The Importance of Sleep Health for Diabetes

Everyone who lives with diabetes knows that the cornerstones of successful management include insulin therapy, strict monitoring of one’s diet, exercise, and managing stress. But another, lesser-known key element to good diabetes management is sleep health.

According to the Centers for Disease Control and Prevention (CDC), nearly 1 in 3 Americans don’t get enough sleep. The National Sleep Foundation recommends that adults between 18 and 60 sleep at least 7 hours every night. Sleeping less than that is associated with an increased risk of developing chronic conditions such as obesity, type 2 diabetes, hypertension, heart disease, and even stroke.

Sleep health is especially important for people with diabetes. This article will outline the reasons why sleep health is so important and how you can improve your sleep health to improve your diabetes management.

Why Is Sleep Important?

Sleep is important for everyone. Sleep plays an important role not only in physical health but in mental health maintenance as well. During sleep, the body heals and repairs cells damaged during the day (like muscles worked and stretched during exercise), and even restores and clears out both heart and blood vessels, reducing inflammation throughout the body.

Sleep brings much-needed balance back to hormone levels, such as cortisol, serotonin, leptin, ghrelin, melatonin, and adrenaline, working to restore mental and emotional health. Restoration of these key hormones helps the body control stress, combat depression, achieve satiety, and manage hunger levels throughout the day.

Most importantly, sleep helps protect immune function. One study monitored the development of the common cold after giving people nasal drops with the virus to a group of people. The researchers discovered that those who sleep fewer than 7 hours for two weeks were nearly 3 times more likely to develop a cold than those in the study who slept 8 or more hours each night for the duration of the study.

Americans Are Not Getting Enough Sleep

This is all great, except Americans are simply not getting enough sleep. City-dwellers are more likely than those living in rural areas to suffer from sleep deprivation, and the CDC shows that the northeastern and Appalachian mountain parts of the country are the most affected. Nearly 11 percent of Americans are only getting 6 or fewer hours of sleep per night!

There are many reasons why people aren’t getting enough sleep: 24/7 technology, ever-increasing workloads, light and noise pollution in cities, the but most stunning reason, from the National Sleep Foundation, is that Americans simply don’t prioritize sleep.

In a survey, when Americans were asked which of five activities were most important to them, just 10% of people said sleep, the lowest by far out of exercise, nutrition, work, and other hobbies.

As a nation we are not getting enough sleep,” said Dr. Wayne Giles, director of CDC’s Division of Population Health. “Lifestyle changes such as going to bed at the same time each night; rising at the same time each morning; and turning off or removing televisions, computers, mobile devices from the bedroom, can help people get the healthy sleep they need.”

People With Diabetes Need to Prioritize Sleep!

Even though sleep is often disrupted because of diabetes due to CGM alarms, insulin pumps beeping, low and high blood sugars, and the 24/7 nature of the disease, sleep is crucial for good diabetes management.

“Getting inadequate amounts of sleep can negatively impact blood sugar levels short and long term,” says Dr. Gregg Faiman, an endocrinologist at University Hospitals Cleveland Medical Center. “In fact, sleep is as essential to your health as nutrition and exercise,” he says.

Not having enough of it can cause insulin resistance and insatiable hunger due to out of balance hormones, fatigue that makes exercising more difficult, and brain fog that makes carbohydrate counting and the self-control to properly manage food and diet harder.

Sleep affects all other elements of diabetes management: when you don’t have enough sleep, you need more insulin (due to insulin resistance from spiked cortisol levels) to control blood sugars, your body is hungrier when your hormonal leptin levels are off balance, which makes eating and balancing carbohydrates more complex, you’re more tired which makes exercise all the more difficult, and your body is naturally stressed out, wreaking havoc on diabetes management.

Plus, if you nap during the day to try and make up for a bad night’s rest, you may not be tired at bedtime, and one sleepless night can lead to two, which can then turn into a chronic problem, which sets the stage for harder to control blood sugars, higher HbA1c, and possibly even complications later on in life.

how to get enough sleep

Photo credit: iStock

Strategies to Improve Sleep Health

Creating good sleep habits can take time, but the following recommendations can help you improve your sleep, which will positively affect not only your diabetes management but your overall health as well:

  • Exercise daily so you are tired at bedtime
  • Avoid all caffeine after 12 p.m.
  • Go to sleep and wake up at the same time every day
  • Do not nap during the day
  • Use the bathroom right before bed, so you don’t wake up in the middle of the night to go
  • Limit fluids before bed
  • Make sure your blood sugar isn’t too high or low at bedtime
  • Turn your thermostat down at bedtime for more peaceful sleep
  • Take a relaxing bath before bed
  • Eat foods that contain natural melatonin at night: cherries, pomegranate, grapes, walnuts, peanuts, or sunflower seeds work well
  • Do some gentle yoga, meditation, or breathing exercises to calm you down before bed
  • Do not allow screens in the bedroom; opt for journaling or reading in bed instead (except, of course, your continuous glucose monitor and insulin pump)
  • Close all curtains and make your room as dark as possible
  • Keep pets outside of the bedroom, and especially off the bed (except diabetes alert dogs, of course).

