Article Listings
Expand All | Collapse All
Active Living
Full Listing with story descriptions
A Healthy Balance
Ankle Sprains
Active Kids, Healthy Kids
Active Kids in Winter
Athletic Skin Infections
Children, Nutrition & Exercise
Beat the Heat!
Cold Weather Workouts
Concussions
Core Stability
Cross Country Skiing
Exercise and Disabilities
Exercise and Menstrual Irregularities
Exercise in the Cold
Exercise in the Heat
Exercise is Medicine
Exercise Options
Exercising in Pregnancy
Female Athletes
FITT Prescription
Footwear for Running
From Surviving to Thriving
Flexibility
Gadgets & Gizmos
Get Moving!
Get Motivated
Golf Exercises
Golf Injury Prevention
Head Injuries
Hockey Injuries
Home Gyms
Immunization
Jump Start Weight Loss
Knee Cap Pain
Knee Ligament Injuries
Live Actively
Low Back Pain
Osteoporosis & Exercise
Osteoarthritis
Osteoarthritis of the Knee
Plantar Fasciitis
Prehistoric Workout
Prevention of Sports Injury
Proprioception
Recreational Safety Equipment
Running
Safe Snow Shovelling
Shin Splints
Ski Conditioning
Shoes & Fit
Sore Elbow
Sore Shoulder
Spinal Cord Injuries
Staying Active
Staying Fit in the Cold
Sports Nutrition & Supplements
Strength Training
Swimming Injuries
Teen Sports Injuries
Walking
Water and Exercise
Weight Training
7 Wonders of Walking
Adolescent Health
Full Listing with story descriptions
Acne
Adolescent Behaviour Problems
Adolescent Growth & Development
Body Image
Body Piercing
Bullying
Chronic Diseases in Teens
Communications Skills
Concussion in Sport
Cosmetics & Skincare
Dangers of Artificial Tanning
Depression
Depression - Causes
Drug Use
Female Physical Exam
First Period
Internet Safety
Junior High
Mentoring to Quit Smoking
Mononucleosis
Parent-Teen Communication
Parent -Teen Interaction Patterns
Personal Care
Psychological Assessment
School Problems
Self Esteem
Self Esteem & Body Image
Sexually Transmitted Diseases
Talking About Sex
Taking Chances
Tattoos
Teaching Respect
Teens & Smoking
Teenage Blues
Teen Bedwetting
Teen Drivers
Teen Girls
Teen Health
Teen Immunization
Teen Independence
Teen Rebellion
Teens & Divorce
Teenagers and Sexual Issues
Teens & Exercise
A Woman's Physical
Your First Job
Youth Violence
Childbirth
Full Listing with story descriptions
Advice from the Maternity Clinic
Advice from the Maternity Clinic (Part 2)
Alcohol in Pregnancy
Building a Better Baby
Birthing Etiquette
Birth Plans
Birthing Procedure Trends
Bleeding in Pregnancy
Breastfeeding Benefits
Caesarean Section by Request
Care for the New Mother
Cord Blood Banking
Delaying Motherhood
Blue after Baby or Postpartum Depression
Diabetes in Pregnancy
Eating Well for Pregnancy
Evolving Ideas about Pregnancy and Birth
Exercise in Pregnancy
Flying During Pregnancy
Folic Acid in Pregnancy
High Blood Pressure in Pregnancy
Getting a latch on breastfeeding
Group B Streptococcus
Induction of Labour
Infections During Pregnancy
Intrauterine Growth Restriction (IUGR)
In-Vitro Fertilization
Low Birth Weight Babies
Medication & Pregnancy
Miscarriage
Managing Your Own Labour
Monitoring Your Labour
Nausea & Vomiting in Pregnancy
Pain Relief in Labour
Prenatal Classes
Preterm Labour
Planning a Pregnancy
Pregnancy Weight
Prenatal Care Providers
Postpartum Repetitive Strain Injuries
RH Disease
Rupture of Membranes Before Labour
Sex During Pregnancy
Skin Changes in Pregnancy
Smoking and Pregnancy
Support During Labour
Travelling While Pregnant
Ultrasound for Fun & Photos
Natural Remedies in Pregnancy
Vaccinations During Pregnancy
Vacuum & Forceps for Delivery
Vaginal Birth After Caesarean
When Baby Comes Home
Childhood
Full Listing with story descriptions
Asthma in Children
Attention Deficit Disorder
Babysitter
Bed Wetting
Chickenpox
Childcare Options
Children's Headaches
Childhood Obesity
Choosing A Babysitter
Circumcision
Colds & Flu
Common Childhood Skin Infections
Croup
Developmental Milestones
Diaper Rash
Daytime Wetting
Introducing Solid Foods
