A paper from Penn State University found that the risk of death from stroke and heart disease was significantly higher in people who get less than six hours of sleep a night. Researcher Julio Fernandez-Mendoza, PhD, said, short sleep “multiplies the risk of poor outcomes in people with CVD [cardiovascular disease] or stroke.” Heart disease and stroke are the leading causes of diabetes-related deaths.
“We have to look beyond sleep apnea,” said Dr. Fernandez-Mendoza. “Most of these patients without sleep apnea but with coronary vascular disease or stroke complain of poor sleep or chronic insomnia. We know now that when such objective short sleep is present their long-term prognosis is much worse.”
According to the American Sleep Association, “animal studies show that sleep is necessary for survival.” The immune system, our bodies’ repair system, is strengthened by sleep. Rats deprived of sleep developed sores on their tails and paws because their immune systems weren’t working.
I don’t know how the rats were kept awake, but this sounds like a very cruel study. Rats normally live for two to three years. Those deprived of REM (dream-time) sleep survived only about five weeks on average, and rats deprived of all sleep stages lived only about three weeks.
Sleep “may help the body conserve energy and other resources that the immune system needs to mount an attack” on invaders or heal injury. When we’re awake, our bodies may work so hard on immediate needs that they don’t have time to heal.
According to the Sleep Association, the nervous system needs sleep to keep functioning well. “Some experts believe sleep gives neurons a chance to shut down and repair themselves. Without sleep, neurons may become so depleted in energy or so polluted with byproducts of normal cellular activities that they begin to malfunction.” Sleep is crucial for good memory function and learning, which may be why children need more sleep than adults.
In addition to allowing nerves to recharge, sleep seems to promote the body’s creation of proteins. Proteins are the building blocks of animal life. Pretty much every vital chemical in the body, from insulin to hemoglobin, is a protein or made from proteins.
The website How Sleep Works says sleep is a time where the body resets itself. Toxins are neutralized, normal levels of chemicals are restored. Apparently “REM sleep is largely devoted to brain repair and restoration,” they say, “while non-REM [deep] sleep is principally a time for body repair and restoration.”
Basically, being awake is stressful, and sleep is healing. One result is that people who get less sleep have much more insulin resistance and higher blood sugar levels.
Why it’s hard to sleep
Our society does not value sleep and makes it difficult in dozens of ways.
If you have trouble getting to sleep, stress is often the problem. If you find yourself waking in the night, that is often a physical symptom such as sleep apnea, jumpy legs, or an overactive bladder. It could also be hunger or low blood sugar. If you find yourself waking too early with a head full of worries, that could be hunger or it could be depression or anxiety.
Some people don’t have good places to sleep. Imagine trying to get a good night’s sleep if you’re homeless. It can’t be done. But even housed people can have too much noise, too much light, too uncomfortable a surface, or too much household stress to sleep well.
Some medications, such as those containing caffeine, can keep you awake. Getting wound up before bed on the computer or watching TV might make sleep difficult. Lack of physical movement during the day makes it hard to sleep at night. Vigorous exercise before bedtime can excite you and make it hard to let go.
How to get more sleep
All bodies need to sleep, even if our minds don’t want to. Here are some ways:
1. Get checked for medical problems that might be waking you up. For example, there are good treatment options for OSA, including CPAP machines, the new Provent nasal valves, and the Inspire implantable stimulator that keeps your airways open.
2. Set up your environment for sleep — have a comfortable bed, a dark room (or an eye mask, if needed), and quiet (use earplugs, if nothing else).
3. Set up your evening for sleep — do a quieting half hour before bed, with meditation, quiet music, cuddling, or petting time. Don’t take your smartphone to bed; don’t watch the news or upsetting shows in bed. In fact, don’t use your bed for anything except sleep and sex, or stretching in the morning before you get up.
