In the summer of 2008, I was about to participate in my very first triathlon. I had trained in the pool all winter and the bike all spring. I was ready to kick butt and take names in this race. Except, I got a little too pumped up.
Twenty minutes before the race, my blood sugar was 142mg/dL. After I came out of the water and before hopping on the bike, I checked my blood sugar. 356mg/dL?! What happened?! Whether it was my uplifting pregame ritual or getting punched and kicked in the face during the open water swim, I had just learned the hard way was that stress causes blood sugar to rise. Over the following years, I would learn, in life and the classroom, how often stressors can affect blood sugar. It's not just pre-race jitters that can induce such a response. Public speaking or even the joyful-but-mentally-demanding events of a family holiday can wreak havoc on glucose numbers.
Types of stress
Stress usually results in a higher demand for insulin. There are a few physiologic pathways that can cause this, but for the sake of simplicity we will break it down into two categories: Acute and chronic. (Look out for the super-geeky scientific explanations coming soon to activediabetes.com)
Sometimes labeled as "healthy" stress, acute stress is caused by a sudden, passing event. Think of that feeling leading up to your first public speaking experience or the jitters you felt just after you narrowly missed a car accident; that is acute stress.
The body releases a dose of cortisol and epinephrine, which leads to a whole cascade of events that gets your body in "fight or flight" mode. As a step in that process, cortisol signals the liver to release its glycogen (glucose) stores into the bloodstream. This event is an entirely natural and healthy response to a stressful event. It gives the body the fuel it needs to confront the situation. However, with diabetes, you have to supply exogenous the insulin to counteract the glycogen release. Any event that you are agonizing or dreading over for days or hours can have a similar effect.
For example, you may see higher blood sugars during that two hour drive to the family holiday while meeting your girlfriend's parents for the first time, or even the flu. These longer-term stressful events can cause temporary insulin resistance, meaning that half of cup of mash-potatoes might require much more insulin than usual. But, be conservative in these situations because almost as soon as the stressful event or situation is over, so is the insulin resistance.
Chronic stress is a whole different beast. Typical examples of chronic stress include sleep deprivation, a non-stop stressful job demands, and poor living conditions. But some that you may not have thought about include dehydration, over-training, and malnourishment. This form of stress can also cause insulin resistance. More insulin will take care of your blood sugars, but the underlying stressor needs to be addressed to achieve successful long-term glucose control.
Most stressful events lead to an increased demand for insulin, but the amount and timing of treatment can be dramatically different depending on the situation. To safely manage diabetes during stressful events, first follow the following steps:
- Identify stressful events that affect your blood sugar
- Track blood sugars and insulin during and after these events
- Work with a diabetes coach or physician to discuss how to anticipate and create a plan
- Consult with a diabetes or sports psychologist to discover ways to manage stress better
Armed with some knowledge and a plan of attack, stress can be much more manageable. And it's especially important to keep an eye on your stress levels around the holidays! Even in times of joy and cheer, stress can creep up on you and make blood sugar management much trickier than it has to be. Good luck!