in our society. Nurse once said some of my clinic's diabetics came in and wanted to quit taking all meds because they were thinner as an untreated diabetic. Some can walk around with blood sugar levels of 400 or more, and feel perfectly fine. Some docs now think that having a blood sugar above 160 is dangerous to one's health. Some say it blood sugar threshold for no damage is lower. Diabetics can have lower voices, some have genius IQ's, and many Diabetics (with or without a high IQ) can be quite cranky, respond instantly rather than thinking. While they may say hurtful things, often the same diabetic is quite loving in reality. I believe there is an increase in depression in diabetics. Although treating the diabetes alone, will not get rid of deeply set patterns of "stinking thinking"

Diabetics tend not to gain muscle, or at least, not very easily.

I have several unexplained observations in my life. Drinking water in the evening often leads to my getting up less at night to use the Bat-room.

One of the people who taught at my Diabetes education class was a pharmacist, although not a diabetic, went through a regimen to simulate what diabetics went through. She tested her blood sugar every two hours and injected distilled water instead of insulin (ouch). During the time she did this her father came from out of town to visit. She felt she could handle her father as she was now an adult with a small child. Her blood sugar was like 180 after one and half hours with her father. Stress raises blood sugar levels. On another occasion, as she loved chocolate covered mint she ate one and and ended up with a blood sugar of 160. Some foods can create high blood sugars in normal people. A nurse suggested to me that, a normal teenager can pig out the buffet, finish with several desserts, then immediately drink a sugar big gulp, and their blood sugar would not get above 120. Pharmacist said the diet nearly did her in, it was so hard to eat only fixed portions of some things, was happy for her two weeks of diet to be over with, and really understood the diet problem of diabetics in a way not clinical. She was really glad for the two weeks to be over with. It is easy to say, do this diet, it is really difficult to actually do it.

I know that when the heart is stressed, it tends to compensate by telling the kidneys to dump more fluid to lessen its load. Which should mean that successful sleep apnea treatment should lead to getting up fewer times at night.

My recent experience says that drinking more coffee (yes, early in the day) reduces my blood sugar without changing anything else. I have long used Salmon Oil capsules for the same thing. Salmon Oil effect is apparently driven by reducing the stickiness of the blood platelets, like a blood thinner.

In my case, I know that I am often awakened by the level of arthritic pain in my body, although I can not tell which joint it is in. I do know that I can take Acetaminophen again, and get another four and half hours sleep. Point is, If I take the pain meds at the correct times at night so I can keep the pain down, I can sleep maybe 9-10 hours instead of 6-8 hours. Which leads to something perplexing, two nights of longer sleep and my body seems thinner, without changing anything else.

There is a good case which can be made that high insulin levels may be more harmful than high sugar levels, but that is not accepted by the medical establishment.

Purple, where do I start?
First, a little knowledge can be dangerous. Type II diabetes is insulin resistance. They don't produce more insulin because they are diabetic, they produce more insulin because a "normal" amount will not do the job of stabilizing blood glucose. Type II's who need to take insulin usually don't have a "burned out" pancreas, they have increased insulin resistance. Oral medications taken by Type II's do not increase insulin levels, they reduce insulin resistance, which in turn reduces insulin production.

The objective of Stomach stapling (bariatric surgery) is to reduce the surface area and time that food has to be digested and absorbed into the blood. The intestines are poor digestion devices. Diabetes "goes away" in bariatric patients because there is less absorption of the food they eat, and they must eat much less food anyway. "Air in the stomach" cannot in any way change it's absorptive properties, just might give you a stomach ache and cause you to eat less.

Losing weight for a Type II diabetic is certainly more difficult to do than it is for a non diabetic. But it is still basically a simple formula: fewer calories in, lower anti diabetic medication, more exercise to improve metabolic function, maintenance of good glucose levels--there is no magic to it. You don't need "high insulin levels", you need the proper medication to utilize a "normal" insulin level. Remember, Type II diabetes is insulin resistance.

Diabetics can gain muscle the same way non diabetics can. In an uncontrolled diabetic, because the cells are not getting glucose into them, the body is in effect "starved". The reaction is to start metabolizing protein, or muscle. Control the blood sugar and you don't lose muscle. Control the blood sugar and exercise regularly and you will gain muscle mass.

The pharmacist who you mention actually was diabetic. If her blood glucose got up to 180, then by definition she is diabetic. If you can eat a certain way and have it raise your blood sugar to 180, then you have diabetes, period. The Atkins diet is the closest thing to mimic diabetes. It depends on eating only protein and fat to induce ketoacidosis to cause weight loss. Any non diabetic can handle this, it would likely kill a diabetic. It is not the diet that causes diabetes, it is the underlying inability to metabolize the diet. That is diabetes.

High insulin levels are indeed dangerous. The medical profession readily accepts this. Oral meds are prescribed to utilize the proper insulin levels in a diabetic patient. Remember, type II is insulin resistance. The option of successfully utilizing the native amount of insulin by taking oral anti diabetice medication instead of increasing the amount of insulin available by taking injections is always preferable for a type II.

Please do not rely on the Internet for information specific to your conditions. Instead, rely on you doctor and diabetic team. Yes, I am a doctor, and a diabetic for almost 40 years.

