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Do You Suffer From Blurry Vision
Blurred or out of focus vision or any rapid changes to your vision can be an early sign of diabetes. Surprisingly, your diabetes related blurry vision could be caused by any of these factors:
- Hyperglycemia High blood sugar levels can cause fluid shifts and swelling of your eyes which moves the lens closer to or away from the retina, causing blurred vision.
- HypoglycemiaLow blood sugar levels cause changes in your brain, preventing your ability to focus.
- Rising and falling blood sugar levels. Fluctuating blood sugar levels can cause fluctuating vision as your eye changes in size and distance from lens to retina.
- Your body adjusting to a new insulin or a new dosage of insulin. New insulin levels or new medications may cause shrinking and swelling leading to vision changes.
If the underlying causes are identified and addressed, these vision changes are relatively short term and temporary. However, uncontrolled diabetes or chronic hyperglycemia or hypoglycemia can lead to permanent damage to your vision.
Researchers Conducted A Trial To Understand The Connection Between Disturbed Blood Sugar Level Control And The Timing Of Meals Relative To Sleep
Blood sugar level control, which is impaired in individuals with diabetes, is affected by various factors, including the timing of meals relative to sleep and melatonin levels, a hormone primarily released at night that helps control sleep-wake cycles.
Investigators at Massachusetts General Hospital , Brigham and Womens Hospital and the University of Murcia in Spain performed a clinical trial to connect blood sugar level control and meal timings.
Senior author, Richa Saxena, PhD, a principal investigator at the Center for Genomic Medicine at MGH, addressed the study: We decided to test if late eating that usually occurs with elevated melatonin levels results in disturbed blood sugar control.
The research was published in Diabetes Care.
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Few Need It But Many Take It
Esben Lauritzen says that the research results are relevant for the debate on taking melatonin as a sleep aid.
Melatonin is approved as a sleep aid for people older than 55 years, for treating jet lag and for children and adolescents with attention-deficit/hyperactivity disorder and other mental disorders. However, the drastic increase in consumption also suggests that other people take melatonin.
The use of melatonin is increasing even though the side-effects have not been mapped, and although the new study does not provide a clear answer, it suggests that melatonins effects extend beyond purely sleep-related ones.
Our bodies produce melatonin at night, but the doses that people take to fall asleep can result in concentrations in the bloodstream that are 100 times greater than the concentration we produce naturally. Perhaps melatonin in the concentrations that we produce ourselves does not have negative effects on glucose homeostasis. However, we cannot rule out that taking hefty quantities of melatonin may affect glucose metabolism and be harmful to health. Conversely, disturbed sleep is also associated with reduced glucose uptake into the tissue because of decreased insulin sensitivity and an increased risk of obesity, type 2 diabetes and cardiovascular disease. This means that elucidating the potential effects of taking melatonin daily, as many people do, is important, concludes Esben Lauritzen.
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What Is The Connection Between Sleep Apnea And Diabetes
Though sleep apnea does not directly cause diabetes, it is a risk factor for type 2 diabetes and has been shown to increase insulin resistance, even in non-diabetic and non-overweight people. The American Diabetes Association estimates that up to one in four people with type 2 diabetes also suffers from OSA, and a further quarter of type 2 diabetics suffer from another sleep-related breathing disorder.
Both OSA and type 2 diabetes are more common in people who are overweight and obese. However, OSA appears to affect insulin resistance and glucose control even after controlling for obesity. Not only does OSA cause sleep fragmentation that interferes with slow-wave sleep, but it also periodically cuts off the bodys oxygen supply. Together, these effects lead to insulin resistance and impaired glucose metabolism.
In many studies, short-term sleep apnea treatment appears to improve blood sugar levels, while long-term CPAP treatment improves blood sugar and insulin resistance. However, other studies have failed to find improvements in blood glucose levels after treating OSA, leading some researchers to believe the connection could be due to other variables such as weight.
More research is needed to further characterize the nature of the connection, but it is clear that physical health plays an important role in sleep apnea and diabetes. A combination of weight loss and CPAP treatment may be the most effective way to treat sleep apnea in people with type 2 diabetes.
Genetics Of Melatonin Receptors
Genome-wide association studies have enabled us to scan markers across genomes of many individuals to identify gene variations that may be associated with diseases. This approach has revealed a wide array of gene variations that are associated with the development of diabetes mellitus.