Developmental Co-ordination Disorder
Diarrhea
Discipline
Earache
Eczema
Feeding Your Baby
Feeding Your Toddler
Fever
Head Lice
Hearing
How Children Grow
Hearing Loss
Hearing Issues in Newborns
Heart Murmers
Hip Clicks
Influenza
Iron
Is it an Emergency?
Children and Sports Injuries
Lazy Eye (Amblyopia)
Learning Disabilities
Leg Problems
Not Just Baby Fat
Orthodontics
Preparing for Lab Tests
Recognizing Learning Disabilities
Red Rashes
RSV-Childhood Respiratory Virus
Safe Summer Fun
School
Scoliosis
Sick Toddler
Sleep Struggles
Sniffles, Fevers, Rashes & Coughs
Sore Throats
Speech Problems
Strep Throat
Toddler Safety
Thumbsucking
Tooth Injuries
Tummyache
Urinary Tract Infections
Vaccinations
Vaccination and Autism
When to go to the Doctor
Whooping Cough
Worried Sick
Yeast Infections in Children
Chronic Pain
Full Listing with story descriptions
Introduction
Managing Your Pain
Movement Matters
Moving Forward
Nutrition
Opioids
Pacing
Pain Medications
Prevention
Returning to Work
Understanding and Goal Setting
When Pain Doesn't End
Dental Health
Full Listing with story descriptions
Antibiotics and Dental Surgery
Baby Bottle Tooth Decay
Baby Teeth
Bad Breath (Halitosis)
Children's Dental Injuries
Choosing a Dentist
Cosmetic Dentistry
Mouth Guards
Dental Exam
Dental Care Devices
Dental Caries
Dental Care Offshore
Dental Implants
Dental X-Rays
Dentures and Healthy Jaw
Esthetic Dentistry
Fluoride
Fluoride Findings
First Dental Visit
Headaches
A Healthy Mouth
Healthy Mouth, Healthy Body
Jaw Joint and Muscle Problems
Keeping it Clean
Laser Use in Dentistry
Mouth Protection Equipment
Oral Cancer Screening
Oral Healthcare
Oral health and long term care
Oral Health Care Products
Orthodontics
Orthodontist First Visit
Painless Dentistry
Periodontal Disease
Removable Dentures
Root Canal
Seniors Oral Care
Sensitive Teeth
The Smile You Want
Sore Mouth, Aching Jaw
Snoring and Sleep Apnea
Smiling through the Senior Years
Teeth for Life
Temporomandibular Disorders (TMD)
Tobacco Risks to Oral Health
Tongue Piercing
Tooth Whitening
Travel Dentistry
Water Fluoridation
Wisdom Teeth
Your Healthy Smile
DIABETES
Full Listing with story descriptions
10,000 Steps
A1C Test
Accurate Blood Glucose Testing
Alchohol and Diabetes
A Diabetes Success Story
ABCs of Diabetes Management
Alternate Site Testing
Artery Health
ASA Therapy
Benefits of Insulin
Benefits of Breakfast
Blood Glucose Medications
Blood Glucose Myths
Blood Glucose Testing
Blood Glucose Testing Tips
Blood Sugar Lows
Blood Glucose Monitors
C-Peptide Testing
Canada Food Guide Revisited
Carbohydrate Counting
Catastrophic Drug Plan
CDA Guidelines for Diabetes
Celiac Disease and Diabetes
Childhood Diagnosis of Diabetes
Children and Type 2 Diabetes
Cholesterol-lowering Medications
Colds and Diabetes
Constipation
Continuous Blood Glucose Monitoring
Cutting Edge
Debunking Diabetes Myths
Driving and Diabetes
Diabetes and Menopause
Diabetes and OTC Medications
Diabetes Care Team
Diabetes and Celiac
Diabetes and Depression
Diabetes Diet
Diabetes Eating on a Shoestring Budget
Diabetes Etiquette
Diabetes and Oral Health
Diabetes and Thyroid Disease
Diabetes and Your Mouth
Diabetes and Your Eyes
Diabetes in Cats
Diabetes in Dogs
Diabetes Management ABCs
Diabetes Meter Technicians
Diabetes Myths
Diabetic Ketoacidosis
Diabetic Retinopathy
Diet Tips for South Asians
Dining Out
Drinking and Diabetes
The Discovery of Insulin
Eating Disorders
Easing the Strain of Stress
Eating to Protect Your Kidneys
Eggs in a Diabetic Diet
Emotional Eating
Emotions of Diabetes Diagnosis
Erectile Dysfunction
Exercise Excuses
Why Fad Diets Fail
Fats
Fibre
Fill Your Day with Energy
Financial Support for Diabetes
Food Temptation
Foot Care
Footwear and Foot Health
Fruits and Veggies
Gastroparesis
Gestational Diabetes
Get Active
Get Physical
Gift Ideas
Glycemic Index and Glycemic Loads
The Glycemic Index
Going Green in the Kitchen
