stress and diabetes: how passive and chronic stress impact blood sugar
5 minute read
while any stress can be a challenge, chronic stress is where it can cause complications, so it’s important for people living with diabetes to find ways of reducing stress that work for them.
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the body’s stress response is designed to help keep you safe, evolutionarily speaking. in today’s modern world, though, much of the stress people experience isn’t saving them from being attacked by a wild animal in the cave they call home, or from outrunning something. it’s being late for work, failing a test at school or getting in a heated argument with the person you love most, to name a few examples.
some modern stress can be chronic, lasting for days, weeks or even months on end. that’s where the body gets into trouble. if you have diabetes, that troublesome stress can be detrimental to your disease management.
“stress causes a variety of physiological reactions with the endgame often being higher sugars,” said dr. jeremy gilbert, an endocrinologist based in toronto, ont. “when you’re under a lot of stress, your body needs energy to deal with that stress, and so you’re making more sugar to feed the brain and the muscles and the parts of the body that need to handle that stress.”
but how does stress actually cause higher blood sugar?
stress hormones and blood sugar
during bouts of stress, your body starts releasing various hormones to help you cope. cortisol, a hormone produced by the adrenal gland, is one that plays a role. adrenaline is another.
“when a person’s stressed … they may have more adrenaline running through their body,” said dr. gilbert. “you can imagine if robbers are chasing you down the block, you’d be like freaking out and your adrenaline levels would be through the roof. well, you need a lot of sugar in your body to get your muscles moving so you can run away.”
but the body doesn’t just call on glucose that you’ve consumed to help get you out of a stressful situation. in fact, you may not have eaten anything at all and can still see your blood sugar rise during stress because your liver and kidneys actually create new sugars to deal with the events at hand, whether they are psychological or physical stressors. they do this because rises in both adrenaline and cortisol drive that response.
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“the liver is responsible for two-thirds of the sugar that is made in our body, and the kidney is responsible for the other third, and we do store sugar in our liver in the form of a product called glycogen,” said dr. gilbert. “what happens is the reason why people don’t die when they fast for 24 hours is that their glycogen stores get broken down and the body can use that energy source, even though they’re not eating.”
the liver and kidneys producing sugar are another reason why someone’s glucose levels may be high initially, as is the case with diabetes, because the sugar making is not matched by the sugar processing of insulin, the hormone that keeps blood sugar levels balanced.
“in one sense, they’re [people without diabetes] are making sugar, on another sense, the body is lowering sugar to always keep things in balance,” said dr. gilbert. “if your pancreas doesn’t work right [to create enough insulin], then you’re not going to make the right amount of insulin.”
so, in people with diabetes, their bodies are already making sugar that cannot be processed adequately, which is then elevated by the foods they eat even further, and when stress enters the picture, the hormones released make the entire situation that much worse.
passing stress versus chronic stress
being stressed out now and again is unavoidable, and while it can raise blood sugars because of the hormones that get released, it’s not necessarily going to be a severely detrimental effect on people living with diabetes. the stress hormones will decrease once the event is over.
however, when stress gets built up over time, those hormones begin to accumulate, and that’s when it can do a real number on your health.
“if somebody already doesn’t process sugars properly due to diabetes, then when they get in that stress state on top of the whole thing, their sugars can often be quite hard and high and more challenging to manage,” said dr. gilbert.
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living with diabetes in and of itself is stressful, too, says dr. gilbert, which makes managing blood sugars under chronic stress that much more difficult.
“are they going to take a little bit of insulin to bring that [stressful situation] down? are they not going to do that because they expect the traffic to get better in two minutes and then everything’s going to steel again?” he said.
many people living with diabetes aren’t aware of what stress can do to their bodies, too.
“i hear that a lot of the time from people that are in my practice. they’ll say, ‘you know what, i ate the same thing every day. i exercise the same way every day, but one day my sugar’s five and one day it’s 13. i don’t understand. i did everything the same.’ so, i said, ‘well, was one day more stressful than the other?” said dr. gilbert, noting that typically, for patients, the higher sugar level day was more stressful.
“i think just pointing out the elephant in the room [can help] that, yes, stress impacts sugars, and that could explain why the numbers are off, even though you had a perfect diet and perfect exercise and perfect taking of your medication; that can happen,” he said.
while any stress can be a challenge, chronic stress is where it can cause complications, so it’s important for people living with diabetes to find ways of reducing stress that work for them. that can be anything from getting more exercise to burn off stress, doing meditation and finding a support system, said dr. gilbert.
but most importantly, people with diabetes need to understand that stress is unavoidable, and while it does raise blood sugar, it’s out of their hands even if they’re doing everything right.
“it’s not their fault. we see a lot of guilt and blame in diabetes. if only i ate better and if only i did this better. it’s not about that. it’s a chronic condition, and there will be some days that are better than other days, and stress sometimes can be avoided, and sometimes it can’t be avoided,” he said. “but what you want to do is acknowledge that it can affect the sugars and have your own personal strategy on how to kind of address it best.”
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