4. Set up your days for sleep — get sunshine during the day. Use a sunlamp if there’s no sun where you live. Sunshine causes your body to produce the neurotransmitter serotonin. This converts to melatonin, which helps with sleep at night. Get some physical movement, so your body doesn’t want to move when it’s time to sleep.
5. Prevent hunger and low blood sugar. A bedtime snack including protein and some complex carbohydrate might help you stay asleep.
6. In consultation with your health-care provider, consider proven sleep supplements such as magnesium and valerian.
7. Get help with anxiety, stress, and depression, if you think those might be problems.
8. Accept that sleep is important. It’s not being lazy; it’s not shirking your responsibilities. Your body needs it. You may have to spend some time in the day clearing up things that are worrying you, like taking care of the kids so that you can relax and heal at night.
Want to learn more about getting sleep with diabetes? Read “Getting the Sleep You Need,” “Have Diabetes? Can’t Sleep? Don’t Eat These Tonight,” “Eating for Better Sleep,” and “Getting to Sleep and Staying There.”
A nurse for 25 years at University of California San Francisco and Kaiser hospitals, and one of the first professional health coaches. Nurse Spero is author of Diabetes: Sugar-Coated Crisis and The Art of Getting Well: Maximizing Health When You Have a Chronic Illness, as well as co-author of Diabetes Heroes and the diabetes chapter in Where There is No Doctor. He writes for Diabetes Self-Management, Pain-Free Living, and Everyday Health.
Learn more about David Spero:
What is type 1 diabetes?
Type 1 diabetes is an autoimmune disorder in which the immune system attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the pancreas produces little or no insulin. Type 1 diabetes is also characterized by the presence of certain autoantibodies against insulin or other components of the insulin-producing system such as glutamic acid decarboxylase (GAD), tyrosine phosphatase, and/or islet cells.
When the body does not have enough insulin to use the glucose that is in the bloodstream for fuel, it begins breaking down fat reserves for energy. However, the breakdown of fat creates acidic by-products called ketones, which accumulate in the blood. If enough ketones accumulate in the blood, they can cause a potentially life-threatening chemical imbalance known as ketoacidosis.
Type 1 diabetes often develops in children, although it can occur at any age. Symptoms include unusual thirst, a need to urinate frequently, unexplained weight loss, blurry vision, and a feeling of being tired constantly. Such symptoms tend to be acute.
Diabetes is diagnosed in one of three ways – a fasting plasma glucose test, an oral glucose tolerance test, or a random plasma glucose test – all of which involve drawing blood to measure the amount of glucose in it.
Living with type 1 diabetes and wondering what you can eat? Check out our 15 top tips for healthier eating, below.
15 tips for healthier eating with type 1 diabetes
It is estimated that 40 percent to 50 percent of Americans make New Year’s resolutions, and losing weight is among the most popular, along with quitting smoking and exercising. Unfortunately, even the most favorable research on success rates of resolutions shows that by June, only 4 out of 10 people are still making good on their promises to themselves.
The good news is that by making a resolution in the first place, you are much more likely to change than someone who has not made one. Remember: There is no rule that all resolutions have to begin on January 1. If you want to change your eating habits and slim down, you can begin or renew your resolution now.
But before you resolve again to improve your diet and lose weight, think about what made you give up on your last attempt. All too often, people think of “going on a diet” as an all-or-nothing endeavor. But after a few weeks (or if you’re very strong, months) of restricted eating, it’s common for people to gradually start going back to their old eating habits. They then deem the attempt to lose weight a failure and ultimately revert completely to their former ways, because eating right is just too hard. Sound familiar?
There are two basic problems with this way of attempting to change one’s eating habits, and the first is the mentality of the word “diet.” The English word is derived from the Greek diaita, which, according to Webster’s, literally means “manner of living.” But people have a way of reinventing language, and now one of the formal definitions of “diet” is “a regimen of eating and drinking sparingly so as to reduce one’s weight.”