Grocery Shopping Tips
Guidelines for Diabetes Management
Holiday Party Survival Guide
Health Information on the 'Net
Healthy Happy Holidays
Healthy Beverage Choices
Health Benefits of Soy
Healthy Restaurant Meals
High Blood Pressure and Diabetes
High Blood Pressure
HbA1c Test
Healthy Eating for Active People
High Blood Lipids
Home from the Hospital
Home Alone and Sick
Hypoglycemic Unawareness
Impaired Glucose Tolerance
Immunization & Diabetes
Incretins-a Hormone Treatment
Injecting Insulin
Insulin Discovery-The Story
Insulin
Insulin Handling
Insulin - the Key to Energy Management
Insulin Pumps
Insulin Pen Needles
Insulin Pump Infusion Sets
Insulin Pump Therapy
Immunization and Diabetes
Internet Health Sites
Islet Cell Transplantation
Insurance
Ketones
Kidney Disease - Reducing the Risk
Living with Diagnosis of Diabetes
Living Powerfully with Diabetes
Low Blood Glucose
Managing Diabetes
Managing Blood Glucose
Metformin
Nutrition Food Labels
Meal Planning
Your Medication Expert
Medication Research Studies
Metabolic Syndrome
Microalbuminuria
New Diabetes Technologies
Natural Medicines and Diabetes
No Need for Insulin?
Not Snoozing
Over-the-Counter Medications
Oral Health and Diabetes
Osteoporosis and Diabetes
Diabetes and OTC Medications
Pedicure Precautions
Peripheral Arterial Disease
Pet Diabetes
Planning for Pregnancy
Prebiotics and Probiotics
Preparing for Activity
Putting off Insulin
Reducing Stress of Surgery
Safe and Successful Travel
Schizophrenia and Diabetes
Sensible Snacking
Setting Health Goals
Setting Goals for Physical Activity
Sharps Disposal
Shorter Insulin Needles
Sleep - a Missing Link
Smart Snacking
Smart Summer Nutrition
Snack Bars
Snacking with Diabetes
Sodium
Social Media & Diabetes
Solving the Insurance Puzzle
Stress and Diabetes
Success in School
Supplements
Supporting Spouse with Diabetes
Sweeteners
Sugar, Carbs and Blood Glucose Control
Think Positive with Diabetes
Tiny Bites Equal Big Calories
Traveling with Diabetes
Tips for a Better You
Tobacco Use and Diabetes
Top 10 Reasons to Exercise
Treating Low Blood Glucose
Treating Hypoglycemia - Role of Glucagon
Tune up Your Diet
Type 1.5 Diabetes
Type 2 Diabetes
Understanding Diabetes
Understanding Diabetes Medications
Understanding Ketones
Used Sharps
Urinary Incontinence
Vacationing with Diabetes
Vegetarian Eating for Diabetes
Vitamin D
Walking
Wise Choices About Natural Medicines
Wonderful Water
Natural Medicines & Diabetes
World Diabetes Day
Your Medicine Cupboard
Zimbabwe Hand Jive
Family Medicine
Full Listing with story descriptions
ADHD in Children
Allergic Rhinitis
Allergies
Antibiotic Use
Arthritis
Aspirin Every Day?
Asthma
Back Pain
Back Pain Myths
Back Pain - Lower
Birth Control
Bladder Problems
Blood Transfusions
Breaast and Prostate Cancer Screening
Carpal Tunnel Syndrome
Check-Up
Colon Cancer Screening
Contact Lenses
Contraception
COPD
Cost of Doctor's Visit
Diabetes Management
Diarrhea
Diagnostic Tests
Do I Need a Bone Density Test?
Doctor Visit
Driving Vision
Dizziness
Dealing with Dry Eyes
Does My Sore Knee Require an MRI?
Do I Need an Annual Physical?
Eczema
Electronic Medical Records
Epilepsy
Eye Exam
Family Doctor
Fibromyalgia
Floaters and Flashes
Food Poisoning
5 Ways to Stay Healthy
Gallbladder
Get Active!
Glare
Headaches
Healthcare Teams
Heart Health
Hemorrhoids
Hepatitis C
Human Papilloma Virus
High Blood Pressure
High Blood Pressure Risks
How to Talk to Your Doctor
Hypothyroidism
Insomnia
Irritable Bowel Syndrome
Joint Replacement Surgery
Kidney Disease
Lazy Eye Blindness (Amblyopia)
Medical Digital Technology
Migraine
Meningitis
Multiple Sclerosis
Multiple Myeloma
Obesity
Opioid Myths
Primary Healthcare Reform
Prostate Problems
Quitting Smoking
Red Eyes
Respiratory Tract Infections
Restore Your Core
Rosacea
Screening Tests
Shingles
Sinusitis
Special Diagnostic Tests
Stopping Stroke
Stroke
Superbugs
Thyroid
Ulcers
Urine Tests
