Lack of sleep not only leaves people with a sleep debt but also disrupts other body functions, such as our ability to balance our blood glucose levels

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Sleep tight

Studies into what causes Type 2 diabetes - and how we might prevent it - have dominated diabetes research news over the last few months. As well as the major studies, which for the most part concentrated on the effect of diet and exercise on the onset of the condition  a number of smaller studies sought answers in some quite unexpected quarters.

One project suggested some particularly fascinating insights, as well as providing new reassurance for those of us who like our kip. This small study, which was presented at the American Diabetes Association's Annual Conference in June, compared the effects of sleep duration in a group of 27 adults. None of the participants were obese adults or had diabetes.

According to the researchers, lack of sleep not only leaves people with a sleep debt but also disrupts other body functions, such as our ability to balance our blood glucose levels. The study showed that insulin sensitivity - the body's ability to use insulin to maintain good blood glucose levels - was almost 40 per cent lower in the participants who had been identified as chronic short sleepers (the chronic short sleepers had on average 5 hours 16 minutes sleep per night, compared to around 8 hours in the comparison group).

These results complement research undertaken at the University of Chicago, which showed that people who don't sleep enough are at greater risk of weight gain, even when they have excellent diet and regular exercise. 

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Sweet 'n' low

Depression and diabetes are closely linked, but for years researchers have been arguing as to exactly how the two relate.

Although it is widely accepted that having diabetes doubles the likelihood of suffering from severe depression, we have lacked the evidence to convince the health service that psychotherapeutic services could make a real difference to the health and happiness of people with diabetes. Until now, that is.

Preliminary results from several studies accepted for presentation at the EASD conference (see pages 8 and 14) showed that both psychotherapy and antidepressant drugs are effective in treating depression in people with diabetes. Moreover, the studies showed that recovery from depression can significantly improve blood glucose management, lowering HbAlcs by between 0.5 and 1 per cent. This in turn, significantly reduces the risk of developing complications from diabetes.

Dr Patrick J Lustman, one of the leaders of the research team at the Washington University School of Medicine in the US, told Balance, "The emotional impact of diabetes should not be ignored. Depression in people with diabetes is especially worrying as it affects diabetes control and the risk of long-term complications. It is essential that healthcare professionals take into account both the physical and the psychological aspects of diabetes.

 

Ramadan and Diabetes

Ramadan is a period for worship, self-discipline, austerity and charity. Fasting is obligatory for all healthy adult Muslims, with no food or drink being consumed between dawn and sunset. There are only two meals a day - Sehri (pre-dawn meal) and Iftar (break of fast after sunset). The fast is one of the five pillars of Islam (the other four are the statement of faith, prayers five times daily, charity to the poor and pilgrimage to Mecca). As the Islamic calendar year begins with the sighting of the new moon, Ramadan (the ninth lunar month) therefore starts approximately ten days earlier each year. This year it takes place in mid-November.

Fasting foods

As fasting during the month of Ramadan is practiced by Muslims all over the world, particular foods and drinks can vary. For example in the UK, the pre-dawn meal may consist of cereal, toast or fruit but some may choose to consume meals including parathas or chapatis with curry.

Traditionally the fast is broken with one or two dates and a glass of water, which is then followed by the evening prayer, and then dinner. In the UK, foods such as samosas, pakoras, and kebabs are popular and may be prepared as a starter, once the fast is broken at sunset. This is usually accompanied by a glass of fruit juice or a milkshake and fruit salad.

Dinner usually consists of foods such as rice, chapatis, and meat/chicken/vegetable curry, served with salad and yogurt. During Ramadan it is a blessing to share the prepared meal with family and friends, and to break the fast together. Preparing and providing food and/or funds to the poor, including those in other countries, is also very important.

Diabetes and fasting

People with diabetes who fast during Ramadan, may experience large swings in blood glucose levels. This is a result of both long gaps between meals and (for some individuals) the consumption of large quantities of sugary drinks, together with fried foods, sweet foods and carbohydrate-rich meals. Therefore, if you have diabetes, you can be exempt from fasting. However, many people express a great desire to fast, and don't want diabetes to stop them doing something they feel so strongly about.

So before Ramadan begins, if you have Type 1 or Type 2 diabetes and are treated with insulin injections, sulphonylurea drugs, or a combination of the two, you should discuss your blood glucose control - and how fasting may affect it - with your diabetes team.

If you have Type 2 diabetes and are treated with diabetes medication not already mentioned, you may need to take this medication at the end of the fast in the evening (to cover the period of eating), rather than at the beginning of the day.

If your diabetes is treated by diet alone, there should be no problem with fasting during Ramadan. However, there may be major changes in the food and drink you consume, with more than usual amounts of sugary drinks and carbohydrate-rich foods eaten during the non-fasting hours - and you should be aware of the effect this may have on you and your diabetes.

Finally, regardless of whether you have Type 1 or Type 2 diabetes, remember that treatment is directly related to diet and regular meals. So it is important to make sure that you eat and drink when the day's fasting is finished and before the next day's fasting begins.

At the end of Ramadan Muslims celebrate `Eid-ul Fitr', a day of thanksgiving and happiness.