What is Stress and Why does Stress Affect Diabetes?

It is the nature of our fast paced society to be overwhelmed by numerous family responsibilities and career obligations which can cause stress and anxiety. Although such emotional and physical stress is considered normal, it can take a great toll on the health of a diabetic person who needs to maintain normal blood sugars. According to a Dr Hans Selye who published ‘The Stress of Life’ in 1956 the effects of stress vary depending on the intensity. In the book, Dr Selye recognizes that the right amount of stress which he calls ‘optimal stress’ increases focus and maximizes performance. On the other hand he attributes too much stress to unhappiness and anxiety.

Dr Selyes stress model is that at its ‘optimum level’ stress is beneficial but beyond that the body resists and ultimately wears out. However, this theory fails to take into account the fact that different individuals respond differently to stress. While some can thrive and perform optimally under stress, others crash immediately they get stressed. Since stress is subjective and individual responses differ greatly, it is quite a complex concept to study. In diabetic people, stress has a significant impact on blood glucose level as well as on the blood pressure. This article attempts to thoroughly detail how stress impacts diabetic patients negatively by causing hyperglycemia (excess blood glucose levels in the bloodstream). At the end of this article you will be able to answer important questions such as, does stress raise blood sugar? What are the effects of stress induced diabetes? You will also get information on effective stress management techniques that diabetics can employ to reduce stress.

What is stress and why does stress affect Diabetes?

Stress is the humans’ body physical response to any demand or potential threat. When the stressed the human body goes into a ‘flight or fight’ mode and as a result releases chemicals and hormones such as cortisol, adrenaline and epinephrine which primarily prepare the body for physical action. Stress induced diabetes is as a result of the production of these stress hormones. Hormones like epinephrine and cortisol boost blood sugar levels to help boost energy levels in readiness for ‘fight or flight’. Non diabetic people can cope with stress because they have the compensatory mechanisms that keep blood sugar in check. On the other hand, in diabetic patients these mechanisms are either ineffective or lacking so blood sugar can easily swing out of control. Stress induced diabetes increases blood glucose levels making it harder for diabetics to maintain normal blood sugars.

Cortisol levels significantly reduce insulin sensitivity leading to increased blood glucose levels while epinephrine can stimulate glucogeneogenesis (production of glucose by the liver). When this glucose is released into the bloodstream, it causes a further increase in the blood glucose level. Furthermore, these hormones also trigger the release of fat from fat stores leading to increased triglyceride and blood fat levels increasing vulnerability to high blood pressure. High blood pressure coupled with high blood glucose levels are detrimental to people living with diabetes and can worsen ones health condition significantly.

Can consistent elevated stress levels cause Diabetes?

Stress induced diabetes was just a theory but several studies have been done to determine if stress is indeed a precursor for diabetes. A study done in Sweden which followed. Over 5200 adults for a period of over 8 to 10 years conclusively established that elevated emotional stress levels had twice the risk of developing pre-diabetes. Additionally people with consistent high emotional stress levels also had 3 times the risk of developing Type 2 Diabetes as compared to those with normal stress levels.

Two recent studies also prove that high stress level are a precursor for Diabetes Type 2; based on an extensive epidemiological study by Knot et al.(2006) and another extensive study by Mezuk et al. (2008) consistent elevated stress levels cause Diabetes type 2. Mezut et.al (2008) included a total of 13 studies which investigated over 6,916 cases to ascertain if stress was a risk factor for diabetes. A meta-analytic review of this studies showed that incidences of diabetes were 60% higher in people with high stress levels as compared to those with normal stress levels.

Other Short term and long term health issues related to diabetes and stress induced higher blood sugars.

Chronic elevations of cortisol, epinephrine and norepinephrine which are released when the body is under stress have effects on several body systems. Some of the effects of stress induced diabetes include:

  • When epinephrine and norepinephrine levels rise to extreme levels, blood flow is shifted away from the digestive organs and this significantly reduces digestive processes such as nutrient absorption and enzyme production. In high concentration, stress hormones also have the potential of increasing the permeability of digestive tract to proteins that are not well digested. Since stress hormones hinder the normal digestive processes they ultimately have an undesired impact on the blood glucose level especially in people with diabetes.
  • Living with diabetes is hard enough and stress hormones only make it worse because of the negative impact that these hormones have on the immune system. When stressed the human body has reduced response to viral attacks. For instance cortisol triggers the immune system to produce pro inflammatory cytokines called TNF-alpha which negatively impacts the body’s immune system. TNF-alpha also affects the body’s metabolism and affects other body hormones.