Vaccination Controversies (ask the doctor)
Win by Losing
Urinary Tract Infections
Vision Flickers
First Aid
Full Listing with story descriptions
Bites and Stings
Burns
Choking
Cuts and Scrapes
Eye Injuries
Fainting and Convulsions
First Aid Travel Kit
Hypothermia and Frostbite
Nosebleeds
Poisoning - Household
Emergency Care Guidelines
Sunburn
Growing Older
Full Listing with story descriptions
Advance Care Plans
Age-Related Macular Degeneration
Alzheimer Disease
Avoiding Memory Loss
Building Strength
Dementia and Agitation
Cataracts
Can I see Well Enough to Drive?
Cholesterol
Congestive Heart Failure
Coping with Dementia
Constipation
Controlling Medications
C.O.P.D.
Delirium
Dizziness (Vertigo)
Eating Well
Elder Abuse
Exercise Benefits
Erectile Dysfunction
Eye Care
Eyesight and Driving
Feet
Frailty
Fungal Nail Infections
Get Active!
Glaucoma
Grief
Have Health, Will Travel
Health Tips for Seniors
Hearing
Incontinence
Joint Replacement
Lab Tests
Living Longer With Diabetes
Macular Degeneration
Male Menopause (Andropause)
Maintaining Quality of Life as You Age
Memory Loss
New Corneal Treatments
Nutrition for Seniors
Osteoarthritis
Osteoporosis
Parkinson Disease
Problem Gambling
Prostate Health
Retirement
Seniors and Medications
Senior Sexuality
Sexually Transmitted Infections
Screening Tests
Seniors and Driving
Sleeplessness
Skin Structure
Skin Protection
Skin Over 50
Solving Sleep Issues
Staying Healthy
Stroke Prevention
Travel Tips for Snowbirds
Wills and Personal Directives
Modern Living
Full Listing with story descriptions
Abuse
Acupuncture
Adult ADHD
Aging and Memory
Alcohol and Your Health
Anger Management
Antidepressants
Barbecue Basics
Bathtub Safety
Binge Drinking
Bisphenol A
Canada's New Blood System
Caring for a Loved One Dying at Home
Carpal Tunnel Syndrome
Computer Stress
Coping With Change
Cosmetic Surgery
Cosmetic Pesticides
Depression
Diabetes Epidemic
Discipline
Diseases from Pets
Downsizing
Dying at Home
Erectile Dysfunction New Treatments
Exotic Travel
Fertility Issues
Fetal Alcohol Spectrum Disorder
Foodborne Illness
Flu Pandemic
Grief
Harassment
Healing Through Music
Healthy Computing
Humidex
Hypnotherapy
Ice Safety
Indoor Air Quality
Lymphedema
Mature Student
Melamine in Food
Middle Age Health
Mind-Body Connection
Mom Time
Money Matters
Outdoor Workers and Sun Safety
Patient Safety in the Hospital
Pets and Health Benefits
Pet Therapy
Physiotherapy Visit
Planning for End of LIfe
Reproductive Freedom
Safe Drinking Water
Schizophrenia
Smokeless Tobacco
Sexually Transmitted Diseases
Soy
Stigma of Mental Illness
Street Drugs
Stressed or Depressed?
Stress in the Workplace
Stress Leave
Swim to Survive
Sunburn
Time Management
Travel Health Protection
Travel Comfort Tips
Travel Immunization
Understanding Change
Unplugging
Whiplash
Wind Chill Index
Workplace Drug Testing
Workplace Health
Nutrition
Full Listing with story descriptions
5 Tips to Manage Weight
10 Ways to Cut Down on Fat
Battle the Bulge
Boost Your Bone Strength
Body Image
Breakfast is Important
Bowel Health
Building Your Bones
Celiac Disease
Challenging the Milk Myth
Diet Reality Check
Drink Up!
Eating Smarter & Cheaper
Energy Drinks
Food Allergies
Food for Active Kids
Fast Food
Food Labels
Giving Up Gluten
Healthy Diet, Healthy Smile
Healthy Eating for Boomers and Zoomers
Healthy Eating for Seniors
Healthy Eating on Business Travel
Healthy Ethnic Meals
Fad Diets
Fruits & Veggies - 5-10 a Day
Fats
Fat Phobias
Fats & Cholesterol
Feeding Your Kids
Fibre
Food Chemistry 101
Food and Mood
Getting Kids to MOVE
Healthy Eating for Teens
Healthy Habits
Herbal Medicine and Nutrition
New Ingredients for Your Shopping Cart
Iron
Kid's Food
Liquid Candy
Meal Planning with Planned Overs
Mercury Levels in Fish
Night Snacking
Night Shift Eating
Nutrition on the Net
Nutrition Myths Busted
Nutrition Questions Top 5
Nutrition for Menopause
Essential Omega-3
Preventing Cancer Through Nutrition
