Evaluation of a 64-year-old patient with poorly-controlled diabetes offered three different specialists a glimpse of how serious the situation could become.
Even a perfect control on blood glucose level does not help, they found.
The patient, with a HBA1C of 9.3 per cent, was evaluated for a 24-hour period for three things — blood glucose levels during sleep, heart rhythm and sleep hygiene. He had three to four episodes of asymptomatic hypoglycaemia (low blood glucose). Though he did not exhibit sleep disturbances, if hypoglycaemia remained untreated, it might become fatal, said G. Sengottuvelu, intervention cardiologist attached to Apollo Hospitals, speaking at a press meet on Wesnesday.
A patient with hypoglycaemia, when awake, would typically experience sweating and tremors and eating a chocolate would result in a rise in glucose levels. But, these symptoms are absent while a patient is sleeping. “Hypoglycaemia has been recognised as a potential cause of death ever since the introduction of insulin therapy. Patients are unaware that they can be hypoglycaemic at night. We advise that patients who have hypoglycaemia have their glucose levels checked even at night,” said Vijay Viswanathan, chief diabetologist, MV Hospital for Diabetes and Research, Royapuram.
Though sleep apnea, a condition where a person snores, is considered normal in India, studies have shown that about 30 percent of those who have diabetes have obstructive sleep apnea. When a person snores, the upper airways are narrowed and reduce the amount of air getting into the lungs.
“There is increasing evidence to suggest that sleep apnea is linked to poor control of diabetes and hypertension. Sleep apnea is significantly under-recognised,” said N. Ramakrishnan, director, Nithra Institute of Sleep Sciences.
“Diabetes Mellitus is one of the major risk factors in the development of coronary artery diseases and frequently both diabetes and heart disease co-exist. Treating sleep disturbances would help identify diabetes and heart disease as well,” he added.