BY NOEL LOPEZ M.D. and DIANA F. RAMIREZ
Many of my patients are surprised when I prescribe better sleep to treat diabetes. It is an uncommon request that will not often be found on a prescription pad; but as I further delve into the complexities of sleep disorders I find the benefits of treatment are numerous.
This is especially true, in treating problems like risk of heart attack and stroke, hypertension and diabetes; problems that are common in our community. This short article will focus on the treatment of diabetes in those who also suffer from Obstructive Sleep Apnea (OSA).
Total treatment of diabetes includes more than the traditional use of finger pricks and insulin injections. We have found that about half of those who suffer from Type 2 diabetes suffer from obstructive sleep apnea, independent of obesity, as was previously unknown. This statistic is even more alarming when we note that 30 percent of the population in the Rio Grande Valley suffers from diabetes an average two to three times higher than that found in the rest of the United States. Research shows that the existence of sleep apnea in diabetics creates insulin resistance and increased fasting glucose without regard to whether the patient also suffers from obesity. That is, if you suffer from sleep apnea, and it remains untreated the insulin that is vital to your quality of life, may not be working to its full potential. Further, the more severe the sleep apnea, the greater the degree of increased resistance to insulin and fasting glucose we find in your body. This validates the idea that a correlation exists between diabetes and sleep apnea. This correlation requires that treatment for diabetes be done in combination with treatment for sleep apnea so as to achieve the best results.
As a physician specializing in sleep and family medicine, I have found that the best course of treatment for chronic ailments like diabetes are multi-faceted. Treatment of diabetes with insulin is powerful and effective, but a well rounded treatment should include improvement of quality of sleep for those also suffering from sleep apnea. This is where positive airway pressure or PAP, as it is commonly known, excels. The treatment of airway blockages that are common in those who suffer from sleep apnea is a non-pharmacological treatment, that when used in combination with medications prescribed by your family doctor, can produce increasingly positive results. That is, use of PAP can make patients more sensitive to insulin and in turn eventually reduce the amount required for successful treatment.
Moreover, when OSA is successfully treated the risk of complications traditionally associated with diabetes is reduced. As such, my recommendation for treatment of Type 2 diabetics mirrors that of the International Diabetes Federation (IDF), OSA should be a consideration in the assessment of patients with insulin insensitivity. It is true, after all, that the achievement of the beauty sleep we have all been chasing could be a tool used more often in the full treatmentof diabetes.
The Rio Grande Valley Diabetes Association (RGVDA) is a local non-profit organization whose mission is dedicated to the prevention of diabetes and its complication through educational services, early detection and awareness. The RGVDA’s focus is to bring attention on a growing health epidemic that affects one out of every four people in Hidalgo County, making it one of the worst afflicted areas in the country. Type 2 diabetes is preventable and also manageable through a healthy regimen of exercise and dieting.
The RGVDA provides monthly articles and recipes to The Monitor to help educate the public about the prevention and control of diabetes.
Noel Lopez is part of the Palm Valley Sleep Lab and Diana F. Ramirez is the president of the Rio Grande Diabetes Association.
The RGVDA offers free monthly cooking classes on the second Tuesday of the month in Edinburg and on the fourth Tuesday in Weslaco. For more information call your RGVDA office at (956) 782-1900.
TOTAL TIME: 40 minutes
PREP: 20 minutes
>> 1 tbsp. extra-virgin olive oil
>> 1 large onion, chopped
>> kosher salt
>> 2 cloves garlic, minced
>> 2 teaspoon ground cumin
>> 2 teaspoon chili powder
>> 3 cups shredded chicken
>> 1 1/3 cups red enchilada sauce, divided
>> 4 large zucchini, halved lengthwise
>> 1 cup Shredded Monterey Jack
>> 1 cup shredded Cheddar
>> Sour cream, for drizzling
>> Fresh cilantro leaves, for garnish
Preheat oven to 350 degrees. In large skillet over medium heat, heat oil. Add onion and season with salt. Cook until soft, 5 minutes, then add garlic, cumin, and chili powder and stir until combined. Add shredded chicken and 1 cup enchilada sauce and stir until saucy.
On a cutting board, use a Y-shaped vegetable peeler to make thin slices of zucchini. Lay out three, slightly overlapping, and place a spoonful of chicken mixture on top. Roll up and transfer to a baking dish. Repeat with remaining zucchini and chicken mixture.
Spoon remaining 1/3 cup enchilada sauce over zucchini enchiladas and sprinkle with cheeses.
Bake until melty, 20 minutes.
Garnish with sour cream and cilantro and serve.