Picky Eaters
Power of Fruits & Veggies
Portion Control
Power Lunch
PMS and Nutrition
Preparing for Surgery
Probiotics
Reducing High Blood Pressure
Replacement Meals
Sensible Snacking
Sodium
Sodium and Blood Pressure
Sports-Minded Nutrition
Sugar Substitutes
Survive and Thrive
Teen Nutrition
Tips for a SuperDiet
Understanding Food Biotechnology
Vacation Eating
Vitamins D
Vitamins and Minerals
Vegetarian Diet
Weight Loss
Weight Wise Tips
Pharmacy Care
Full Listing with story descriptions
After a Heart Attack
Adverse Drug Reactions
Adult Vaccinations
Allergy Attack
Antibiotic Overuse
New Anticoagulant Medications
Inhaled Asthma medications
Arthritis Medications
Biologics
Biological Response Modifiers
Blood Pressure Monitoring
Blood Thinners
Calcium and Iron Supplements
Changing Role of the Pharmacist
Children's Cold Remedies
Child's Fever
Choosing Sunscreens
Cold Relief
Cold Sores
Constipation and Haemorrhoids
Diuretics and Potassium Supplements
Drug Recalls and Withdrawals
Drug Interactions
Emergency Contraception
Erectile Dysfunction
Expanding Role of Pharmacies
Eye Protection - Sunglasses
Feminine Hygiene
Generic or Name Brand?
Heartburn
Heart Health
Insomnia
Kids and Cold Medications
Medication Questions?
Metabolic Syndrome
Natural Medicines
New Blood Thinners
Non-Steroidal Anti-Inflammatory Drugs
Obesity Medication
Over-the-Counter Drugs
Over-the-Counter Drugs and Pregnancy
OTC Pain Relief
Packing Medications for Travel
Pharmaceutical Studies
Preventing Summer Hazards
Research Studies
Quit Smoking
Skin and Cosmeceuticals
Sports & Nutrition Supplements
Sunscreen
Taking Medication
Take as Directed
Using Antibiotics Wisely
Viagra
Vitamin D
Yeast Infections
Your Best Shot
Your Medicine Cupboard
Prevention
Full Listing with story descriptions
Accident Prevention
Alcohol
Antibiotic Resistance
Backpack Pain
Bacteria Fight Back
Bedbugs
Disaster Planning
Diseases from Pets
Caffeine
Cell Phones and Driving
Childhood Obesity
Cancer Prevention Tips
Chronic Disease Prevention
Cold and Flu Season
Disaster Planning
Diseases from Pets
Distracted Driving
Farm Safety for City Kids
Foodborne Illness
Flu Pandemic
The Flu and You
Heading Home for a Visit
Health Tips for Snowbirds
Hearing Loss and Music Players
H1N1 Virus - Plan Ahead
Household Mould
Infection Control
Injury Prevention
Live Actively!
Insect Repellant
Keys to Preventing Cancer
Kids' Mental Health
Live Actively!
Low Birth Weight
Meningitis
Norovirus
Are Pesticides Safe?
Preventing Burns and Scalds
Preventing Cancer through Nutrition
Quit Smoking 101
Respiratory Infections
Seniors and STIs
Should You Immunize?
Sun Safety
Surviving Disaster
Sushi Preparation
Teens, Drugs and Driving
Travel Health Considerations
Travel Medicine 101
Travel Tips
Type 2 Diabetes Prevention
Water Smarts
Vision Damage
Water Wisdom
West Nile Disease
Whooping Cough
Workplace Alcohol Abuse
Women's Health
Full Listing with story descriptions
15 Great Reasons to Breastfeed
Anemia
Approaching Menopause
Birth Control
Breast Cancer Screening
Breast Cancer - Genetic Risks
Breast Cancer Self-Exam
Breast Cancer Screening Guidelines Changes
Breast Health
Breastfeeding Myths
Cervical Cancer Screening
Contraception
Contraception for Mature Women
Cosmetic Procedures
Cystitis
Endometriosis
Estrogen's Effect on the Brain
Fear of Fracture
Fibroids
Heart Attack
Hirsutism - Unwanted Hair
Hormone Replacement Therapy
The IUD
Menopause - What Men Should Know
Menstrual Bleeding - Abnormal
Menstrual Bleeding - Heavy
Menopause
Menstruation Myths
Menstrual Pain
Third Generation Birth Control Pills
Osteoporosis
Ovarian Cancer
Ovarian Cysts
Oral Contraction (The Pill)
Pap Test
Premenstrual Syndrome
xx
Sexually Transmitted Infections
Urinary Incontinence
Vaginitis
Varicose Veins
Viagra for Women
Yeast Infections
Your Pelvic Floor
Family Health Online / Pharmacy at Safeway
All Words Any Words Phrase
Managing Diabetes Magazine - diabetes

