Sleep, Stress and Type 2 Diabetes

Type 2 Diabetes (T2D) is often described as a ‘lifestyle disease’. This would suggest that our choices are a significant feature in its development or prevention. To suggest that developing T2D is down to our lifestyle choices only is unfair and inaccurate, as other factors outside of our control play a role too, such as our genetics, environmental pollution and socio-economic situation [1]. But, looking at the research on diabetes and lifestyle factors can help those of us who want to be proactive in its prevention, or management, make positive changes if we can.  When we consider that someone diagnosed with diabetes is more likely to experience depression and anxiety than the general population, we realise that this is both a physical and mental health concern.

Some statistics

It is estimated that 1 in 11 of the world’s adult population is living with diabetes, with the vast majority of cases being Type 2 diabetes (T2D). In the UK, someone is diagnosed with diabetes every two minutes, and another 12 million people in the UK are described as ‘pre-diabetic’. Rates have doubled in the past twenty years, and it is now widely acknowledged as an epidemic, leading to raised awareness about the disease and recommendations around its prevention.

What can we do about it?

When we look at the general advice around preventing diabetes, the majority of it focuses on diet and exercise. This makes sense, as the typical ‘Western-diet’ (a diet high in sugar, refined grains, high GI carbs, dairy, trans-fats, ready-to-eat foods and processed meats) and sedentary behaviour can both lead to insulin-resistance, a driving factor of T2D. But when it comes to modifiable lifestyle factors – things that we can proactively do to help prevent or delay the onset of diabetes – this doesn’t give us the full picture.

We can eat healthy food and go to the gym every day, but if we’re not sleeping enough or effectively managing our stress levels, we can still be prone to the metabolic conditions that can lead to T2D. When I look at the research, it seems worthwhile suggesting that a more holistic approach, one that extends beyond just exercising and eating well, is essential. 

Sleep and Stress

Research has shown that people who average less than 6.5 hours a night are prone to insulin-resistance and have a higher risk of developing T2D. In line with this, a 2015 meta-analysis of studies exploring sleep duration and risk of T2D concluded that the lowest risk of developing T2D is associated with an average of 7-8 hours sleep per night [2], which aligns with the general recommendations for health and wellbeing. So, besides making time for movement and exercise, and having a healthy diet, the research tells us that we should aim for 7-8 hours of quality sleep each night if our goal is to reduce the risk of developing T2D.

Another relevant research finding to consider is that high evening cortisol levels have been linked to T2D (cortisol is a hormone produced in response to stress) [3]. This makes sense when you consider that cortisol raises both blood sugar levels and insulin. Interestingly, ongoing poor sleep causes elevated evening cortisol levels, as does feeling stressed, or anxious in the evening, which suggests the importance of stress management throughout the day. This will look different from person to person, depending on their unique circumstances, but taking regular recovery breaks during your workday and sticking to a work cut-off time that allows you at least two-hours to unwind and relax in the evening will help.

Think holistically

So, if you’re looking to be proactive around your health, and take active steps towards preventing, or helping to manage T2D, the research suggests you should look to include healthy sleep and effective stress combatting strategies as part of your lifestyle regimen. If you’d like some extra guidance around this, check out our series ‘Combatting Stress’ and be on the lookout for ‘Understanding Sleep’ and ‘Optimising Sleep’, both launching in September 2018.

1] Type 2 Diabetes: Demystifying the Global Epidemic. Ranjit Unnikrishnan, Rajendra Pradeepa, Shashank R. Joshi, Viswanathan Mohan. Diabetes Jun 2017, 66 (6) 1432-1442; DOI: 10.2337/db16-0766

[2] Sleep Duration and Risk of Type 2 Diabetes: A Meta-analysis of Prospective Studies. Zhilei Shan, Hongfei Ma, Manling Xie, Peipei Yan, Yanjun Guo, Wei Bao, Ying Rong, Chandra L.Jackson, Frank B. Hu, Liegang Liu. Diabetes Care Mar 2015, 38 (3) 529-537; DOI: 10.2337/dc14-2073

[3] Hackett RA, Kivimäki M, Kumari M, Steptoe A. Diurnal cortisol patterns, future diabetes, and impaired glucose metabolism in the Whitehall II Cohort Study. J Clin Endocrinol Metab. 2016;101(2):619-625.

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