Diabetes & Stress: How Stress Affects Your Blood Sugar

Everyone experiences stress at some point in their lives. And stress can have a drastic effect on your blood sugar — both immediately and in the long run.

Even the fun stress of a roller coaster ride triggers an increased production of hormones like cortisol, adrenaline, and glucagon. Without these hormones, your body couldn’t complete the task of grocery shopping, let alone endure a heated argument with your mother.

In this article, we’ll look at how each of these stress-related hormones can affect your blood sugar.

At the end of the post, we will summarize how all of this comes together to impact the day-to-day lives of people living with diabetes, and what you can do to reduce stress in your daily life.

What is stress?

Quite simply, stress is your body’s response to any situation, event, or change in your life that requires a reaction or adjustment. Stress can develop physically, mentally, and emotionally.

And it’s an unavoidable part of life. Both positive and negative experiences can create a stress reaction in your body and mind.

In some cases, you might experience an event that causes stress with no end in sight. An abusive relationship or an unbearable environment at your work are examples of an ongoing source of stress that a person may struggle to break free from.

These types of stress can lead to a state of “distress,” which is putting it lightly if you’ve ever experienced it.

Let’s take a closer look at what stress looks like before we add diabetes to the mix.

The symptoms of stress

Stress can manifest differently in one person from the next. For some, positive or negative stress may produce immediate tears, for example. In others, it may cause them to be silent and speechless. And others may become easily angry and irritable.

Depending on the severity of the stress level, your symptoms can vary. Here are some examples of stress symptoms:

Mild to moderate stress

• crying
• anger
• irritability
• excitement
• high blood pressure
• headache
• lack of appetite
• binge-eating
• acid reflux
• difficulty sleeping
• loose bowels
• muscle tension in your neck
• sweaty palms
• tiredness
• shaking
• trembling
• changes in weight
• lack of sex drive

Severe stress

• chronic headaches
• nausea
• diarrhea
• severe high blood pressure
• chest pain
• sexual dysfunction
• insomnia
• depression
• panic attacks
• anxiety

Research suggests that stress also can bring on or worsen certain symptoms or diseases. Stress is linked to 6 of the leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide.

Before we move on to how stress can affect your blood sugar and what you can do to reduce stress, let’s take a closer look at the hormones involved in a stress reaction.

What is cortisol?

This hormone is often discussed in a negative light because too much of it can be a sign that your body is under severe mental or physical stress, and is associated with inflammation and weight gain. 

While its primary role is to help your body manage stress, it also affects nearly every organ in your body and is something your body needs 24 hours a day to stay alive.

Without cortisol, you wouldn’t be able to climb a flight of stairs, let alone endure the intense stress of losing a loved one, going through a divorce, or having surgery. 

Cortisol also helps your body:

• Manage your blood pressure 
• Manage the function of your heart 
• Reduce your immune system’s inflammatory
• Reduce overall inflammation
• Breakdown sugar (with the help of insulin) to be used for energy
• Manage how your body metabolizes protein, carbohydrates, and fat

Just like your insulin or other diabetes medication needs can change based on what you’re doing and eating, your body’s cortisol production must precisely match your needs during any given moment, too.

How does cortisol affect your blood sugar?

Not only can cortisol contribute to unwanted high blood sugars, but it’s also essential for treating low blood sugars, too. Let’s take a look.

When cortisol levels are high

When cortisol production increases beyond a healthy baseline, it blunts your body’s sensitivity to insulin. This means you need more insulin during those hours in order to keep your blood sugar in your goal range.

While your body does produce cortisol 24 hours a day, there are certain times of day anyone can expect to be producing more, like first thing in the morning.

If you manage your diabetes with insulin, this also explains why you may notice that you need more insulin in the earliest hours of the day, and with breakfast.

As soon as you wake up in the morning, your body produces a surge of cortisol. This surge is critical for simply starting your day and functioning fully now that you are awake!

And if your overall baseline cortisol needs to increase due to constant, ongoing stress, you’ll notice that your baseline insulin needs increase, too.

You can read the post “How to Avoid High Morning Blood Sugars” for more information and practical tips for dealing with morning highs.  