Sleep
A missing link in diabetes care

George is a 52-year-old moderately overweight businessman recently diagnosed with Type 2 diabetes. He has started on oral blood glucose lowering medications. Although George takes his medications, watches his diet and exercises as recommended, he is still having trouble bringing his blood glucose to target levels. He is also being treated for high blood pressure and high cholesterol.

Tips to Help Improve Your Sleep Habits

  • Avoid caffeine after 4 p.m.
  • Avoid alcohol for at least two hours before bedtime.
  • Avoid nicotine for at least four hours before bedtime.
  • Do some physical exercise during the day. This is best done during the late afternoon or early evening.
  • Avoid exercise close to bedtime, as it will keep you awake.
  • Try to avoid napping during the day or limit your nap to 15 minutes.
  • Only go to bed when you feel sleepy.
  • Wind down to relax before going to bed.
  • Have a regular sleeping pattern. Go to bed at the same time each night, and get up at the same time each morning, even on weekends.
  • Avoid heavy meals and drink fewer liquids before bedtime.
  • Improve your sleeping environment. Make your bedroom quiet, dark and cool. Ensure that your mattress is comfortable.
  • It may be necessary to sleep alone if your partner keeps you awake with their snoring or restlessness
  • It is also a good idea to keep your bedroom (and your bed) as a place to sleep. For example, do not pay your bills while sitting up in bed.

Like George, many people who are overweight also have elevated blood pressure, cholesterol, blood glucose and insulin resistance. This combination of problems is more than just coincidence. It is called Syndrome X or ‘Metabolic Syndrome,’ and is very common, affecting a quarter of the population.

People with metabolic syndrome are four times as likely to develop Type 2 diabetes. The prevalence of diabetes has doubled over the past 20 years and now affects four per cent of Canadians. Diabetes is very serious and a major cause of heart disease, kidney failure and blindness.

Diet and exercise can contribute to achieving target blood glucose, cholesterol and blood pressure levels, but for many people this is not enough. Sleep may be the missing link to more effective diabetes management.

George’s long-suffering wife has put up with his loud snoring for years. However, the pauses in his breathing followed by snorting and gasping for air really worry her. Sometimes, she lies awake just so she can nudge him to start breathing again. George’s daytime fatigue and irritability are also a problem. He gets sleepy in the afternoon at work, and usually has to nap when he gets home. One day, an article in a magazine about obstructive sleep apnea (OSA) catches his wife’s eye. It describes George perfectly.

