What is the Link Between Stress and Diabetes?

Stress can trigger diabetes or make it more difficult to manage. How? Learn the answer here.

Written and verified by the doctor Mariel Mendoza.

Last update: 13 January, 2023

Stress and diabetes are linked by several important elements. Stress can be a risk factor for the onset of diabetes, as well as a consequence of metabolic disease.

In people with a genetic predisposition, high levels of stress cause an increased risk of developing type 2 diabetes mellitus. While in those people already living with diabetes, stress interferes with the control of their glycosylated hemoglobin and blood glucose levels (glycemia).

Understanding stress

Stress is a defense mechanism against any physical or psychological stimulus that tends to alter the body’s homeostasis. In these situations, the hypothalamic-pituitary-pituitary-adrenal hormonal axis is activated, which allows the body to adapt to situations of special energy demand.

In the autonomic nervous system, there is a predominance of the sympathetic system, which results in an increased release of adrenaline and noradrenaline. While the activity of the hypothalamic-pituitary-adrenal hormonal axis results in increased glucocorticoid release, with a predominance of cortisol.

Hyperglycemia in stress and diabetes

Cortisol, often referred to as the stress hormone, and adrenaline are the main effectors of stress-associated symptoms. Cortisol, adrenaline, glucagon, and growth hormone are known as counter-regulatory hormones. This means that they have the opposite effect to that exerted by insulin.

The increase in counter-regulatory hormones results in hyperglycemia and peripheral resistance to insulin action. This explains how stress and diabetes are related in their genesis.

Hyperglycemia occurs because there is the degradation of hepatic and muscle glycogen by cortisol. Glycogen is a form of glucose storage in tissues, so glucose is released into the blood by the disposition of the stress picture.

In addition, there is increased glucose production in the liver, from amino acids and triglyceride degrading factors. The end result is again hyperglycemia.

Finally, peripheral insulin resistance is due to the inhibition of the insulin-dependent glucose transporter. This receptor allows, under normal conditions, the entry of glucose into adipose tissue and striated muscle. When inhibited, glucose continues to circulate in the blood.

Neuronal damage due to stress hyperglycemia

In cases of stress associated with acute injury (underlying diseases, injuries, or surgeries), the state of systemic inflammation adds its harmful contribution. These are situations with increased release of proinflammatory cytokines, such as tumor necrosis factor-alpha and interleukin-1.

These factors lead to increased glucose uptake in the central and peripheral nervous system. Neurons, therefore, become more prone to damage from hyperglycemia.

It’s not just hyperglycemia

While it’s true that stress can be a trigger for diabetes in predisposed individuals, diabetes is a chronic disease that is associated with other factors. Stress is simply one more element.

Diabetes results from a defect in insulin secretion or action, which triggers sustained hyperglycemia. However, like any chronic disease, a large percentage is attributed to unhealthy lifestyle habits, such as inadequate diet, a sedentary lifestyle, and irregular sleep patterns.

Addressing stress and diabetes

Chronic stress can trigger diabetes not only by hormonal mechanisms, but is also associated with the adoption of unhealthy lifestyle habits that further increase the risk of hyperglycemia. These stress-induced lifestyle habits include a poor diet, smoking, and excessive alcohol consumption.

In addition, abnormal hormone levels are associated with weight gain and increased waist-to-hip ratio. The waist/hip ratio is an important marker for diabetes and for the likelihood of cardiovascular disease.

Stress management techniques such as paying attention to your breathing, muscle relaxation, cognitive restructuring, physical activity, and social support, among others, have a key impact on glucose control. The American Diabetes Association recommends taking care of both mind and body in people living with the condition.

To reduce stress, the American Psychological Association recommends the following:

• Exercise at least 30 minutes daily.
• Seek social support from friends or family.
• Try meditation or mindfulness.
• Take up a hobby or have hobbies.
• Maintain a balanced diet.
• Get enough and adequate sleep.

Managing diabetes also requires healthy lifestyle habits

Many sources of long-term stress are mental. The mind often reacts to events that are harmless, as if they were a real threat. In people who do not have diabetes or a genetic predisposition to diabetes, these stimuli can be channeled. However, in other cases, hyperglycemia is triggered.

Also, people with stress are more likely to have unhealthy lifestyle habits. They tend to drink alcoholic beverages, exercise less, and not plan their meals. Type 2 diabetes mellitus is related to environmental factors, such as obesity, a sedentary lifestyle, a diet rich in fats and carbohydrates, smoking, abnormal cholesterol levels, and high blood pressure. Stress is often behind all of these. People with diabetes who report being stressed have inadequate intake of their medications and do not follow healthy lifestyle guidelines.

In addition, chronic stress is a risk factor for other chronic diseases, such as cardiovascular disease. So, it’s clear that the approach to patients living with diabetes and stress is complex. Medication alone will not suffice, but mechanisms for anxiety reduction and profound lifestyle changes will have to be put in place.