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Diabetes Knowledge

How Stress Affects Blood Sugar

6/29/2020 by Miriam Stangs

How Stress Affects Blood Sugar

From adrenaline-soaked excitement to prolonged anxiety, stress can have many faces. Sometimes, it can feel like all those stressors don’t play well with your diabetes monster. We’re here to share how stress impacts your blood glucose and how you can gain control.

Back in our evolutionary history, the original purpose of your stress response was to provide energy reserves for fight-or-flight in an emergency. The urban/media jungle we live in today hardly requires a prehistoric escape, but our body still reacts to our daily stress in the same way it did back then. And constant, heavy, stress causes blood sugar levels to rise. But also acute stress in certain situations that you perceive as stressful can cause spikes in your blood sugar levels.

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Stress Hormones

Stress is the body's method of reacting to threats, challenges, or physical and psychological barriers. The biophysical response is typically triggered by the autonomic nervous system and can create a cascade of hormones that flood the body including: 

  • Adrenaline 
  • Norepinephrine 
  • Cortisone 
  • Dopamine

Because of the autonomic nature of our body’s response, sometimes people can be unaware that they are experiencing a stress response. After all, we release stress hormones when there is a lack of sleep or when we are pressed for time. Being overworked, annoyed, or constantly exposed to excessive noise can even trigger a stress response. Unfortunately, these stress hormones make us more resistant to insulin, and therein lies the rub for people with diabetes.

When stress hormones are involved, most people with diabetes need more insulin to get the sugar into the cells. In addition, more sugar is released from the liver into the blood during stress because our brain needs more fuel to function. It’s pretty clear how those two processes combined can make managing glucose levels hard for people with diabetes. 

Thank goodness for good tech! If you enter stress-related glucose values in the mySugr app, and note any stressful events when they occur, it can help you understand your body's unique reaction so you can track trends and alter therapy proactively!

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Everyday Stress

These days, stress is so common that literally everyone experiences it. An exam, an important meeting, an upcoming doctor's appointment, or lingering anxiety, are all things that we deal with on a regular basis. They are so common that sometimes you can look at a wonky glucose value ​​and think, "What's going on in my body?" You can try relaxation techniques to lessen the physical impact of stress, but sometimes you just need more insulin and that can be tricky with stress-related glucose increases.  

“Before my oral exam, I was over 260 mg / dl. When I had this behind me & I could relax, my blood sugar quickly dropped to 108 mg / dl.” 

Conny, 39, lives with type 1 diabetes                                                               

Again we’ll remind you, stress hormones can cause insulin resistance. So sometimes your standard correction isn’t as effective as you hoped and so you try additional insulin. The risk here, however, is that glucose levels sometimes stabilize themselves as soon as the stress subsides, and then you are left with too much insulin-on-board and fighting a low.

Illness and Stress 

The stress response isn’t isolated to just mental or emotional stressors. Physical illness, inflammation, fever, trauma, and even severe allergic reactions can put stress on the body. This is why it is important to discuss insulin adjustments with your doctor during periods of illness. In fact, most healthcare providers have a sick-day protocol that can include:

  • Regular blood sugar checks every 2 to 4 hours even at night. 
  • In case of a fever without vomiting and diarrhea - adjustment of both bolus (rapid) and basal (long-acting) insulin rates may be necessary. 
  • MDI therapy options can include additional long-acting insulin doses for the duration of illness.
  • An insulin pump wearer might require a temporary basal rate adjustment over a few hours or even days.

And of course, all of this illness and additional management of diabetes can be compounded by the hormones created from...you guessed it...stress! Being aware of how you handle stress during non-sick days can help shape your doctor’s approach to sick-day protocols. So good records can bring better therapy choices! 

Note: In the event of vomiting or diarrhea, it can also be the case that your values​​ will plummet if the carbohydrates “do not stay in”. Then there are the ketones. If you have type 1 diabetes, measuring ketones in the urine or blood is critical to rule out ketoacidosis. 

The Stress-Sleep Connection

Do your thoughts and worries wake up regularly at night? Do you struggle with insomnia? Even just one night with a lack of sleep can lead to a reduction of insulin sensitivity. This can also result in an increased feeling of hunger.

How much sleep each person ultimately needs is individual.  But a constant lack of sleep can trigger elevated adrenaline levels during the day due to your body needing additional energy to function through fatigue. You should aim for at least 6 hours a night if you can and keep a closer watch on your glucose values during periods of insomnia.

Stress and Exercise

Remembering that stress is also a reaction to physical challenges to the body, it’s not a big leap to understand how exercise can trigger a stress reaction. Even the fun, ballistic-style, exercises like intensive cross-training sports can lead to an "adrenaline rush". But gentler activities like yoga, spinning, or swimming, can lead to smaller spikes in hormones.

With almost any exercise efforts, the body often switches to stress mode. This can cause blood sugar to rise in the short term - whereas endurance sports, provided that your body has already adapted to them, do not create stress and can usually lower the sugar significantly. Tracking your exercise regularly can help you target your trends and proactively adjust your therapies for them.

Stress Eating

We mentioned that our brain needs more fuel to function during periods of stress. In fact, the brain typically needs about 130g / day of sugar, but in case of stress, the need can increase up to 180 g per day. 

The brain sends signals for more fuel and typically our liver plays the regulatory role to manage more glucose to be released. However, in most of us, we also find ourselves grazing and snacking more often which can lead to elevated blood glucose levels and the need for additional corrections.

Don’t Let Stress Rule You

It can often feel like managing your diabetes can feel like walking a tightrope. And adding in stress management can feel daunting. But we are here to reassure you, you can do it! As always, keep calm and regularly check your blood sugar and watch the trends in your CGM.  If you take insulin, let it run its course when you make small corrections and, avoid the angry bolus. Keep good records, use your mySugr App to track your stressors, and let your coach or doctor guide you on good therapy choices.

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Miriam Stangs

Miriam is a diabetes consultant DDG (German Diabetes Association) and a qualified diet and nutrition consultant VFED (Association for Nutrition and Dietetics). She works as a diabetes coach at mySugr and takes care of children with diabetes mellitus type 1 in a pediatric clinic on a part-time basis.
She found her vocation while studying ecotrophology with focus on nutrition at the HAW - University of Applied Sciences in the beautiful city of Hamburg. She discovered diabetes mellitus in a practice for diabetology and has been advising people with all types of diabetes ever since.
Miriam's home is the Bergische Land in Germany. In her free time, she goes on hikes and searches for forest and meadow monsters with her dog.