ENT.9 Sleep Deprivation and Diabetes Through Insulin Resistance
- Ethan Jones
- May 21
- 7 min read
Do we as a society promote the lifestyle that is fueling one of our greatest chronic health epidemics? Is there an association between our cultural lifestyle of hard work ethic, long nights, and early mornings, and the rising epidemic of Diabetes in our country? The simple answer is yes.
Earlier this year, I read Matthew Walker's book “Why We Sleep” taking an in-depth dive into the reality of sleep and how it affects our daily lives. Sleep is a part of all of our lives, yet its importance is often downplayed outside of increasing one's feeling of energy during the morning or throughout the duration of their day. This said, modern research, such as Mathew Walker's work, on sleep has demonstrated how sleep has a much greater effect on us than we imagined. One of these findings was a relationship between sleep, and lack thereof, with one of the greatest health detriments in our modern world today. There are an estimated 40 million people with either diagnosed or undiagnosed diabetes living within the United States alone, accounting for nearly 12.5% of the population, with an additional 115 million living with prediabetes (CDC, 2024). This statistic makes diabetes the third most prevalent chronic health condition in the United States, trailing only behind obesity and hypertension, which are often comorbidities of each other (Telesford et al., 2025). Additionally, it is estimated that out of the 40 million people living with diabetes in the United States, only 2.1 million are categorized as type 1 diabetes (CDC, 2024). This means that the large majority of individuals struggling with diabetes, roughly 95%, are struggling with type 2 diabetes markedly defined by one's body's development of resistance to insulin.
Insulin Resistance, Diabetes, and Sleep
Insulin functions within the body as a signaling molecule for the absorption of glucose, a sugar, within the blood to be absorbed into the cells of your body. This is essential for the functioning of the body, as glucose is broken down and used within the cell as fuel to generate energy for every cell within our bodies to function. Insulin binds to a protein within the cell wall, initiating the opening of a channel allowing glucose to be absorbed from the blood into the cell. Insulin resistance occurs when those proteins that insulin usually binds to become less reactive or less willing to bind to insulin, and therefore, those glucose channels do not open as effectively. This leads to a buildup of excess glucose within the blood, which is characteristic of diabetes as a whole. Type 1 diabetes is distinguished, differently, by a lack in the production of insulin itself from the pancreas, not so much the reduction in insulin sensitivity at a cellular level. For the majority of cases, Type 1 diabetes can not be developed through lifestyle but is rather regarded as an autoimmune disorder in which your body destroys the cells that produce insulin. With that understanding of diabetes, and type 2 diabetes in particular, it is easy to ask. How does sleep deprivation have any effect here?
Sleep duration, as well as other factors such as sleep quality, have been found to have a causational effect on insulin resistance and, furthermore, both type 2 diabetes and obesity (Liu et al., 2025; Antza et al., 2022). Individuals receiving an average of 5-6 hours of sleep per night are statistically twice as likely to develop type 2 diabetes when compared to individuals sleeping a normal 7-8 hours per night (Antza et al., 2022). Many potential pathways lead to this association, and, like most of the time within science, it is not simply a single answer but rather a complicated web of pathways leading to this association. Some of these pathways that we know of include increased ghrelin:leptin ratio leading to increased appetite, impaired beta-cell function, reduced GLP-1 stimulus, sympathetic nervous system predominance, increased free fatty acids, increased inflammation, and decreased activity (Antza et al., 2022). It is worth noting that the result of sleep deprivation on insulin resistance and type 2 diabetes risk is also variable based on factors such as age, gender, or race (Liu et al., 2025).
Ghrelin:Leptin Ratio and Appetite
The hormone ghrelin is often associated with appetite as the “hunger hormone,” as it is one of the driving hormones for the desire to eat or the sensation of hunger. On the other hand, the hormone leptin is related to the feelings of satiety or feeling full usually after eating a meal and causes a reduction in appetite. Sleep deprivation has been found to increase levels of the hormone ghrelin by 14%, with an additional 7% decrease in leptin, increasing your hunger hormone and decreasing your sensation of satiety (Antza et al., 2022; Van Egmond et al., 2022). This increase in appetite has been shown to lead to an increase in daily caloric intake, particularly an increase in carbohydrate consumption, leading to increased glycemic index and overall blood glucose (Antza et al., 2022). Chronically elevated blood glucose levels lead to constantly elevated insulin release and are a leading risk factor for insulin resistance (CDC, 2024b).
Impaired Beta-Cell Function, Reduced GLP-1, Sympathetic Predominance
Insulin is produced in the pancreas in response to levels of glucose within the blood, as well as GLP-1, a hormone, which is released in response to digestion. Beta-Cells are the specific cells within the pancreas that produce insulin. Sleep deprivation has been associated with a reduction in GLP-1 released from the digestive tract in response to food, leading to a reduction in the stimulation of beta-cell and release of insulin in response to food (Antza et al., 2022). A reduction in the proportional release of insulin in response to digestion can lead to a lack of proper glycemic control or proportional glucose absorption from the blood. Additionally, this reduction in sleep is associated with an increase in the predominance of the sympathetic, fight or flight, nervous system. An increase in sympathetic predominance can lead to a reduction in beta-cell response to glucose as well as a reduction in insulin sensitivity overall (Antza et al., 2022).