We all know that eating “sparingly” is difficult to keep up for long. So the first thing that you should resolve to do before making any changes to your meal plan is to go back to the original meaning of the word and make your new diet a new way of life. This means that all foods are allowed in some amount, but that you will be making a shift in the foods and drinks that you consume most often or in larger amounts. If you think about your diet in this way, you will not look at the changes as temporary and restrictive, but as lifelong habits that include good, flavorful, healthy food and sometimes even high-calorie treats.
That brings me to the second major problem with the New Year’s resolution diet mentality: the idea that at midnight on December 31, you will be able to instantly transform your mind, body, spirit, refrigerator and cupboards into a model of healthy living — and make it last. This is extremely difficult because of the way that our brains form and break habits. Habitual activities, like driving to work or always eating cookies before bed, are hard-wired in our basal ganglia, an area of the brain that also controls addictions and learning procedures. Eating habits, therefore, are essentially our brains on autopilot.
Research finds that while we can rewire the brain and break a habit by changing the stimulus (such as eating celery instead of cookies), it has a very easy time reverting back to the old wiring when the former stimulus returns (such as when your spouse brings home cookies instead of celery). Some research finds that making gradual behavioral changes, or letting our brains adapt to one thing at a time, is the best way to maintain changes over the long term. So as you renew your resolve to improve your eating habits, throw out that all-or-nothing attitude, and consider changing your diet a little at a time.
The following are 15 food-related habits that will almost certainly improve the nutritional quality of your diet and that can also help you lose weight. Plan on adopting them over the course of this year (not all in one week). It may be helpful to select a “goal date” to start each new habit. Make these changes to your routine, and next New Year’s Eve, the best resolution may be to simply continue along the path you’re already on.
1. Write down everything you eat and drink for at least a week.
Keeping a food journal is helpful in a number of ways. Not only does writing down what you eat actually make you choose better foods (who wants to see on paper that they ate six doughnuts?), but it will also give you a sense of how much food you are really eating and what your specific problem areas might be. People can underestimate what they eat by up to 50 percent, so you may not perceive that you are eating as much as you are until you write it down. When you keep your food journal, make sure you note the time of day, portion size, and a rating of how hungry you are on a scale of 1 to 5 (1 = not hungry, 5 = ravenous). If you have access to a computer, you can use the MyFoodAdvisor tracker designed by the American Diabetes Association. Otherwise, a simple notebook or even some sheets of paper will do.
After you have kept your journal for a few days, you may notice that you often eat late at night or that you sometimes eat out of boredom rather than hunger. You may also find that you eat the same foods over and over (most people do) or that you skip meals and end up overeating when you finally get to the table.
In addition to helping you lose weight, keeping a food journal can help you avoid regaining it. If you have lost weight and find the scale creeping up again, start writing things down to get yourself back on track.
2. Learn to read food labels.
Nutrition Facts panels are required on the labels of almost all packaged foods in the United States. They are best used to compare similar products, such as two breakfast cereals or two canned soups. At a glance you can see which product has more fiber, sodium, sugar, fat, etc., per serving.
Use the % Daily Value column as a guideline for each nutrient: 0 percent to 10 percent is low, 10 percent to 20 percent is moderate and greater than 20 percent is high. Look for low percentages of fat (especially saturated fat), cholesterol, and sodium, and moderate to high values for fiber, vitamins and minerals. A note on trans fat: There is no Daily Value established, and it is best to avoid it altogether. Use the ingredients list to avoid added sugars. In the ingredients list, the items are listed in descending order by weight (from most to least). If sugar or another caloric sweetener such as high-fructose corn syrup is the first or second ingredient in the list, you know the food is high in added sugar.
Keep in mind that all the numbers on the Nutrition Facts are based on one serving, which may be more or less than you eat. If one serving is 1/2 cup of cereal and you eat 1 cup of cereal, you must multiply all of the numbers by two. Beware of misleadingly labeled items, such as a 16-ounce carton of juice that is labeled as two 8-ounce servings even though it is clearly packaged as a “single serving” item.
