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The logic is that any acute metabolic effects peak during waking hours rather than during sleep

Ponirakis G, Abdul-Ghani MA, Jayyousi A, Zirie MA, Qazi M, Almuhannadi H, Petropoulos IN, Khan A, Gad H, Migahid O, Megahed A, Al-Mohannadi S, AlMarri F, Al-Khayat F, Mahfoud Z, Al Hamad H, Ramadan M, DeFronzo R, Malik RA (2021) Painful diabetic neuropathy is associated with increased nerve regeneration in patients with type 2 diabetes undergoing intensive glycemic control

Physical trauma caused by repetitive scratching and chronic inflammation can result in epidermal thickening and lichenification

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