TNF-alpha inhibits testosterone and DHEA formation while increasing production of estrogen like hormones. Since testosterone assists in maintaining glucose-requiring lean muscle, a decrease in testosterone levels can lead to increase in blood glucose which is detrimental in people suffering from diabetes.

TNF-alpha significantly reduces insulin production by the pancreas and this is detrimental for diabetics who already suffer from insulin deficiency. Since insulin controls blood sugar levels, when in short supply a diabetic person will need more insulin supply that may not be sufficiently provided by their medication. Insulin shots for diabetics are meant to supplement the little insulin that a diabetics body can produce naturally, if this natural production of insulin is further hindered then it becomes more difficult to maintain a normal blood sugars.

  • Cortisol can increase blood glucose levels by reducing sensitivity to insulin making it hard to maintain normal blood sugars. When insulin sensitivity is reduced, the blood glucose remains in bloodstream for a longer period of time and is rarely absorbed into the body muscles and other tissues. Therefore, insulin insensitivity not only reduces glucose supply to body tissues and muscles but also hinders the efficiency of insulin medication that is administered to patients suffering from diabetes. If your insulin medication fails to work as required because of insulin resistance then a diabetic person is at high risk of hyperglycemia which can worsen a diabetic’s health and make it hard to maintain normal blood sugars.
  • Hyperglycemia can cause the cells in the walls of blood vessels to be overloaded with glucose. When this glucose overload persists for a long time, the blood vessels get damaged because the walls thicken and weaken overtime. As a result of thickening of the blood vessels, blood flow to organs that are supplied with small blood vessels such as the nerves is hindered. Consistent unlimited supply of blood to nerve cells hinders efficient functioning of the nervous system.

Effective Stress Reduction Techniques that can help in the Management of Diabetes

As already established above, stress induced diabetes is proven medical occurrence that can increase the likelihood of getting diabetes. Proper stress management techniques are indispensable for diabetics who aim at maintaining a low blood sugar level and also for non-diabetic people who want to alleviate the possibility of getting diabetes because of stress. An exhaustive study by Surwit et al. in 2002 ascertained that stress management training does indeed help to reduce blood sugar levels. According to this reliable study, diabetics who received stress management training had approximately 0.5% reduced blood glucose level as compared to counterparts who did not receive any stress management training. This study unequivocally establishes that every diabetic has to take measures to manage stress in order to avoid increased blood sugar levels that can be spiked by high level of stress. Here is a brief but detailed rundown of effective stress management techniques that will come in handy in preventing stress induced diabetes and in maintaining normal blood sugars.

Having a regular Tai Chi regimen

Tai Chi is actually one of the most studied stress reduction therapies in Type diabetes management. Tai Chi is a movement based therapy that focuses on long fluid movements that are accompanied by intense breathing exercises. For Tai Chi to be effective in the reduction of blood glucose levels, it has to be done intensely over a long period of time.  A recent study on the effectiveness of Tai Chi in reduction of blood glucose levels in people with type 2 Diabetics had remarkable results; after an intense Tai Chi regimen featuring 2 Tai Chi sessions in a week for 6 months the participants not only reported reduced HbA1c and fasting blood sugar but also had a general improvement in their quality of life.

Practising Yoga

Yoga is essentially a movement based practice that features different styles which require different degrees of physical fitness. Just like Tai Chi, Yoga also incorporates breathing exercises. Although very few recent studies of Yoga in type 2 Diabetes have been published in the United States, a recent uncontrolled study in India published by Singh et al established that yoga substantially boosts the reduction of fasting blood sugar levels and HbA1c level (fasting blood sugar reduced by an average of 50mg/dl while HbA1c levels reduced by 1.2%. Although the results of this study are not unequivocal because its uncontrolled nature, the degree of improvement is incredible. Based on these remarkable results, it is safe to say that yoga plays a role in the management of stress that can spike high blood glucose levels. Regularly practicing yoga can help prevent hyperglycemia and help in controlling normal blood sugars.

Regularly practicing Qiqong

This is yet another breathing practice that has a movement component. Qiqong unlike Tai Chi features fewer repeats and smaller body movement. It can also include hand-on therapies and massages coupled with visualization exercises, An uncontrolled study done by Bastyr University in Seattle, WA which was published by Tsujiuchi et al. in 2002 showed that Qiqong helped in the management of blood glucose levels for persons with Type 2 Diabetes. After regular sessions of Qiqong for 4 months, the participants dad an average reduction of 0.8% in HbA1c and also had higher insulin secretion levels together with decreased anxiety levels. Therefore, Qiqong can help prevent hyperglycemia and also help maintain normal blood sugars.

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