Stress and Blood Sugar: Managing Diabetes in the UK's Modern Lifestyle (2024)

The pace of life in the 21st century is at odds with human physiology in many ways. Instead of having periods of rest and activity, people are now subject to prolonged intervals of mental alertness and physical stress.

This state of being constantly “wired” hijacks the body’s natural fight-or-flight response, causing stress hormones to be released in abundance, which leads to symptoms of chronic stress.

Diabetes requires tight control over blood sugar levels, so the aforementioned hormonal imbalances can create issues that affect diabetes management. Problems with blood pressure control and sleep quality that result from unchecked stress levels can also be detrimental to proper diabetes care.

Here’s how stress changes the body, its effect on people with diabetes, and how to handle it in daily life.

Stressful situations can arise every now and then, which might require our bodies to react in a timely manner, causing some natural physiological changes to occur.

The changes are often due to an electrical and chemical cascade that helps blood glucose levels rise, causes the respiratory rate to increase, blood vessels to constrict, and muscle cells to take up glucose from the bloodstream to fuel themselves.

These changes are the result of an evolutionary reaction to physical threats that require a “fight-or-flight” response; hence the name.

That said, very few sources of physical danger exist in our modern world. Meanwhile, mental stressors run rampant, so instead of fearing being chased by a large animal, triggers of the fight-or-flight response can be psychological.

You might be stressed about a big work presentation, a social situation where you feel trapped or uncomfortable, or angry about being treated unfairly by someone you know, and then start to feel these physiological effects.

The higher the frequency of these situations, the more likely you are to experience chronic stress.

The body has a natural rhythm that controls the release of certain hormones throughout the day. When a person wakes up, their body is recovering from a state of rest, which requires an extra push to start normal functioning.

The hormone responsible for this task is called cortisol, a glucocorticoid produced by the external layer of the adrenal gland. Its antagonist, released at night, is melatonin, which is also called “the sleep hormone” because it helps the body unwind after a long day.

Cortisol performs the following functions:

• Signals the liver to change stored starch (glycogen) into glucose and release it into the bloodstream

• Constricts blood vessels, raising blood pressure

• Suppresses the immune system to reduce inflammatory reactions

• Prepares the body for activity during the day by antagonising the action of melatonin, a hormone released when it’s ready to sleep.

Another hormone released by the adrenal gland is adrenaline (epinephrine). Unlike cortisol, which is released according to the body’s circadian (daily) rhythm, adrenaline is a stress hormone designated specifically for situations requiring a metabolism boost.

The effect of adrenaline on the body is an increase in:

• Breathing rate

• Heart rate

• Blood pressure

• Blood glucose levels

• Pupil size

• Sweating

These physiological enhancements aim to improve the body’s response to external dangers. However, chronic stress co-opts these functions, making them a liability in everyday life.

The continuously elevated levels of these hormones put the body in a constant state of exhaustion due to the rise in breathing and heart rates. Blood pressure also rises, creating excess stress on internal organs.

The overproduction of these hormones, especially cortisol, can also cause chronic inflammation.

Since cortisol suppresses the immune system, excessive amounts of it can lead to a weakened immune response. When someone is experiencing constant levels of chronic stress, the adverse effect on their immune system can manifest in several ways, one of which is systemic low-grade chronic inflammation.

This type of inflammation is characterised by the persistent accumulation of metabolic products in the blood, called cytokines, chemokines, growth factors, adipokines, and neuropeptides. These molecules affect the body’s organs, creating “targets” for white blood cells to attack.

In some cases, the body starts attacking the pancreatic beta cells responsible for producing insulin, which can trigger lower insulin production. Additionally, chronic inflammation can cause the body’s cells to develop resistance to circulating insulin, which can affect glucose metabolism, leading to type 2 diabetes .

The way chronic stress affects sleep is a vicious cycle. Since melatonin, the sleep hormone, is affected by the amount of cortisol in the blood, high levels of cortisol in the blood prevent its timely release.

The delay and reduction in melatonin release cause later bedtimes, fragmented sleep, and waking up feeling tired. This, in turn, causes higher levels of cortisol in the blood, which completes the cycle and leads to even worse sleep quality.

An animal study published in Elsevier Food and Toxicology Journal found that the administration of extrinsic melatonin in rats could reverse brain damage caused by chronic stress. It also saw improvement in depression-like behaviours the rats exhibited due to the damage.

Chronic psychological stress is a proven culprit of obesity because it affects food-related behaviours. Emotional eating and preference for high-sugar, high-fat foods due to their pleasurable psychological effects and activation of the reward system in the brain are proposed explanations for the link.

