Type 2 Diabetes and Sleep

Type 2 Diabetes and Sleep

People who have diabetes often have poor sleep habits, including difficulty falling asleep or staying asleep. Some people with diabetes get too much sleep, while others have problems getting enough sleep. According to the National Sleep Foundation, 63% of American adults do not get enough sleep needed for good health, safety, and optimum performance.

There are several causes of sleep problems for people with type 2 diabetes, including obstructive sleep apnea, pain or discomfort, restless legs syndrome, the need to go to the bathroom, and other problems associated with type 2 diabetes.

Sleep Problems and Type 2 Diabetes

Sleep Apnea

Sleep apnea involves pauses in breathing during sleep. The periods of stopped breathing are called apneas, which are caused by an obstruction of the upper airway. Apneas may be interrupted by a brief arousal that does not awaken you completely — you often do not even realize that your sleep was disturbed. Yet if your sleep was measured in a sleep laboratory, technicians would record changes in the brain waves that are characteristic of awakening.

Sleep apnea results in low oxygen levels in the blood because the blockages prevent air from getting to the lungs. The low oxygen levels also affect brain and heart function. Up to two-thirds of the people who have sleep apnea are overweight.

Sleep apnea alters our sleep cycle and stages of sleep. Some studies have linked altered sleep stages with a decrease in growth hormone, which plays a key role in body composition such as body fat, muscle, and abdominal fat. Researchers have found a possible link between sleep apnea and the development of diabetes and insulin resistance (the inability of the body to use insulin).

Peripheral Neuropathy

Peripheral neuropathy, or damage to the nerves in the feet and legs, is another cause of sleep disruption. This nerve damage can cause a loss of feeling in the feet or symptoms such as tingling, numbness, burning, and pain.

Restless Legs Syndrome

Restless legs syndrome is a specific sleep disorder that causes an intense, often irresistible urge to move your legs. This sleep disorder is often accompanied by other sensations in the legs such as tingling, pulling, or pain, making it difficult to fall asleep or stay asleep.

Hypoglycemia and Hyperglycemia

Both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) can affect sleep in those with diabetes. Hypoglycemia may occur when you have not eaten for many hours, such as overnight, or if you take too much insulin or other medications. Hyperglycemia occurs when the sugar level rises above normal. This may happen after eating too many calories, missing medication, or having an illness. Emotional stress can also cause your blood sugar to rise.

Obesity

Obesity, or too much body fat, is often associated with snoring, sleep apnea, and sleep disturbance. Obesity increases the risk of sleep apnea, type 2 diabetes, heart disease, hypertension, arthritis, and stroke.

How Are Sleep Problems Diagnosed?

Your doctor will ask you about your sleep patterns, including whether you have trouble falling or staying asleep, are sleepy during the day, have difficulty breathing while asleep (including snoring), have pain in your legs, or move or kick your legs while sleeping.

Your doctor may refer you to a sleep specialist who may do a special sleep study called a polysomnogram to measure activity during sleep. The results of the sleep study can help your doctor make an accurate diagnosis and prescribe an effective and safe treatment.

How Are Sleep Problems Treated in Type 2 Diabetes?

There are several treatments for sleep problems in people with diabetes, depending on the condition:

Sleep Apnea

If you are diagnosed with sleep apnea, your doctor may suggest that you lose weight to help you breathe more easily.

Another potential treatment is continuous positive airway pressure (CPAP). With CPAP, patients wear a mask over their nose and/or mouth. An air blower forces air through the nose and/or mouth. The air pressure is adjusted so that it is just enough to prevent the upper airway tissues from collapsing during sleep. The pressure is constant and continuous. CPAP prevents airway closure while in use, but apnea episodes return when CPAP is stopped or is used improperly.

Peripheral Neuropathy

To treat the pain of peripheral neuropathy, your doctor may prescribe simple pain relievers such as aspirin or ibuprofen, antidepressants such as amitriptyline, or anticonvulsants such as gabapentin (Gralise, Neurontin), tiagabine (Gabitril) or topiramate (Topamax). Other treatments include carbamazepine (Carbatrol, Tegretol), pregabalin (Lyrica), lidocaine injections, or creams such as capsaicin.

Restless Legs Syndrome

Various medications are used to treat restless legs syndrome, including dopamine agents, sleeping aids, anticonvulsants, and pain relievers. Your doctor may also prescribe iron if you have low iron levels.