When cortisol levels are low

On the flip side, without enough or any cortisol you would struggle with constant hypoglycemia (low blood sugar). 

When a person with diabetes experiences a low blood sugar, cortisol is actually critical to enabling your body to make use of the glucose you consume to bring your blood sugar back up to a safe level.

A severe low blood sugar can nearly deplete your body’s cortisol reserves, which contributes to symptoms of exhaustion even after your blood sugar has returned to a safe level.

If you think cortisol is wreaking havoc on your blood sugar levels, talk to your healthcare team about adjusting your insulin doses or other diabetes medication to help compensate. And of course, take a look at what areas of your life you could adjust to reduce your emotional and physical stress.

What is adrenaline?

Adrenaline — also known as “epinephrine” — is commonly associated with athletic events, but your body produces adrenaline in response to other events, too. 

An intense argument, a near-miss car accident, or a roller coaster ride can all lead to increased adrenaline production.

Adrenaline is your body’s hormonal “flight or fight” response to intense good or bad stress.

This hormone essentially signals your liver to release glycogen — the stored glucose in your liver. When your body suddenly encounters intense stress, you need extra glucose for energy to endure that stressful event. Without that extra glucose, your blood sugar would drop and you’d simply be lacking the energy necessary to perform during that stressful event.

How does adrenaline affect your blood sugar?

In a non-diabetic body, that surge of adrenaline triggering a surge of glycogen would be accompanied by a surge of insulin, too.

As people with diabetes, we’re missing the “surge of insulin” part, which can easily spike your blood sugar from 120 mg/dL to 300 mg/dL in less than an hour.

Adjusting your insulin for this can be tricky. A quick bolus of insulin using your normal “correction factor ratio” could easily produce little or no effect on the high blood sugar while adrenaline is present.  

Personally, I’ve found that I needed a significant increase in my background insulin doses on the day of a powerlifting competition in order to keep my blood sugar from spiking due to adrenaline. A quick bolus would have no impact and the only thing that would otherwise bring my blood sugar down was when the competition ended and my body relaxed. 

If you’re dealing with predictable adrenaline around a sporting event, for example, talk to your healthcare team about making an adjustment in your background insulin.

If you’re dealing with sudden, unexpected surges of adrenaline because you just got into a car accident, for example, you’ll likely have to try lowering it with a bolus of insulin but may not see it come down for a few hours.

When it’s actually not adrenaline…

One thing adrenaline is often incorrectly associated with is during your workout at the gym. There are other reasons your blood sugar can spike during a typical workout — but unless you’re truly in a competitive environment (rather than just an intense solo workout), it’s unlikely to be adrenaline. 

More likely, you’re breaking down muscle which involves breaking down stored glycogen. Your body then breaks that glycogen down into glucose and cycles it back to your muscles for energy. Without extra insulin on board, this can easily lead to high blood sugars.

Read “Why Some Types of Exercise Can Make Your Blood Sugar Increase” for more information. 

What is glucagon?

Glucagon is another hormone that helps your body endure certain types of stress — including skipping breakfast! 

Glucagon’s role is simple: it tells your liver to release glycogen (mentioned above) which is then converted into glucose and can be used for energy or to purposefully raise your blood sugar.

How does glucagon affect your blood sugar?

Glucagon is actually less associated with emotional stress but does play a role during physical stress when you’ve gone too long without a meal or when you experience a severe low blood sugar.

“The release of glucagon is stimulated by low blood glucose, protein-rich meals, and adrenaline (another important hormone for combating low glucose). The release of glucagon is prevented by raised blood glucose and carbohydrate in meals, detected by cells in the pancreas,” explains this study.

During a severe low blood sugar…

When you experience a severe low blood sugar, likely below 40 mg/dL, you may see your blood sugar skyrocket within the hours after, even if you only treated that low with a careful amount of carbohydrates. 

This is your body’s way of saving your life! That surge of glucagon triggers a surge of glycogen which is broken down into glucose and raises your blood sugar. In those of us with diabetes, it simply raises it too high!

When you eat a strict low-carb diet…

During a ketogenic diet, your body is actually going to produce more glucagon throughout the day in order to get more glucose because your body cannot function on ketones alone. 