Apnea means ‘no breathing.’ A visit to the doctor followed by an overnight sleep study at the local sleep lab confirms George’s severe OSA. The study shows that during sleep, the flow of air to George’s lungs was being repeatedly shut off more than 40 times per hour. The blockages in airflow were caused by the collapse of his upper airway at the back of the throat when he sucked in his breath.

Each time a blockage occurred, the oxygen level in his blood dropped from a usual level of 95 per cent down as low as 70 per cent. Fortunately, the drop made his brain wake him up to breathe. The awakenings lasted only three to 15 seconds. Although they were usually not long enough for George to remember that he was awake, they were frequent enough to severely interfere with the quality of his sleep. This severe sleep disturbance left him tired and sleepy the next day.

A drop in blood oxygen is an emergency in the body. It triggers the body to release a shot of adrenalin that wakes the person up. It also jump-starts the cardiovascular system, raising the blood pressure, heart rate and blood glucose. Studies show that half of people with OSA develop high blood pressure. Those with diabetes have more difficulty controlling their blood glucose. Decades of jump-starting the cardiovascular system, often hundreds of times per night, stresses the heart. It significantly increases the risk of heart attack, heart failure and stroke. In fact, 25 to 30 per cent of patients with high blood pressure, heart disease or stroke have OSA contributing to their health problems.

The medical term ‘obesity’ refers to people who are significantly overweight. Central obesity (fat around the middle) is a common feature of both Type 2 diabetes and OSA. Being overweight contributes to narrowing of the airway making a blockage more likely. Eighty per cent of people with OSA are obese. OSA affects four per cent of adult males and two per cent of adult females. Due to the high occurrence of central obesity in Type 2 diabetes, OSA in people with diabetes is much higher than average. One study found OSA in 12 per cent of people with diabetes who had a history of snoring and a body mass index (BMI) of greater than 35 (kg/m2). OSA appears to be a common factor contributing to the fatigue and cardiovascular complications of diabetes.

Even though he had felt tired for a number of years, George is shocked to learn he has a severe sleep disorder. He always thought he was a good sleeper, able to fall asleep whenever he wanted to. What he did not know was that people who fall asleep ‘before their head touches the pillow,’ or who can easily nap during the day, are abnormally sleepy. It may mean they are simply not getting enough sleep, or it may mean the person has a sleep disorder.

Once George’s OSA is treated, his blood glucose and blood pressure begin to meet his target levels. He is no longer tired and sleepy during the day. He can also follow his diet more easily because the craving to snack for energy is gone. Now that he is able to exercise on a more regular basis, he begins to lose weight.

Joanne is a 37-year-old office worker who has had Type 1 diabetes for 15 years. Her blood glucose has been poorly controlled. For the past two years, she has had difficulty getting her legs comfortable and keeping them still. She notices it most when she sits for long periods or lies down in bed. Moving her legs or walking around relieves the sensation, but only for a few seconds or minutes. As a result, she has great difficulty getting to sleep and staying asleep. Her husband notices that she kicks and twitches repeatedly throughout the night. Joanne has lost much of her motivation and enjoyment of life because she is too tired to do anything.

The symptoms Joanne is experiencing while awake are called Restless Legs Syndrome (RLS). It affects 15 per cent of the general population, but is much more common in people with diabetes and those with kidney failure on dialysis. This condition is a real torture and causes insomnia. The symptom her husband notices when she is sleeping is Periodic Limb Movement Disorder (PLMD). Her legs kick or twitch every 30 to 90 seconds during periods of the night. The brain may wake up momentarily, so PLMD can cause significant sleep disturbance. People with this problem are often tired and sleepy the next day. Eighty per cent of people with RLS have PLMD.

Joanne’s doctor tells her that she has early peripheral neuropathy, a nerve disease that leads to reduced sensation in the lower limbs. It is caused by prolonged high blood glucose levels that can damage the tiny blood vessels in the nerves and interfere with nerve function. When Joanne’s blood glucose is brought under better control, her symptoms subside. She feels much more rested in the morning and is no longer sleepy during the day. Fortunately, better control of her blood glucose has improved her sleep. Joanne’s doctor reassures her that if she has more problems, there are medications that can provide good relief for RLS and PLMD.