There are also several medications that treat insomnia, including:

  • Over the counter drugs such as antihistamines including diphenhydramine (such as Benadryl). These drugs should be used short term and in conjunction with changes in sleep habits.
  • Medications used to treat sleep problems such as eszopiclone (Lunesta), suvorexant (Belsomra), zaleplon (Sonata), and zolpidem (Ambien).
  • Benzodiazepines are an older type of prescription medicine that cause sedation, muscle relaxation, and can lower anxiety levels. Benzodiazepines that were commonly used for the treatment of insomnia include alprazolam (Xanax), diazepam (Valium), estazolam (ProSom), flurazepam, lorazepam (Ativan), temazepam (Restoril), and triazolam (Halcion)
  • Antidepressants such as nefazodone and very low doses of doxepin (silenor).

How Can I Improve my Sleep?

In addition to medications, recommendations to improve sleep are:

  • Learn relaxation and breathing techniques.
  • Listen to a relaxation or nature sounds CD.
  • Get regular exercise, no later than a few hours before bedtime.
  • Don’t use caffeine, alcohol, or nicotine in the evening.
  • Get out of bed and do something in another room when you can’t sleep. Go back to bed when you’re feeling drowsy.
  • Use the bed only for sleeping and sexual activity. Don’t lie in bed to watch TV or read.This way, your bed becomes a cue for sleeping, not for lying awake.

Are There Other Links Between Sleep and Type 2 Diabetes?

People who have poor sleep habits are at greater risk for becoming overweight or obese and developing type 2 diabetes, according to several studies. Chronic sleep deprivation may lead to insulin resistance, which can result in high blood sugar and diabetes.

Some studies show that chronic sleep deprivation can affect hormones that control appetite. For example, recent findings link inadequate sleep with lower levels of the hormone leptin, which helps control the metabolism of carbohydrates. Low levels of leptin have been shown to increase the body’s craving for carbohydrates regardless of the amount of calories consumed.

Trish Cruz, RN

SOURCES: Medscape: “Expert Column — Sleep Disorders in Diabetes.” Yaggi, H.K. Diabetes Care, 2006. Nilsson, P. Diabetes Care, 2004. Mallon, L. Diabetes Care, 2005.

Never Ignore Depression

Never Ignore Depression

Studies show that depression is underreported. People aren’t getting the help they need, sometimes because they don’t know the warning signs or where to turn, or are embarrassed because of the stigma that can still surround mental health issues.

But the numbers are too great to ignore. Up to 26 percent of U.S. women and up to 12 percent of men will experience major depression at some point in their lives. In any given year, that’s 16 million American adults.

As many as one in 33 children and one in eight teens also struggle with depression — that’s 9 percent of kids aged 12 to 17 in any given year. And new research suggests these numbers may be even higher.

It’s important to recognize signs of depression in yourself or a loved one, including a child, and to get help from a doctor.

Signs of depression:

  • Persistent sadness, anxiety or an “empty” feeling
  • Hopelessness, guilt, worthlessness, helplessness
  • Loss of interest in hobbies and favorite activities
  • A lack of energy and persistent fatigue
  • Difficulty concentrating, remembering, making decisions
  • Difficulty sleeping, early morning awakening or oversleeping
  • Appetite and/or weight changes
  • Restlessness or irritability
  • Physical symptoms including pain
  • Thoughts of death or contemplating suicide
  • Take immediate action if you or a loved one is having suicidal thoughts. If you’re thinking of harming yourself or attempting suicide:

Call 911 or go to the nearest hospital emergency room.
Call the toll-free 24-hour National Suicide Prevention Lifeline at 1-800-273-8255.
Ask a family member or friend to help you make these calls or take you to the hospital.
The stigma around depression exists, in part, because it’s poorly understood. However, one study found that once people are educated about it — that it’s an illness and not something those affected bring on themselves — they are more likely to change their thinking and accept that depression can and should be treated.

Family members of someone going through depression should become educated about the disease because they make up an important part of the depressed person’s support network and can help prevent a recurrence.

Posted by
Trish Cruz, RN

Resourced by
WEB, MD

Healthy-Fat Foods

Healthy-Fat Foods

Fish
Naturally fatty fish like salmon, mackerel, herring, lake trout, sardines, and albacore tuna are good sources of omega-3 fatty acids. These are “good” fats that help keep your heart healthy. They may also help keep your brain sharp, especially as you get older. The American Heart Association suggests eating two servings of fatty fish a week. A serving is 3 ounces — about the size of a deck of cards. Try it baked, grilled, or poached.

Avocado
Eat it on your sandwich, or serve it up in guacamole. Tasty avocado is good for your heart and may help with osteoarthritis symptoms, thanks to healthy fats.