One example of this is a genetic variation in the MTNR1B gene. This gene codes for one of the melatonin receptors. Those who carry a particular alternate form of this gene experience higher blood sugar levels and are at significantly greater risk of developing type 2 diabetes than those with the C-allele, or wild type.
It is important to note that the G-allele is atypical, but it is not particularly rare. Though its prevalence varies to some degree by ethnicity, it has been estimated to occur in roughly 30% of the human population.
It has been hypothesized, based on animal models and in vitro evidence, that individuals with this risk variant have melatonin receptors that are more sensitive to the hormone, which results in exaggerated inhibition of the beta cells and slower insulin release.
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How Is Melatonin Production Coupled To Daylight And Darkness
There is a nifty mechanism that ties melatonin production to light levels. When its dark, less light falls on our retinas the light sensitive layer at the backs of our eyes. This drop in light levels is then signalled to another part of the brain called the suprachiasmatic nucleus.
The SCN, which is found in a brain structure called the hypothalamus, is sometimes known as the master clock. It is our main internal body clock that regulates circadian rhythms: hormonal, physical and behavioural processes which follow a 24 hour-cycle. The pattern of sleeping at night and waking during the day is an example of a circadian rhythm. The daily fluctuation in body temperature is another example of a circadian rhythm.
During darkness, the SCN stimulates the pineal gland to produce and secrete melatonin. This, in turn, enters the bloodstream and has various effects in the body, including making us feel sleepy, reducing our core body temperature and, as well shortly discover, inhibiting the release of insulin. By contrast, bright light causes the SCN to suppress the production of melatonin by the pineal gland.
Levels of melatonin therefore stay high in the bloodstream during the night-time, until the re-emergence of daylight in the morning begins to inhibit melatonin secretion.
KEY POINTS
- Light levels are detected by the retinas and relayed to the suprachiasmatic nucleus .
- The SCN is the bodys master clock and regulates melatonin release by the pineal gland.
Research Reveals A Surprising Link Between Melatonin And Type 2 Diabetes
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We typically associate the hormone melatonin with sleep. However, melatonin is actually involved in the timing and synchronization of a number of different physiological functions throughout the body. One of these functions is the regulation of blood sugar.
Recent research has found that a relatively large proportion of the human population is genetically predisposed to be more sensitive to the impact of this hormone on blood sugar control. This can lead to higher blood glucose levels and ultimately greater risk of developing type 2 diabetes.
Heres how it works, and what you can do about it.
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Melatonin Is An Appropriate Agent For The Treatment Of Diabetic Nephropathy
Diabetic nephropathy, as one of the main microvascular complications of both type 1 and type 2 diabetes mellitus, is the most frequent cause of end-stage renal diseases. Diabetic nephropathy is characterized by nephron enlargement, glomerular hyperfiltration as well as the hypertrophy of mesangial cells, which eventually develops into glomerulosclerosis . Several mechanisms have been proposed for diabetic nephropathy progression and development, including lipid disorders, oxidative stress, pro-fibrotic and fibrotic cytokines generation -1, plasminogen activator inhibitor -1, and connective tissue growth factor .
As mentioned above, ROS have a key role in diabetic complications . In hyperglycemia state, the persistent oxidative stress contributes to damage to the nuclear DNA and the mitochondrial genetic material .
Hyperglycemia leads to apoptosis in different types of cells in diabetic nephropathy, such as the proximal tubule epithelial cells . It has been previously explained that the apoptosis occurs through activating numerous intracellular signaling pathway . Now, it is acknowledged that hyperglycemia mediates apoptosis and promotes the gradual loss of kidney function in diabetic nephropathy .
Table 5 The application of melatonin for the treatment of diabetic nephropathy
Plasma Adipokines And Melatonin
Values recorded for adipokines and melatonin are presented in Table 7. Plasma adiponectin levels in Group D were significantly lower than those in Group C, but the plasma leptin level and leptin/adiponectin ratio did not differ from those of Group C. All of the melatonin-treated groups had significantly higher plasma adiponectin levels than Group D, but they were still lower compared to those of Group C. Groups M and H had significantly lower plasma leptin levels than those of groups C and D. The leptin/adiponectin ratio in Group L was lower than that in Group D, and those in groups M and H were lower than that in Group L. Plasma melatonin levels in Group D were significantly lower than those in Group C. The melatonin-treated groups had significantly higher plasma melatonin levels compared to Group D. Group L had significantly higher plasma melatonin levels compared to those of Group C, and those of groups M and H were significantly higher than that of Group L.