Increased Free Fatty Acids, Increased Inflammation, and Reduced Activity
Sleep deprivation has additionally been shown to increase circulating free fatty acids through the increase in catecholamines such as norepinephrine as a part of an increased sympathetic nervous system response, as mentioned earlier (Antza et al., 2022; Broussard et al., 2015). Increased free fatty acids are associated with insulin resistance and can be associated with increased inflammation within the body (Antza et al., 2022; Volpe & Nogueira-Machado, 2013). Additionally, Sleep reduction itself is associated with increased inflammation, increasing inflammatory cytokines, signalling proteins, and having a negative effect on insulin resistance as well (Antza et al., 2022). In addition to these, sleep deprivation is linked with a decrease in athletic performance and generally overall reduced activity (T & Mw, 1989; Charest & Grandner, 2020), and reduced activity is associated with poor blood glucose control (Colberg et al., 2016). Exercise, and activity in general, helps stimulate glucose absorption into the cell from the blood through a similar pathway as insulin and is therefore beneficial for lowering and maintaining a healthy blood glucose. Inactivity can therefore also be a factor leading to chronically elevated blood glucose and eventual insulin resistance.
Conclusion
Overall, this is a complicated relationship, but a “preventable contribution,” as Mathew Walker states in response to the fact that chronic sleep deprivation has become a recognised contributor to the escalation of type 2 diabetes. Per the CDC, it is estimated that over 30% of adults in the United States get less than 7 hours of sleep a night (Ng, 2026). The prevalence of chronic sleep deprivation could be one of the causal factors contributing to the 40 million individuals in the United States with diagnosed or undiagnosed diabetes and the 115 million living with prediabetes (CDC, 2024). The causal relationship between sleep deprivation and insulin resistance is the leading factor in the relationship between sleep deprivation and the increased risk of developing type 2 diabetes. It is hard to summarize the implications of this research other than to highlight the fact that sleep duration is a preventable contributor to insulin resistance. Therefore, it is a variable that we can affect, a variable that we can change, and something within our control to try and mitigate one of the largest chronic health epidemics of our time. All of this said, I am still left with this question. Is this something our society promotes, or do we encourage the lifestyle of chronic sleep deprivation, a hard work ethic, long nights, and early mornings, promoting the lifestyle that is fueling one of our greatest chronic health conditions?
References
Antza, C., Kostopoulos, G., Mostafa, S., Nirantharakumar, K., & Tahrani, A. (2022). The links between sleep duration, obesity and type 2 diabetes mellitus. Journal of Endocrinology, 252(2), 125–141. https://doi.org/10.1530/joe-21-0155
Broussard, J. L., Chapotot, F., Abraham, V., Day, A., Delebecque, F., Whitmore, H. R., & Tasali, E. (2015). Sleep restriction increases free fatty acids in healthy men. Diabetologia, 58(4), 791–798. https://doi.org/10.1007/s00125-015-3500-4
CDC. (2024a, May 13). National Diabetes Statistics Report. Diabetes. https://www.cdc.gov/diabetes/php/data-research/?
CDC. (2024b, May 15). About Insulin Resistance and Type 2 Diabetes. Diabetes.
Charest, J., & Grandner, M. A. (2020). Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health. Sleep Medicine Clinics, 15(1), 41–57. https://doi.org/10.1016/j.jsmc.2019.11.005
Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., Horton, E. S., Castorino, K., & Tate, D. F. (2016). Physical activity/exercise and diabetes: a Position Statement of the American Diabetes Association. Diabetes Care, 39(11), 2065–2079. https://doi.org/10.2337/dc16-1728
Liu, H., Zhu, H., Lu, Q., Ye, W., Huang, T., Li, Y., Li, B., Wu, Y., Wang, P., Chen, T., Xu, J., & Ji, L. (2025). Sleep features and the risk of type 2 diabetes mellitus: a systematic review and meta-analysis. Annals of Medicine, 57(1). https://doi.org/10.1080/07853890.2024.2447422
Ng, A. (2026). Short Sleep Duration and Sleep Difficulties Among Adults: United States, 2024. https://doi.org/10.15620/cdc/252438
T, V., & Mw, R. (1989, April 1). Sleep Deprivation and the Effect on Exercise Performance. Sports Medicine (Auckland, N.Z.). https://pubmed.ncbi.nlm.nih.gov/2657963/
Telesford, I., McGough, M., Tevis, D., & Cotter, L. (2025). How has the burden of chronic diseases in the U.S. and peer nations changed over time? - peterson-kff health system tracker. Peterson-KFF Health System Tracker. https://www.healthsystemtracker.org/chart-collection/how-has-the-burden-of-chronic-diseases-in-the-u-s-and-peer-nations-changed-overtime/#Agestandardized%20share%20of%20the%20U.S.%20experiencing%20chronic%20diseases
Van Egmond, L. T., Meth, E. M. S., Engström, J., Ilemosoglou, M., Keller, J. A., Vogel, H., & Benedict, C. (2022). Effects of acute sleep loss on leptin, ghrelin, and adiponectin in adults with healthy weight and obesity: A laboratory study. Obesity, 31(3). https://doi.org/10.1002/oby.23616
Volpe, C., & Nogueira-Machado, J. (2013). The Dual Role of Free Fatty Acid Signaling in Inflammation and Therapeutics. Recent Patents on Endocrine, Metabolic & Immune Drug Discovery, 7(3), 189–197. https://doi.org/10.2174/18715303113139990041
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