An extra benefit? When you eat avocado with other foods, it helps your body better absorb their nutrients. Half a medium avocado is one serving and about 115-160 calories.

Seeds
Little pumpkin seeds, sunflower seeds, and sesame seeds pack a big punch. They have “good” fats that can lower cholesterol. In general, fats that come from plants are healthier than those from animal products. “Bad” fats are in foods like fatty cuts of meat, full-fat dairy products, and some packaged foods. Check food labels to see how much fat, and what type, you’re getting. Limit saturated fats and avoid trans fats.

Nuts
From hazelnuts to pecans, all nuts are good for your heart. Walnuts, especially, deliver heart-healthy fats. But don’t overdo it. Just because the fats are healthy doesn’t mean you can eat as much as you want. A serving is 1 ounce. That’s about 14 walnut halves, 23 almonds, 28 peanuts, 18 cashews, and 19 pecan halves.

Olive Oil
Whether you’re cooking or dressing your salad, try olive oil. It’s high in good fat. Remember, though: It’s always smart to watch how much fat — even good fat — you eat. So cook with less oil than a recipe calls for. Or use an olive oil spray. In baking, you can use applesauce for half the oil to cut back on some fat and shave calories.

Eggs
Eggs are a great source of inexpensive protein. A large, hard-boiled egg has 5.3 grams of fat, most from healthy fats. Some eggs are also enriched with extra omega-3s. It will say so on the carton.

Ground Flaxseed
As part of a healthy diet, good-for-you fats can help make your skin look great — plumper and younger. Plus, they add fiber and can help ease inflammation. Get good fats by sprinkling a teaspoon of ground flaxseed on your salad or your cereal, or use it when you’re baking.

Beans
Whether they’re kidney, Great Northern, navy, or soybeans, adding beans to your diet can be good for you mentally and physically. Beans have omega 3s, which may help with mood.

Omega-3-Fortified Foods
There are also many foods that have added omega-3s to make them healthier. You can find enriched milk and eggs, bread, and breakfast bars, for example. Check product labels to make sure. Plus, you may get more health benefits by getting omega-3s through fortified products than from a supplement.

Your Guide to Eating Healthy Carbs

Your Guide to Eating Healthy Carbs

Make the Right Choice
Think of carbs as raw material that powers your body. You need them to make sugar for energy.

They come in two types: simple and complex. What’s the difference? Simple carbs are like quick-burning fuels. They break down fast into sugar in your system. You want to eat less of this type.

Complex carbs are usually a better choice. It takes your body longer to break them down.

Read the “Fine Print”
Nutrition labels offer an easy way to spot added sugar, the source of simple carbs that you want to cut back on. Just look for words that end in “ose.”

The chemical name for table sugar is sucrose. Other names you might see include fructose, dextrose, and maltose. The higher up they appear in the ingredients list, the more added sugar the food has.

Just Avoid Simple Carbs?
Well, it’s not quite that easy. Foods that have been processed with added sugars generally aren’t as healthy a choice, it’s true. But simple carbs occur naturally in some foods that are part of a balanced diet. For example, most milk and other dairy products contain lactose, or milk sugar.

Get Smart About Bread
Does your loaf have the complex carbs that are good for you? It depends on the grain used to make it.

Look for bread made with whole grains. Barley, rye, oats, and whole wheat are some top choices.

What About Fruit?
They’re sweet, which must mean they have simple carbs, right? That’s true, but they’re still a healthy choice. They’ve got fiber in them, which helps slow the breakdown of sugar. Plus, most are a good source of nutrients like vitamin C and potassium.

Fruits with skins you can eat, such as pears, apples, and berries, are especially high in fiber.

Watch What You Drink
That soda you’re sipping could be a sneaky source of simple carbs. That’s because non-diet sodas contain a sweetener, often high-fructose corn syrup. It’s right there on the nutrition label, usually one of the first ingredients listed. Twelve ounces of a regular soda can pack 39 grams of carbs, all coming from the sugar in it.

Think Fall
Many of the foods you associate with autumn are great sources of complex carbs.

Try starchy vegetables such as sweet potatoes, squash, and pumpkin.

Sweeten With Caution
You can quickly load up on simple carbs if you’re not careful about what you stir into your hot drink or put on your oatmeal. Go easy on brown sugar, maple syrup, honey, and molasses.

And don’t overdo it on fancier-sounding sweeteners, like turbinado and agave nectar. They’re also sources of simple carbs.