3. Plan your menu for the week on Saturday.
Menu planning makes life easier on several levels. If you shop with a planned menu, you will be less likely to buy unnecessary food that can spoil, which will save you money. Shopping with a specific list also saves time and can deter you from adding unhealthy snacks to your cart. Knowing what is for dinner every night can make preparation easier, since you may be able to prepare some of the meal earlier in the day (or week) rather than hastily putting it together right before dinner.
Planning menus can also help you add variety to your diet and get out of ruts in your eating habits. For example, you can plan for a different vegetable each day and alternate lean meats, chicken, fish, beans and tofu for your protein. If you have a family, ask them to participate in menu planning. They might have new ideas or remember a favorite dish that you have long forgotten. Planning meals will help ensure that you do not skip meals or choose less favorable foods out of hunger and convenience. Make a plan every Saturday or Sunday, or the day before you usually shop.
4. Include protein, good fat, and high-fiber carbohydrate in each meal.
If you had regular pasta with tomato sauce and a few slices of Italian bread last night for dinner, what was missing? Protein and fiber. If for lunch you had a turkey sandwich with mustard on white bread, what was missing? Good fat and fiber.
Eating “mixed meals,” ones that include protein, fat and carbohydrate, may help with diabetes management since the protein and fat can help slow the digestion of the carbohydrate, leading to a lower blood glucose rise after the meal. Including unsaturated fat (“good fat”) and foods that contain fiber in your meals will help you feel satisfied longer and, in the long term, improve your blood cholesterol. Eating a balanced meal with protein, fat and carbohydrate will also prevent a deficiency of any of these groups: Human beings need protein to maintain body tissues, good fat for the brain and immune system, and carbohydrate with fiber for energy and digestive tract health.
5. Switch to lower-fat dairy products.
Dairy products are packed with calcium, magnesium and protein, and fortified milk contains vitamins A and D. However, full-fat and even reduced-fat dairy products are also packed with cholesterol and saturated fat, which are bad for your heart and arteries. Fat is also very dense in calories; all types of fat have 9 calories per gram, while carbohydrate and protein have 4 calories per gram. By using low-fat (1 percent) or fat-free (skim) milk, yogurt, and cheese, you can get all of the nutrition benefits of dairy products with fewer (or no) fat calories.
If you are concerned about a loss of flavor when switching to lower-fat dairy products, try a gradual reduction in milk fat over time. For example, switch from whole milk to reduced-fat (2 percent) milk for one or two months until you get used to the flavor, then proceed over the next several months to low-fat (1 percent) and fat-free (skim) milk, which has only trace amounts of fat and cholesterol.
6. Replace bad fats with good.
You probably know by now that all fat is not created equal — that saturated fat and trans fat raise LDL (low-density lipoprotein, or “bad”) cholesterol, may raise blood pressure, and are even associated with poor blood glucose control. Conversely, unsaturated fats — particularly omega-3 fatty acids – may have the reverse effect.
When choosing foods — even “healthy” cooking oils that are high in unsaturated fat — be aware of three things. First, all fats have 9 calories per gram and will contribute to weight gain if consumed in excess. To keep calories low, moderate your use of all fats and oils. Second, the health benefits of unsaturated fats are not seen when they are simply added to a diet high in saturated or trans fat. To improve your health, you must replace saturated fat, found in animal products and tropical oils, with unsaturated fat, found in other vegetable oils and fish. Finally, focus on adding omega-3 fatty acids to your diet; these are found in flaxseed, walnuts, canola oil and fatty fish. It is thought that the ratio of omega-3 to omega-6 fatty acids, the other type of essential “good” fat, in one’s diet is crucial to obtaining the health benefits of both. Americans currently consume far less of omega-3 than omega-6 fatty acids, which are found in large amounts in many vegetables oils (including corn, sunflower, safflower and soybean oils). So focus on eating foods and oils with omega-3 fatty acids while minimizing saturated and trans fats, and perhaps omega-6 fatty acids, as well.