Managing sleep can be complex and challenging, but making sure to get at least 7 hours of quality sleep per night will make diabetes management easier and better blood sugars more achievable.

Try out these tactics for several weeks, and see if any make a meaningful difference in the amount of quality sleep you’re getting each night, and if it has any positive effects on blood sugar levels the next day.

While an underrated component of diabetes health, sleep is crucial for better blood sugar management, one night at a time. Do you struggle with getting an adequate amount of quality sleep each night? What tactics have helped you improve your sleep health? Share this post and comment below!

Source: diabetesdaily.com

Diabetes is Ruff: Diving into the World of Diabetes Service Dogs

This content originally appeared on diaTribe. Republished with permission.

By Julia Kenney

When you think of tools to help you manage diabetes, you likely think of therapies and devices – but what about dogs? We spoke with Mark Ruefenacht, who trained the first diabetes service dog in the world, to learn how these special animals can support people with diabetes.

There are many reasons to love dogs. Because they are cute, because they are smart, because they are the furry best friends you didn’t know you needed, and they love you unconditionally. But did you know that some dogs can also save your life and help you manage diabetes? Just one more thing to add to the list.

In diabetes, severe cases of high or low blood sugar (hyperglycemia and hypoglycemia, respectively) are dangerous and can lead to serious long and short-term health complications. Diabetes service dogs are trained to help, specifically when the owner’s blood sugar is too low or too high.

There are two kinds of diabetes service dogs, Medical Response Dogs and Diabetic Alert Dogs. Medical Response Dogs are trained to respond to the symptoms of severe low blood sugar such as fatigue, loss of consciousness, and seizure-like behavior to help notify you and others of hypoglycemic events. Medical Response Dogs can also retrieve “low” supplies such as food, drinks, or an emergency kit. Diabetic Alert Dogs, also referred to as DADs, are trained to smell the compounds that are released from someone’s body when blood sugar is high or low. Because of this, Diabetic Alert Dogs are able to alert their owners of dangerous levels of blood sugar before they become symptomatic. A variety of breeds can be trained to be diabetes service dogs, including golden retrievers, Labrador retrievers, mixed-sporting breeds, and poodles.

Dog

Image source: diaTribe

Nobody knows more about these dogs than Mark Ruefenacht, founder of Dogs4Diabetics (D4D), one of the leading diabetes service dog training organizations in the world. Ruefenacht  has lived with diabetes for over 30 years and got involved with service dogs for the blind due to his family history of diabetes-related eye disease (retinopathy). After an incident of severe hypoglycemia, Ruefenacht started training Armstrong, the world’s first diabetes service dog, to recognize and respond to the scent of hypoglycemia in his sweat and breath. Through training and testing, Ruefenacht found that there might be a scent associated with hypoglycemia that is common among people with diabetes and could be taught to other dogs. Since then, he has helped train hundreds more dogs with D4D. In our interview, Ruefanacht shared his insights on the benefits of Diabetic Alert Dogs and how to know if they are right for you.

How are Diabetic Alert Dogs trained? Who are they trained for?

Diabetic Alert Dogs are typically trained for people with type 1 diabetes or insulin-dependent type 2 diabetes. This is for two reasons. As Ruefenacht describes, people with type 2 diabetes who are not dependent on insulin typically do not have life-threatening low blood sugars. Because of this, Diabetic Alert Dogs are most helpful for people who are insulin-dependent. Furthermore, under the Americans with Disabilities Act, service dogs can only be given to people with a recognized disability, which could cause barriers to getting a service dog, especially for people with type 2 diabetes who are not insulin dependent. There are additional requirements and limitations for public service dogs under the Americans with Disabilities Act, so diabetes service dog organizations also train dogs in various support skills to help people with diabetes at home (and not in public). Dogs4Diabetics refers to these dogs as “Diabetes Buddy Dogs.” If you are wondering whether you could qualify for a service dog, talk to a service dog organization.