Bring on the Beans
They’re a good way to get complex carbs. Whether you choose kidney, white, black, pinto, or garbanzo, beans have lots of fiber.

While you’re on that aisle in the grocery store, think about picking up some lentils or split peas, another way to add complex carbs to your diet.

A Guilt-Free Treat
It seems too good to be true, but you can believe it: Popcorn is a whole grain. That means it’s got complex carbs and fiber. Your healthiest choice is air-popped, without any added fat and salt. Season it with your favorite dried herbs and spices instead.

Great Grains to Try
Maybe you’ve heard of quinoa, the whole grain from South America. Some other new-to-you whole grains are becoming more widely available, and they can be a good choice to get complex carbs in your diet.

Some grains to look for are millet, a staple from Africa and Asia, bulgur, which is used in Middle Eastern dishes, and triticale, a hybrid of wheat and rye.

Which Kind of Rice?
You’re ordering Chinese food and the restaurant asks, “White rice or brown?” Which should you choose?

White rice is a “refined” grain, meaning it has lost some key nutrients during processing, like fiber. But brown rice is a whole grain, a good source of complex carbs.

Surprising Causes of Chest Pain

Surprising Causes of Chest Pain

Panic Attack

This can feel like a heart attack. Besides chest pain, you may be short of breath, feel your heart race, or go numb in your hands or feet. Some people feel dizzy or worry that they’re about to die. A stressful event can bring it on, or it could come out of the blue. Panic attacks can be hard to manage on your own. They can get worse if you don’t get help with them.

 

Shingles

If you have chest pain along with a painful rash and blisters on your chest or back, you could have this illness, which is caused by the chickenpox virus. If the nerves of your chest wall are affected, the pain there can be severe. Shingles can clear up on its own, but your doctor can give you medicine to help with your symptoms or make it go away faster.

Hernia

Underneath your lungs, there’s a small area where your stomach and esophagus (your food pipe) meet. Coughing, heavy lifting, or straining during bowel movements can put pressure on this area. If there’s too much pressure, part of your stomach can get pushed into the opening. That’s called a hiatal hernia. Chest pain is a symptom, and so is stomach or esophagus pain, bloating, belching, and a sour taste in back of your throat. Most hernias don’t need treatment, but some people eventually need surgery.

Gallstones

These are hardened bits of digestive fluid in your gallbladder. They can be as small as a grain of sand or as big as a golf ball. If one blocks the way between your gallbladder and bile ducts (which carry waste from your body), you can get a sudden pain in your stomach that you also feel in your chest, back, or right shoulder. This is most likely to happen at night after a heavy meal.

 

Heartburn

If acids from your stomach go up into your esophagus, you can feel pain not only in your chest, but in your jaw and throat as well. Alcohol, smoking, aspirin and other noninflammatory drugs, and citrus fruit can all be triggers. So can eating too close to bedtime. Call your doctor if you burp and don’t feel better, or you have other symptoms like nausea or sweating.

 

Muscle Pain

Being more active or exercising harder than normal can strain the muscles in your chest wall. You may notice that your pain is worse when you’re sitting or standing a certain way. Taking a deep breath or pressing on the sore area might hurt. Scale back your workout and don’t lift heavy things until the pain gets better. A heating pad or ice pack on the area can help.

 

Syphilis

This rather rare sexually transmitted disease  (STD) can cause problems with your lungs. Symptoms include a skin rash, fatigue, headache, and muscle pain. In some people, it also causes extra fliud to build up around your lungs. This can cause sharp chest pain and a cough with mucus. Antibiotics will help clear it up.

Asthma

Chest tightness is a symptom of this, along with coughing, wheezing, and struggling to catch your breath. It can be triggered by many different things, from dust and pet hair to certain things in food or physical activity. Medication can help keep your airways open and help when symptoms flare up.

Pinched Nerve

If you’ve pinched a nerve in your neck or collarbone, you may feel pain in your chest or back. Too much pressure on a nerve can keep it from working the way it should. You could have a tingling “pins and needles” feeling, and your skin could become very tender. This usually can be treated with over-the-counter pain relief and steroid shots. If that doesn’t help, surgery may be needed to ease the pressure.

 

Pulmonary Embolism

This is when a blood clot forms somewhere in your body, then works its way into your lungs. It keeps your lungs from getting enough blood. Your chest may hurt when you breathe deeply, cough, eat, or bend over. You may notice that the pain gets worse when you’re active and doesn’t get better when you stop. If this happens, get medical help right away. Medicine can keep the clot from getting bigger and prevent more from forming.