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Warnings For Some Serious Health Conditions:
The Impact Of Melatonin On Sleep And Weight
Apart from these direct impacts that melatonin tablets can have, there is also a correlation between a good nights sleep and a healthy weight, and melatonin can also potentially help you get that quality sleep.
If you are not sleeping well, that can make you more susceptible to stress, and vice-versa.
This stress makes it harder to stick to a new diet, or feel motivated to exercise .6
If you are sleep-deprived, you are also more likely to make impulsive food decisions. When you are tired during the day, you are more likely to want the instant energy boost of carbohydrates or the feel-better boost of sugar.7
We also know that restricted amounts of sleep , leads to people being more likely to develop obesity.
Regularly getting less sleep than you need is associated with increased levels of ghrelin, salt retention and inflammatory markers.
Ghrelin is the hunger hormone that increases your appetite. Less sleep can also lead to decreased levels of leptin and insulin sensitivity.8
Finally, studies have also shown that when you are sleep deprived, your eCB levels may increase and be amplified.9
Endocannabinoid, or eCB, is a neurotransmitter which is associated with making you crave foods that are really palatable. That could be junk food for instance, or carb-heavy foods.
Of course, sleep deficiencies are just one of many factors that can contribute to weight gain or difficulties losing weight.
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The Body Reacts Differently To Different Ways Of Glucose Intake
Esben Lauritzen investigated the incretin effect, which means that consuming glucose orally elicits a stronger insulin response than intravenous infusion of glucose.
Simplified, drinking a glass of water with glucose initiates a full insulin response, but infusing it directly into the bloodstream causes the pancreas to produce about 50% less insulin.
This difference in insulin production is explained by the two gut hormones, glucagon-like-peptide 1 and glucose-dependent insulinotropic peptide , which are produced after oral intake of glucose and elicit the stronger insulin response following oral glucose intake.
Previous studies have also indicated that if you drink glucose dissolved in water and take melatonin at the same time, the bodys glucose uptake will also be worse. We therefore hypothesised that melatonin negatively affects the insulin secretion by lowering the levels of the two gut hormones, says Esben Lauritzen.
Fifteen healthy young men took large doses of melatonin
The researchers initially asked 15 healthy young men to drink 75 grams of glucose dissolved in 150 millilitres of water and measured the blood concentrations of GLP-1 and GIP.
The researchers gave the participants 10 mg of melatonin every hour for 4 hours to specifically study what happens to gut hormone levels while simultaneously consuming the glucose solution. The researchers also examined how the melatonin affected the participants insulin secretion from the pancreas.
Melatonin As A Regulator Of Metabolism And Body Weight
Within recent decades, a large number of animal studies using both pinealectomized rats and melatonin receptor knock out mice have begun to establish a rather unexpected role for melatonin in the regulation of glucose metabolism and energy balance. Early pinealectomy studies demonstrated that abolishing melatonin levels produces glucose intolerance and insulin resistance . Interestingly, reintroducing exogenous melatonin into this system restored metabolic parameters to levels observed within control animals. Similarly, in mice fed a high fat diet , exogenous melatonin administration was sufficient to restore diminished insulin sensitivity and glucose tolerance . Consequently, another study demonstrated that daily melatonin administration was sufficient to decrease the bodyweight gain of HFD fed rats by 54% compared to HFD rats not treated with melatonin .
Figure 1. Removal of MT1 alters the metabolic response of C3H mice to DIO. Male mice were fed ad libitum with a HFD from weaning at 4 weeks of age until 20 weeks of age. MT1 KO mice showed a small, but significant cumulative weight gain with respect to control . Fasting glucose levels were significantly higher in MT1 KO mice after 10 weeks of HFD. Data are presented as mean ± SEM *p< 0.05, **p< 0.01 WT vs. MT1 KO Two-Way ANOVA .
Previous studies have established a potential role for melatonin in the regulation of body fat by demonstrating that melatonin administration leads to a reduction in body fat content .
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