As for the training these dogs receive, the programs typically focus on scent discrimination. This means that the dogs are taught to detect smells in the air associated with blood sugar changes and to ignore smells associated with normal, safe bodily functions. Ruefenacht said, “The big myth is that dogs are smelling blood sugar. But the dogs are actually sensing the compounds that come out of the liver when the blood sugar is either dropping rapidly or is low.” Though humans can’t detect these smells, dogs likely can. Scientists are not sure what exactly the dogs identify, but research suggests that it’s ketones (for high blood sugar) and may be a natural chemical called isoprene (for low blood sugar). Ruefenacht uses low and high blood sugar breath samples to train the dogs; after about six months of intensive training, they can distinguish these scents in people.

Can diabetes service dogs reliably alert their owners to changes in glucose levels? It depends on the dog and it’s training – but research shows that diabetes service dogs can often be effective, and that quality of life and diabetes management tends to improve in owners. According to Kim Denton, who works for Dogs4Diabetics and has had type 1 diabetes with hypoglycemia unawareness for over 40 years, having a Diabetic Alert Dog “changed my life for the better by helping me keep my blood glucose in a much tighter range, which means fewer health complications and I feel much better both physically and mentally.”

How can diabetes service dogs help their owners?

Dog

Image source: diaTribe

Denton says that her dog, Troy, “has saved my life so many times by alerting me before my glucose dropped to a life-threatening level, that I can’t keep track anymore. Troy tells me long before my CGM detects a rapid drop or rise in my glucose levels, and he does it without that annoying beeping! If my sugar starts dropping while I am sleeping, Troy jumps on me to wake me up and will continue licking my face if I start to fade off.” In addition to alerting owners to early changes in blood sugar so that they can act to stabilize glucose levels, there are other skills that diabetes service dogs can learn. Here are some examples, though every organization has different training programs:

  • Alert the owner to audio signals from insulin pumps, continuous glucose monitors (CGM), and other devices. This is especially helpful for people with impaired hearing, for children, and for diabetes management while sleeping.
  • Alert people nearby to help the owner in cases of severe blood sugar changes, or retrieve a cell phone.
  • Retrieve medications and other necessary supplies in an emergency.
  • Provide emotional support.

It is important to know that diabetes service dogs are an additive tool to help people manage their diabetes. A service dog should never replace CGM, self-monitoring blood glucose with fingersticks, hypoglycemia prevention methods, or healthy lifestyle efforts; a diabetes service dog can be an additional form of support for people with diabetes.

How do service dogs provide emotional support? Why is this important?

The majority of diabetes service dogs are also trained with emotional support and wellness skills. This means that in addition to helping people manage their blood sugar, these dogs can also help improve their owner’s mental and emotional wellbeing. This is especially important for people with diabetes because of the stress that often comes with long-term management of a chronic condition – learn about diabetes distress and how to reduce it here. People with diabetes are also two to three times more likely to experience symptoms of depression than the general population, according to the CDC.

Ruefenacht is keenly aware of the relationship between diabetes and mental health, and he has worked to address this through his diabetes service dog training programs. Ruefenacht says his clients appreciate the diabetes management component of the service dog training, “but they value the companionship and emotional support more.” Like most other dogs, diabetes service dogs are companions and become part of the owner’s family. Many owners appreciate the stress-relieving experience of walking, playing, or just being with a dog, which can be incredibly helpful for people with diabetes. Denton says “Troy understands not only my need to have normal glucose levels but also my need for comfort and companionship when my diabetes gets me down.” Dogs can also be trained to cater to specific mental health conditions such as depression and anxiety.

Could a diabetes service dog be right for me? 

Dog

Image source: diaTribe

Diabetes service dogs are a great option for some people, but not for everyone. There are several ways that people can get support in managing their diabetes, and it is important to think about what works best for you – for example, Diabetic Alert Dogs are trained to sense blood sugar changes in their owners, but for many, this can be accomplished using a CGM. Diabetes service dogs can be a helpful option for people who frequently experience episodes of hypoglycemia, experience hypoglycemia unawareness, need help regulating their blood sugar at night, or need additional support. According to Taylor Johnson, who has type 1 diabetes and a Diabetic Alert Dog named Claire, “Having a service dog is the best decision I’ve ever made regarding my diabetes management. I love gadgets and tech but they are not foolproof, and Claire is the additional piece of mind I need to sleep at night.” Talk with your healthcare professional to assess your need for a diabetes service dog if it is something that you are considering – and remember, a diabetes service dog will not replace the need for careful glucose monitoring and hypoglycemia prevention efforts.