7. Buy and prepare at least one green vegetable every week.
Being “green” in the environmental sense is now in vogue — but there is yet another way to go green, and that is on your dinner plate. Most vegetables are high in fiber, vitamins and minerals and low in calories, so any vegetable is better than none. However, there are some very powerful chemicals found in the pigments that color plants, and the green variety packs an especially powerful punch when it comes to health. Leafy greens (such as spinach, kale and mustard greens) and members of the cruciferous family of vegetables (including broccoli, cabbage and Brussels sprouts) have various phytochemicals as well as other important nutrients such as folate, vitamin K, beta-carotene, vitamin C, iron, magnesium, calcium and even omega-3 fatty acids. These vegetables have been found to reduce the risk of several chronic conditions, including Alzheimer’s disease, osteoporosis, and some types of cancer.
Eating your greens daily would be ideal, but if that’s not possible, start small and try to include one serving per week. Choosing a different vegetable each time will ensure that you get a variety of nutrients, since each has different amounts of vitamins and minerals. Varying your veggies will also make sure that you don’t get tired of eating the same thing week after week.
8. Buy and prepare a deep-orange vegetable every week.
You may know that beta-carotene is the phytochemical that gives carrots and other orange vegetables their color. Since beta-carotene is converted to vitamin A inside the body, orange vegetables are sometimes referred to as being high in vitamin A. Beta-carotene has long been known to boost eye health and immunity, but the nutrients in dark yellow and orange vegetables (including those in the family of beta-carotene, carotenoids) can do even more. Just as with green vegetables, benefits of eating orange plants include strong bones and a reduced cancer risk.
Be cautious about using supplements to get your carotenoids. Although some studies have shown that supplementation can slow the progression of some diseases (lutein supplements help prevent macular degeneration, which causes blindness), other research has shown that it may actually increase the risk of other diseases (beta-carotene supplements have been associated with lung cancer in people who smoke or have been exposed to asbestos). Always check with your physician and/or consult a registered dietitian when considering supplements.
9. Prepare dishes based on dried beans or other legumes.
Beans and legumes (a legume is anything that grows in a pod) pack fiber, vitamins, minerals, and only trace amounts of fat. They are an excellent source of vegetarian protein; when paired with a grain or vegetable, beans form a complete protein, with all of the amino acids that humans need. Not only do beans provide all of these benefits, but by having beans instead of animal protein as your main course, you will be reducing the amount of saturated fat, total fat and cholesterol in your diet. Beans do contain a moderate amount of carbohydrate, but most varieties have a low glycemic index, which means they cause only a small, slow rise in blood glucose. Still, as with all food, beware of portion size (1/3–2/3 cup = one starch exchange, depending on variety; 1/2 cup = one lean meat exchange). Your wallet will also thank you for taking this step, because not only are beans healthy, they are also very inexpensive: A pound of dried beans can cost less than a dollar, and canned beans are only modestly more expensive.
10. Eat at least one piece of fruit every day.
Just like vegetables, most fruits are high in fiber (when the whole fruit is consumed, not just the juice), vitamins and minerals and contain various phytochemicals. Fruits do contain natural sugars, which is why it is advisable to minimize or eliminate fruit juices (even 100 percent juice) and replace them with whole fruits, since a serving of juice can be the caloric equivalent of several pieces of the whole fruit. (For example, you would have to eat a pound and a half of grapes to take in the amount of sugar in 20 ounces of 100 percent grape juice.) Fruits are great snacks and can also serve as a healthy dessert item. Many also travel well, so tote them along and reach for an apple or orange instead of a bag of chips.