Your brain requires a second-by-second delivery of glucose in order to function! 

Does this mean you can’t follow a ketogenic diet? No. But it does mean you may notice your background insulin needs actually increase when you cut your carbs that low. This doesn’t happen to everybody but it’s important to keep in mind if you try a ketogenic diet just to see your insulin need skyrocket. 

When you skip breakfast…

Intermittent fasting is all the rage right now, but there are a few things you need to know if you’re experimenting with this trendy nutrition approach as a person with diabetes.

When you skip breakfast, your body is going to produce more glucagon during those fasting hours because — again — your brain needs glucose in order to function! 

This doesn’t mean you can’t practice intermittent fasting, but it does mean you’ll need to take extra boluses of insulin during those fasting hours to compensate for that additional glucose.

Summary: How stress affects your blood sugar

In short, stress will generally cause your blood sugar to rise. It will also be difficult to bring it down because of the insulin resistance created by stress hormones and the production of glucose from your liver’s response to adrenaline.

The larger majority of stressful situations aren’t something we can easily predict, but once you’re experiencing stress, you can predict that your blood sugar might spike.

Remembering to check your blood sugar during and after stressful situations is an important part of diabetes management, but don’t add to your stress by expecting to be able to easily correct any high blood sugars during a stressful state.

How to deal with stress as a person with diabetes

In general, there’s only so much you can do to prevent blood sugar spikes from different types of stress hormones because we can’t always predict stress. 

However, if you’re dealing with predictable stress or ongoing stress, definitely talk to your healthcare team about an adjustment in your insulin doses that can help tamper those stubborn high blood sugars.

For those unexpected bursts of stress and rapid spikes in your blood sugar:

You should use your established “correction factor” to determine an appropriate dose of insulin to bring the blood sugar down.

But keep in mind: it’s very likely your blood sugar will sit at that higher level (especially in those with type 1 diabetes) until your body has recovered from the stressful state. When those stress hormones are pumping and adrenaline is causing your liver to produce more glucose, it can be very difficult to “get ahead of it.”

For ongoing stress during a period of your life: 

If you know the next few months are going to be stressful because of a promotion at work, a divorce, or the death of a loved one — for example — then a simple increase by a few units in your background insulin dose can have a big impact on staying in your goal blood sugar range.

Don’t underestimate how much ongoing stress can affect your daily insulin needs. Even on the “normal” days during a stressful period of your life, your body is still coping with that ongoing stressor.

How to reduce your stress levels

Learning what helps you manage, reduce, and relieve your overall stress level is a vital lesson. Sometimes the simplest thing can help you take a deep breath, lower your blood pressure, lower stress hormones, and release the physical and mental grip of stress.

Here are a few ideas for reducing your stress levels:

Reducing stress in the moment

• Close your eyes and take deep inhales and exhales for 30 seconds
• Go for a walk
• Exercise to get your heart rate UP which causes your central nervous system to relax
• Go for a drive
• Watch your favorite stand-up comedy
• Make a to-do list to get everything off your mind
• Clean your house
• Call a friend
• Create a “voice memo” like your own private therapy session
• Dance to your favorite music

Everything that makes you calm down, makes you smile, or helps your body relax will have a positive effect on your stress level.

Reducing ongoing stress

Reducing ongoing stress usually requires a significant change in your situation or lifestyle. The causes of ongoing stress are different from person to person, but here are a few ideas for how you can help reduce ongoing stress: 

• Identify your biggest stressor and ask yourself: what can I change about this?
• Make time to see a therapist weekly/biweekly
• Make time for regular exercise — a daily walk can do wonders!
• Use a meditation app to at least stop and breathe deeply for 2 minutes every day
• Get your house/office cleaned up and organized (with help) so your “space” is clear
• Create weekly to-do lists to manage responsibilities and acknowledge productivity
• Look for a new job, sending out two applications per week
• Leave an unhealthy relationship (get help from friends if needed!)

Managing ongoing stress is difficult because in many cases you cannot just walk away from it. Take a deep breath and step back to see the bigger picture around this stressor. There are always going to be things we can control and change, and things we cannot.