There are a few more important things to think about:

  • Cost: The process of getting and training diabetes service dogs and their owners can be expensive. There are some organizations that provide training services for free or for a reduced cost for those who qualify. Other organizations offer financial assistance or payment plans for those who qualify. For example, as a 501(c)(3) nonprofit that relies on charitable donations, D4D does not charge its clients for the dogs or other program services which significantly reduces the costs of owning a diabetes service dog.
  • Time: Owners also need to put a significant amount of time into training and maintaining the skills of their diabetes service dog outside of the formal training the dogs receive. This includes participation in some of the initial training of the dog, giving the dog time to acclimate to your specific needs as a person with diabetes, and follow-up training throughout the dog’s lifetime.

Want to learn more about diabetes service dogs?

  • Check out some different diabetes service dog organizations to get a sense of the application process, service dog training programs, and service dog community

Source: diabetesdaily.com

Diabetes and Divorce: Getting Through the Process

Diabetes can wreak havoc not only on one’s physical health, but on one’s mental and emotional health as well, and oftentimes the toll that diabetes takes will affect the entire family. If you’ve faced or are currently facing a divorce and live with diabetes, you know all too well that it adds a complicated layer that can cause additional stress, heartache, and pain. Here are some ways to protect yourself (and your diabetes!) should divorce come your way:

Court Can Be Ugly

While sometimes divorce can be civil and amicable, going to family court, especially when child custody arrangements are being negotiated or when child support is in the picture, can get ugly. Be prepared for your spouse’s attorney to bring up your diabetes management, and to propose that as a liability against your ability to care for your children. Work with your attorney around this expectation. By providing your attorney your medical records (including HbA1c results), you can defend any argument against you regarding poor diabetes management.

Leaving a Marriage Can Mean Losing Insurance

Leaving any marriage is hard, but this is especially true for people living with diabetes who rely on their spouse’s health insurance, which equals access to insulin, pump supplies, and the ability to see an endocrinologist. Divorce can be a long, brutal process, but knowing that you will lose health insurance gives you time to stock up on supplies, make much-needed appointments, and line up ways to secure health insurance before you have a significant lapse in coverage.

If you were previously unemployed, you may be eligible for Medicaid coverage in your state, or since divorce is a qualifying life event, you can buy a health plan on a state or federal exchange. Check out our resources for securing insurance if you learn that you’ll lose coverage as a result of divorce.

Vulnerabilities Are Laid Bare

As a person with diabetes, we rely heavily on our spouses for everything from helping us take a shot in an unreachable place, to grabbing us a juice for a 3 a.m. low. Losing a spouse means losing part of our support system for managing our diabetes.

If you’re experiencing this sudden loss of support (especially if you struggle with hypo unawareness), try and prepare yourself by getting a continuous glucose monitor (CGM) that can alert you if you go low during the night. Many CGMs now have a “share” option that lets people “follow” your trend lines, and also receive alerts when your blood sugar goes too high or too low. This is an excellent feature for people who live alone and want additional assurance that they’ll be safe when they go to sleep at night.

Additionally, getting a diabetes alert dog can help not only with managing highs and lows, but also with the loneliness that can come with suddenly finding yourself on your own.

Know You’re Not Alone

You may be losing a spouse, but you have a lot to gain in terms of support, if you know where to look. For community encouragement, joining a diabetes support group, volunteering with a diabetes organization, or reaching out to family and friends and letting them know you need some more support around your diabetes can be greatly beneficial. Even becoming more involved in the diabetes online community (on Facebook, Instagram, or Twitter) is an excellent way to stay connected to people from the comfort of your own home.

Go Inward

Divorce is one of the most stressful times in one’s life. Seeking professional counseling can help you return inward, and to start to heal so you can eventually move forward. Counseling can also prepare you to deal with the stressors of moving out, perhaps finding new employment and new health insurance, and dealing with diabetes on your own for the first time in a long time.

Although it can be hard, divorce can also be a truly freeing and necessary step in one’s life, and can lead to beautiful new beginnings. It’s important to take care of yourself and protect your mental health throughout this time. It’s never too early or too late to start (or continue) work with a licensed counselor.

Have you recently gone through the heartbreak of a divorce, while living with diabetes? What aspects of the divorce were the scariest for you, as a person living with diabetes? What tactics and coping strategies helped you the most? Share this post and comment below; we love hearing your stories!

Source: diabetesdaily.com

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