 

Blocked Spleen

This organ lives behind your left ribcage and helps protect your body from infection. It’s rare, but blood flow to your spleen can get blocked because of a blood clot, infection, or disease. If that happens, the tissue there can start to die. This is called a splenic infarction. Some people have no symptoms, but others have chest pain, often on their left side. It can get better with medication but can become serious if it’s not treated.

 

Angina

If your body doesn’t send enough blood to your heart, you’ll feel a squeezing pressure in your chest. That’s called angina. Some people also feel pain in their shoulders, arms, neck, jaw, and back. It can be triggered by stress, heavy meals, or exercise. Or it could be a sign of another heart problem. You’re more likely to have it if your cholesterol or blood pressure is high, you have diabetes, or you don’t exercise or eat healthy food.

 

Pleurisy

If taking a deep breath, coughing, or sneezing brings on chest pain, the lining of your lungs may be inflamed. Called pleurisy, this can be caused by a virus, bacterial infection, or certain drugs you take. Lots of fluids and over-the-counter ibuprofen, like Advil or Motrin, can help. But if you also have a fever or your pain lasts more than a few days, check in with your doctor.

Costochondritis

This is when the tissue in your rib cage gets inflamed because of arthritis, an injury, or infection. You may feel a sharp, aching pain or pressure in your sides. It could get worse after you work out or move your torso a lot.  There’s no cure, and it can last up to a year. Over-the-counter acetaminophen (Tylenol) or ibuprofen can help. A warm compress or heating pad at the site of the pain will give relief, too.

Heart Attack

Chest pain is the most common heart attack symptom. If you feel crushing pressure that lasts more than a few minutes, nausea, severe shortness of breath, or a  squeezing pain in your chest or left upper arm, call 911. Women who are having a heart attack may have more subtle symptoms. Along with chest pain, you may feel tired, have back or jaw pain, or feel dizzy.  These are all signs that you need an ambulance right away.

Cold and Flu on the Rise? How to Prepare

Cold and Flu on the Rise? How to Prepare

Flu Season

Maybe your daughter got off the bus looking pale and feverish. Or maybe you feel a scratchy throat and a stuffy nose coming on. Whatever the symptoms, you expect a lot of sniffles and coughs this week.

Before the virus knocks you and your family out, try these tips to prepare for colds and flu. If you’re lucky, they may also prevent at least some of your family from getting sick.

  1. Stock up on supplies. Be ready before cold and flu season starts. Load up on tissues, hand soap, hand sanitizer, and paper towels. Consider picking up a few distractions in case your kids get sick, like puzzles, coloring books, or DVDs.
  2. Check your medicine cabinet. Make sure it contains pain relievers, fever reducers, and any other medications you use when your family is fighting colds or the flu, like decongestants or cough syrups. Review the correct doses based on age and weight. Check to see if any medications overlap or interact. Test your thermometer to make sure the batteries still work. Clean your humidifier.
  3. Be strict about washing hands. Germy hands spread colds and the flu. Tell your family to scrub their hands well with soap for 20 seconds. Tell kids to wash for as long as it takes to sing “Happy Birthday” twice. Make sure you do it, too!
  4. Set up sanitizer stations. Put a bottle of hand sanitizer in every room. Make sure it’s at least 60% alcohol. Use a squirt as you pass by — and get everyone else to do the same.
  5. Plan for sick days. You may need some days off. Even if you don’t get sick, you may need to take care of your sick kids. Start thinking about it now: What’s your office policy for sick days? Will you have to take unpaid days off?
  6. Line up support. You may need outside help. See if any family members can watch the kids if they’re home sick from school. Or ask a neighbor if they can take the kids to soccer and dance if you’re laid up in bed.
  7. Disinfect.

    You don’t need to spend all day spraying every surface with disinfectant. You may just want to disinfect some heavily touched items — like doorknobs, remote controls, and phones — each day.

  8. Switch to paper goods. If everyone’s sick, use paper towels instead of hand towels in the bathroom. Switch out glasses for paper cups, and toss them after one use. You’ll be less likely to swap germs.
  9. Fill the fridge and pantry. Stock up on some easy-to-make foods for lunches and dinners, in case you need a few days to rest and recover without cooking. Have some favorite drinks and snacks on hand for your kids. Include some (healthy) comfort foods like chicken soup and PB&J.
  10. Rest. Whether you’re trying to recover from a cold or flu, or trying to avoid it, get plenty of sleep. Get your kids to bed on time, too.
  11. Get your flu shot. One of the best ways to help keep the flu away from your house is to make sure your whole family gets vaccinated.