Q: How important is sleep? I am 37 years old, have type 1 diabetes, and work the late shift. I only get about 5 hours sleep a night and am always tired. My sugars are routinely between 30 and 600+ and I take 4 shots of insulin a day. I was in the hospital 5 weeks ago with ketoacidosis. How much sleep do I need?

A. Sleep is vital to our health. Adults need an average of 7-8 hours of sleep, although some can manage on as little as 5 hours. If we lose sleep, the body requires even more on subsequent nights to make up for it. Eventually, the body has a way to make us repay some of the hours lost (we become exhausted and finally have to hit the pillow or we are more susceptible to illnesses that would force us to rest). Did you know that lack of sleep is linked to type 2 diabetes? In addition, lack of sleep causes impaired judgment and slowed reaction time (as does low and high glucose values), not a good combo for someone juggling the demands of type 1 diabetes.

It sounds like 5 hours are not enough as you report being constantly tired. The alarming factor in your scenario is the wildly fluctuating glucose values from extreme lows (hypoglycemia) to extreme highs (hyperglycemia) which can cause severe fatigue, and worse, ketoacidosis. Diabetic ketoacidosis (DKA) is a toxic condition caused by a lack of insulin for people with type 1 diabetes and high levels of glucose (typically above 300). In this environment, glucose is not able to enter the millions of cells located throughout the body. In essence, the cells are starving and in order to survive, they start to breakdown fat for energy. Most people would welcome the idea of burning some extra fat, but in this situation, burning fat causes the release of ketones into the bloodstream and DKA can be deadly if left untreated.

Several questions come to mind for this dear reader:
1. Are you under the care of an endocrinologist who is adjusting your insulin according to your work schedule?
2. Have you seen a certified diabetes educator recently to analyze your glucose patterns?
3. Have you had a continuous glucose monitoring test? It involves wearing a pager-sized device that reads glucose values every 10-15 seconds through a little plastic tube taped under your skin — I've worn one; it's not painful. The doctor looks at the results and identifies any glucose trends that would require a change in insulin type and/or dose.
4. Do you like working the late shift? If not, have you had a conversation with your employer to look at other options?
5. Have you tried using an insulin pump?

With some serious investigation into your glucose patterns and an insulin approach to best manage those highs and lows, I bet your energy will improve and you'll have a more restful sleep.

Q: Why do I fall asleep so easily during the day when I have had a full night's sleep? As soon as I sit for a few minutes, I nod off. Also, the bottoms of my feet are always numb.

A. The two issues raised, being sleepy during the day and having numb feet, may be linked to hyperglycemia (values above 200) or an A1C level sustained above 7% (a 3-month blood glucose average). Another possible cause of being drowsy in the day is having sleep apnea at night (pauses in breathing). You may think you're getting a full night's sleep, but maybe you're not. One sign of sleep apnea is snoring. A sleep study can answer the question about whether or not a sleep disturbance is at play.

Other things to consider are depression, or possible medication side effects. You can ask your doctor and pharmacist for more information so hopefully you'll get 40 winks only at night.

Whether you are running low on glucose or sleep, or if you have any other health issue that doesn't make sense, contact your healthcare provider for individualized assessment. The sooner the problem is identified, the sooner you can get solutions to maximize your health.

Read Theresa's bio here.

Read more of Theresa Garnero's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

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Last Modified Date: February 16, 2013

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