In Joanne’s case, diabetes was indirectly affecting her sleep. Most people with diabetes are aware of the increased thirst and need to pass urine at night associated with elevated blood glucose. For others like George, poor sleep itself is affecting their diabetes. There are a number of reasons why sleep is a key part of managing diabetes.

Studies have shown that chronically sleep-deprived people with Type 2 diabetes have much more difficulty controlling their blood glucose. This is caused by a significant increase in insulin resistance. The insulin is less effective at triggering the cells of the body to take glucose out of the blood into the cell for energy. As a result, the body must secrete more and more insulin to control the blood glucose. Eventually, the body cannot produce enough insulin and the blood glucose rises above normal, resulting in diabetes. Excess levels of insulin also encourage the body to store glucose as fat rather than burning it for energy. The risk of obesity rises.

People with diabetes sleep almost two hours less and report that their sleep quality is worse than the average person. Studies have shown that the worse their sleep, the higher is their HbA1c (glycosylated hemoglobin). Elevated HbA1c indicates that blood glucose has likely been under poor control over the previous three months.

Even people who are simply overweight report more sleep disturbance and less sleep than average. Poor sleep may be the missing link in overweight people who have trouble losing weight despite their best efforts with diet and exercise. This is important since obesity is a significant risk factor for developing Type 2 diabetes.

Poor sleep may reduce the production of three other hormones important in maintaining normal body weight. Growth hormone and testosterone are two hormones released primarily during deep sleep early in the night. These hormones are necessary for maintaining or building muscle mass with exercise both in men and women.

Muscle burns a lot more calories than fat, even at rest. You can burn only a few hundred calories of energy per hour of exercise. During the rest of your day, the resting metabolism is a key factor in burning enough calories to achieve and maintain ideal body weight. Resting metabolism is largely related to muscle mass. Adequate quality and quantity of sleep is important in keeping weight off.

One of the changes that occurs with age is a reduction of growth hormone and testosterone. This is largely due to reduced amounts of deep sleep as we age. Many people blame age as the cause of the loss of these hormones. However, it is likely that poor sleep habits over a lifetime are just as much to blame. When researchers look at healthy active men in their retirement years, both their sleep quality and production of growth hormones and testosterone are much closer to those of younger men than their ailing, inactive and overweight peers.

Many people have difficulty controlling their weight as they get older despite following good diets and remaining active. This may be largely due to poor sleep.In fact, many hormonal and metabolic changes seen in aging and Type 2 diabetes are also seen in people getting inadequate sleep.

Other hormonal changes seen in aging, diabetes and sleep deprivation are elevations of the stress hormones, cortisol and adrenalin. It is likely that poor sleep accelerates the deterioration of our body seen in aging. This is not surprising considering that much of our healing, recovery of day-to-day wear and tear, and recharging of our energy occurs during deep sleep.

Another important hormone in obesity is leptin which is produced by the obesity gene. It triggers feeling full after meals, making you less likely to overeat and promotes the burning of fat and weight loss. Production of leptin peaks at night and is decreased by sleep deprivation. Evidence suggests reduced levels of leptin may lead to obesity and eventually contribute to the body becoming resistant to leptin. It is possible that leptin resistance increases the risk of cardiovascular disease in obesity and diabetes.

Reducing sleep quality and quantity causes hormonal changes that contribute to weight gain as well as developing metabolic syndrome and Type 2 diabetes. Poor sleep makes diabetes worse. People with diabetes are prone to sleep disorders such as obstructive sleep apnea which increases the risk of developing hypertension, heart disease and stroke. These changes are also seen in aging. It is likely that the effects of aging are aided and abetted by poor sleep.

Obesity and Type 2 diabetes are rapidly increasing in our society. The occurrence of sleep disorders and sleep deprivation is also very high. The National Sleep Foundation in the US found that 58 per cent of people suffer from sleep disorders. As well, 66 per cent get less than the recommended eight hours of sleep per night. Although a number of factors contribute to diabetes, including poor diet and lack of activity, inadequate quantity and quality of sleep appear to be just as important.

Along with healthy diet and exercise, good sleep is essential for blood glucose control, managing diabetes and obesity. Healthy sleep helps reduce the complications of diabetes and heightens overall well-being. If you are concerned about your sleep or have symptoms mentioned in this article, talk to your doctor.

More articles from this section
Article Listing
FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2015, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6    [DI_MDa03]
Articles in the Diabetes section of Family Health OnLine are sponsored by: Safeway ad
Articles in this section of
Family Health OnLine are sponsored by:
Safeway Ad