Stephen

IMHO the correlation between OSA and T2 diabetes is pretty simple - stress will put your blood glucose numbers up. Lack of good quality sleep produces stress, and the less quality sleep you get (and the less REM sleep you get) the more your body (and mind) is stressed.

Although my T2 diabetes is very well-controlled, with an A1C of 5.5%, my morning numbers were always the highest of the day, pretty much every day, no matter what I did (ate, meds, exercise). It's taken a few months on CPAP, but now my morning glucose numbers are the lowest of the day, with no other changes.

Cheers,
xena

SRSDDS wrote:The Atkins diet is the closest thing to mimic diabetes. It depends on eating only protein and fat to induce ketoacidosis to cause weight loss. Any non diabetic can handle this, it would likely kill a diabetic. It is not the diet that causes diabetes, it is the underlying inability to metabolize the diet. That is diabetes.

Stephen,

I am not a medical practitioner, but I am a historian.

Please see http://muse.jhu.edu/login?uri=/journals ... estman.pdf

Volume 49, Number 1, Winter 2006

E-ISSN: 1529-8795 Print ISSN: 0031-5982

DOI: 10.1353/pbm.2006.0017

Westman, Eric C.
Yancy, William S.
Humphreys, Margaret, 1955-
Dietary Treatment of Diabetes Mellitus in the Pre-Insulin Era (1914-1922)
Perspectives in Biology and Medicine - Volume 49, Number 1, Winter 2006, pp. 77-83

The Johns Hopkins University Press

Before the discovery of insulin, one of the most common dietary treatments of diabetes mellitus was a high-fat, low-carbohydrate diet. A review of Frederick M. Allen's case histories shows that a 70% fat, 8% carbohydrate diet could eliminate glycosuria among hospitalized patients. A reconsideration of the role of the high-fat, low-carbohydrate diet for the treatment of diabetes mellitus is in order.

Diabetes, as I understand it, is a disease of the carbohydrate metabolism. Therefore, reducing the carbohydrates one cannot digest, as in the Adkins diet could be beneficial.

For other reasons, since 2001, I have eaten no grains, no potatoes, no sugar, no high fructose corn syrup, no artificial sweeteners. My carbohydrates come from fruits, vegetables, and properly prepared yogurt.

In 2004, I had a marginally high A1C, and my GP insisted I see an endocrinologist. (He ignored the fact that the blood was drawn after a period of high pain due to an injury, which had involved a cortizone injection, which can, as I am sure you are aware can raise blood sugar. The endocrinologist looked at my well-balanced diet and informed me that I had to quit eating that way, not I must eat lots of complex carbs. Oh, and I must think of myself as already diabetic. He had no answer when I asked him why, since diabetes was a disease of the carbohydrate metabolism, I should eat foods that I couldn't metabolize.

I fired the endocrinologist. I continued with my well-balanced diet. Once the injury was dealt with, my levels returned to normal, and have continued as normal for the last seven years. I monitor regularly, since my grandmother, my uncle, and several cousins on my father's side have diabetes, though my father does not. (My uncle died of complications of diabetes. Ugly.)

A ketogenic diet, under a doctor's supervision, has been used in the control of seizures.

I suspect that a diabetic, particularly an insulin dependent diabetic, would need medical supervision if they were to significantly reduce their consumption of complex carbohydrates because it would be necessary to modify their insulin dosages. I know some diabetics who could do it on their own, the same way some CPAPers can, but I suspect that without appropriate education, the majority would not.

Kiralynx wrote:
Before the discovery of insulin, one of the most common dietary treatments of diabetes mellitus was a high-fat, low-carbohydrate diet. A review of Frederick M. Allen's case histories shows that a 70% fat, 8% carbohydrate diet could eliminate glycosuria among hospitalized patients. A reconsideration of the role of the high-fat, low-carbohydrate diet for the treatment of diabetes mellitus is in order.[/b]

Kiralynx,
The low carb, high fat/protein diet works to "control" blood glucose only because fat and protein are much more slowly metabolized and place a commensurately lower strain on the compromised metabolism of a diabetic. However, that diet comes with a truly deadly consequence--it causes ketoacidosis. My grandfather lasted about 6 years on just such a diet until he went into an acidosis coma and died. Aside from ketoacidosis death, a high fat diet is certainly not beneficial for one's cardiac health.

And, no matter what the reason, if you present with a fasting blood glucose of over 140, and have a blood glucose over 180 during a glucose tolerance test, you are by definition diabetic.

Cheers,
Stephen

To add to all the confusion, please bear in mind that type 1 and Type 2 diabetes are completely separate illnesses. As a nearly life-long type 1 diabetic, I produce no insulin. I do not have insulin resistance that will improve with weight loss as is characteristic of type 2. I believe that having severe undiagnosed OSA, contributed to my morning pre-dawn high sugars by elevating them even more by creating a "flight or fight" kind of trauma to the body by not breathing multiple times each hour. This releases cortisol (the stress hormone) into the system which elevates blood sugar. I am assuming that the same dynamic would operate in type 2 diabetics, however, I am not positive. I am not saying this causes diabetes. I am saying that, in my case, it made my control worse. And, for years, I had no idea why. Nor did the diabetes team at the Univ of Maryland medical center. I think that all type 1 diabetics, even if they are on the lean side (as am I), with poor morning glucose control, need to be screened for symptoms of OSA.

Lisa