Nocturia and Diabetes
Jeremy Gilbert, MD, FRCPC,
Assistant Professor, University of Toronto, Endocrinologist, Sunnybrook Health Sciences Centre, Toronto, ON.
Abstract
Reduced sleep duration and quality can affect slow wave sleep (SWS) or restorative sleep, which is associated with an increased risk of developing type 2 diabetes mellitus. In patients who have been diagnosed with type 2 diabetes mellitus, treating nocturia and the associated deterioration of sleep duration and quality is particularly important to avoid the worsening of symptoms and the potential development of serious complications. Low-dose sublingual desmopressin (25 µg for adult women or 50 µg for adult men) has proven effective in reducing nocturia with the goal of improving SWS.
Key words: type 2 diabetes mellitus (T2DM), sleep duration, sleep quality, sleep hygiene, slow wave sleep (SWS), optimal glycemic control, desmopressin.
Introduction
Type 2 diabetes mellitus (T2DM) is the most common type of diabetes in adults, accounting for approximately 90-95%1 of cases, and thus will be the focus of this discussion. It is characterized by hyperglycemia, insulin resistance, and relative impairment in insulin secretion. The prevalence of type 2 diabetes mellitus has risen alarmingly in recent years in large part because of rising rates of obesity and sedentary lifestyle.2 Type 2 diabetes can lead to significant morbidity and mortality via its microvascular and macrovascular complications.
Patients with undiagnosed type 2 diabetes mellitus might not report any symptoms. If they do experience symptoms, they can include: intense thirst, polyuria, blurred vision, and fatigue.
Polyuria, or urine output exceeding 3 L/day in adults, may occur in individuals with type 2 diabetes mellitus. This is mainly related to poor glycemic control resulting in the kidneys' inability to reabsorb the large glucose load. As a consequence, glucose is excreted in the urine in a process called glucose-induced osmotic diuresis. Water follows glucose, resulting in amplified water in the kidneys and increased urine output. Polyuria can occur during the day and night; urinary frequency at night is called nocturia.