Stress has also been linked to a specific form of weight gain, where the body deposits fat around internal organs in the abdomen.

Belly fat, also referred to as visceral adipose tissue , has a detrimental effect on health. It was shown to increase the chances of developing a metabolic disease, like hypertension, type 2 diabetes, or hypercholesterolemia.

Stress hormones aren’t the only cause for the rise in metabolic activity seen in chronic stress. The sympathetic nervous system is one of the main controllers of functions that don’t require voluntary action. These actions include breathing and heart rate, blood pressure, and the amount of blood each internal organ receives.

The sympathetic nervous system can become overstimulated due to chronic stress. This has been shown to cause several health problems, like:

• Kidney disease

• Hypertension

• Type 2 diabetes

• Obesity

• Metabolic syndrome

• Sleep apnoea (obstruction of the airway in one’s sleep)

• Ulcerative colitis

• Preeclampsia (a serious condition affecting pregnant people)

Having diabetes requires careful control over blood glucose levels to prevent any possibility of hyperglycaemia or hypoglycaemia (hypos). When external forces arise, such as physical or mental stress, it becomes crucial to know how to spot their effects and handle them.

Stress affects people with type 1 and type 2 diabetes differently, so here are some of its possible outcomes:

People with type 1 diabetes rely on extrinsic insulin injections to control their condition. This entails measuring a number of insulin units and administering them throughout the day to keep the condition in check.

Stress for type 1 diabetes causes fluctuations in blood glucose levels, where your body might be experiencing a hypo, and then a surge of adrenaline and cortisol causes your blood glucose levels to spike.

This is called the Somogyi or rebound effect, and it can last for 6–8 hours after the initial hypo. Controlling this phenomenon using insulin is tricky since the amount of injected insulin can be too much or too little, depending on how long the effect lasts.

It’s advisable for people with type 1 diabetes to avoid sources of physical and emotional stress whenever possible. Using a closed-loop continuous glucose monitor and insulin pump system can also be beneficial in such cases.

Studies have shown that for people with type 2 diabetes, chronic stress tends to always result in hyperglycaemia . This is a culmination of the aforementioned effects on low-level chronic inflammation, weight gain, and increased blood pressure.

Scientific consensus hasn’t yet been established when it comes to the best course of action for treating people with type 2 diabetes. That said, managing any existing mental health issues, like underlying depression or anxiety, has been helpful in reducing chronic hyperglycaemia in people with type 2 diabetes.

The short answer is yes. Stress has a direct effect on neurological and hormonal pathways that can alter the body’s metabolism.

Aside from the overstimulation of the central nervous system’s sympathetic branch, the excessive release of stress hormones causes a cascade of symptoms .

It starts with higher levels of cortisol and adrenaline signalling the liver to release more glucose. The sustained hyperglycaemia causes systemic low-grade chronic inflammation, leading to pancreatic damage and insulin resistance. Finally, the body’s inability to process blood glucose for a prolonged period leads to type 2 diabetes.

Stress reduction is a sound strategy if you want to avoid its adverse effects on your health and well-being when you have diabetes.

Even though most of us can’t control major sources of stress, such as jobs, social relationships, and unforeseeable events, it’s still possible to avoid micro-stressors that end up causing damage.

Here are a few ways you can reduce stress in your daily activities:

• Set an early alarm if you can, so instead of scrambling to get ready in the morning, you have a relaxing routine before you head out to work.

• Practise mindfulness by meditating for at least 10–15 minutes every day. This can help ease your mind and make your inner monologue more peaceful.

• Work with a mental health counsellor or therapist to address any anxiety, depression, or anger issues you might be having.

• Create a calming bedtime ritual to help you fall asleep easier. This can include:

  • Avoiding caffeine for a few hours before bed so you’re not alert at bedtime.

  • Removing any electronics from your sleeping area, and turning on the “Do Not Disturb” mode on your phone so no notifications disrupt your sleep.

  • Setting the room’s temperature a little lower than usual (18–20 degrees C) to help you fall asleep faster.

• Learn to accept that life might throw unexpected events and stressful situations at you, but controlling your reactions and being at peace with your choices is how you maintain a healthy body and mind.

The link between stress and blood sugar management clearly shows that a proper understanding of psychological factors is the key to maintaining a healthy body.

For people with diabetes, staying away from sources of stress to keep blood sugar levels under control can be difficult. However, handling underlying sources of anxiety, depression, or other mental health issues should improve one’s diabetes management.