11. Find a soy product you like and eat it once a week.
Soy is a complete protein and contains omega-3 fatty acids, phytochemicals and only trace amounts of saturated fat. Some soy products also contain calcium, folate, potassium and/or fiber. Soy comes in all shapes and varieties — chances are, there is a soy product that you will like. Try edamame (young green soybeans), which are sold with or without the pod and make a great snack; soy milk (perfect in your coffee); soy-based veggie burgers; soy chips or nuts (beware of sodium); or good old tofu (blend silken tofu in a fruit smoothie, and you won’t even know it’s soy). Just as with beans, substituting soy for meat as a protein source will help reduce your intake of fat and cholesterol while increasing your fiber intake.
12. Eat fish once a week and vary your fish consumption.
All fish are a good source of protein and low in saturated fat, and some types of fish like salmon and tuna are very high in omega-3 fatty acids. Many people now question the safety of eating fish because of the potential for contamination by such pollutants as mercury and PCBs. However, once-a-week consumption should be enough to meet your requirement for omega-3s while minimizing your exposure to pollutants. Varying the type of fish you eat will also help minimize your exposure to any pollutants. If you want to check whether a specific fish is high in mercury, you can visit this website by the FDA. The Environmental Protection Agency also has fish advisory information here. If you are pregnant or nursing, or if you are feeding a small child, the recommendations are more stringent than for most people, so please check the advisories.
13. Use a variety of herbs and spices to flavor your food with less salt and fat.
Herbs and spices not only add flavor to food without the use of fat and salt, but some also confer health benefits. For example, both garlic and turmeric (often used in yellow curry dishes) have been found to reduce the risk of certain types of cancer. Some spices and flavorings go well with a variety of foods; these include parsley, garlic, onion, lemon juice and “spicy” ingredients like pepper and mustard powder. When using leaf-based herbs, it is best to crush them (or rub them on meat) to maximize their flavor. If you need to substitute dried herbs for fresh ones in a recipe, use about half the amount listed. To introduce yourself to new flavors and spices, try making a recipe from a different culture each month. If you can’t find the flavorings you need at your local supermarket, an ethnic market or specialty food store may have what you need.
14. Drink 6–8 glasses of plain water each day.
The human body is 60 percent water, and when we lose even 2 percent of our body weight from water (3 pounds in a 150-pound person), the result is lower energy, slower metabolism and even a false sense of hunger. Our thirst mechanism is fairly weak, so you may not sense thirst in the beginning of dehydration. Aim to drink 6–8 glasses every day, regardless of thirst, and more in the summer months or if you exercise strenuously. A good way to detect your individual need for water is to monitor your urine: Dark-colored or cloudy urine is a sign of dehydration. Also, weighing yourself before and after exercise will give you an idea of how much water you have lost; drink two cups of water for every pound lost.
15. Limit most caloric beverages to 8 fluid ounces or less per day.
This recommendation comes from guidelines published by the American Journal of Clinical Nutrition in 2006. Liquid calories go down easily and can increase your caloric intake considerably, without satisfying hunger. If you reduce your daily caloric intake by 500 calories, you will lose approximately a pound every seven days. A 20-ounce bottle of regular cola has almost 250 calories, so removing it from a daily diet would result in a loss of 1/2 pound per week. Other sweetened (naturally or otherwise) beverages and even 100 percent juice have a calorie and sugar content similar to that of soda, so switch to water, coffee, or tea (up to 40 fluid ounces per day); diet drinks (up to 32 fluid ounces); or low-fat milk or soy milk (up to 16 fluid ounces). If you’re used to drinking more than 8 ounces of juice a day, try diluting 8 ounces with an equal amount of water — you may find it refreshing, and it will have half the calories of regular juice.
Want to learn more about healthy eating with type 1 diabetes? Read “Improving Your Recipes: One Step at a Time” and “Carbohydrate Restriction: An Option for Diabetes Management,” then watch “Healthy Eating With Diabetes.”