Stress is a natural occurrence in day-to-day life and everyone has his/her own techniques to relieve stress. When handled properly, stress does not cause any major health concern. However, chronic or long-term stress can lead to various health conditions, some of which do not show any symptoms early-on. When it comes to diabetes, stress can aggravate the symptoms for diabetics, while those who do not have diabetes are now under the risk of developing it. In this article, we will explore the connection in detail.
As everyone is aware, sugar or glucose, that comes from the food we consume, is required for our body’s cells to function efficiently. Oxygen, glucose (and other forms of natural sugar) and nutrients (like vitamins and minerals) are all equally important for body-cells to function optimally.
The conversion of blood-sugar to energy is catalysed by the hormone insulin. Insulin also regulates the blood-sugar levels. This means, when there is more glucose available from the food consumed, than what is required for energy-conversion, the surplus is stored in different parts of the body in different forms. When there is more work to be done, more glucose is required. This will come primarily from the blood-sugar, while the shortfall is drawn from sugar reserves stored in the body.
This is the normal cycle of sugar conversion into energy, and regulation of blood-sugar by insulin, when all things are normal.
When there is a crisis, or a stressor (stressful situation), the person may decide to fight back, or avoid it altogether, or freeze in shock not knowing what to do. In all these situations, there is more physical and mental activity to be performed by the person. So, more energy conversion must happen, for which more sugar is required.
At the anatomical level, this is what happens. The adrenal glands are a pair of tiny, pyramid-shaped glands that sit on top of the kidney (one on each kidney). In response to a stressor, the hypothalamus in the brain sends a signal to the adrenal glands. In response, these glands produce two hormones – epinephrine (also called adrenalin) and norepinephrine. These hormones are released into the blood. They tense the muscles, speed up the heart-beat, widen the airways (so that more air can be drawn and hence more oxygen supplied), and widen blood-vessels (so that the excess blood-flow can happen freely now). The blood-pressure goes up in order to push the excess blood-flow to the body’s cells, and the hormone norepinephrine prevents the blood-pressure from dropping.
Once sugar from the blood is consumed, and its levels drop, the function of epinephrine kicks in. This coverts sugar stored in muscle-cells and liver (called glycogen) into blood-sugar so that the shortfall is met and energy conversion continues smoothly.
Once the stressor is removed, production of epinephrine and norepinephrine drops. The blood-sugar is first brought to a normal level (as required for normal functioning of the body), and then any excess blood-sugar is sent to the liver and muscle-cells, to be stored for future use.
The above-described sequence is the normal cycle of stress management in a healthy person, or one who does not have diabetes. But what about a diabetic?
In a Type-1 diabetic, the body does not produce enough insulin, so the blood-sugar is not fully consumed or converted to energy, so their levels keep rising. When there is a stressor, the adrenalin cycle described above introduces more sugar into the blood. Nett-nett, there is plenty of blood-sugar which is not being consumed. This leads to various consequences when the person is repeatedly exposed to stressors.
In a Type-2 diabetic, enough insulin is produced, but the body’s cells have developed a resistance against it, so the blood-sugar is not efficiently converted to energy. As a result, blood-sugar levels rise. When there is a stressor, the adrenalin cycle introduces more sugar as described above. There is more sugar in the blood, more insulin in the blood, hence more resistance to the insulin. This means, the Type-2 diabetes condition becomes worse if the person is repeatedly exposed to stressors, over time.
In short, diabetes symptoms become worse when there are repeated stress cycles. This applies equally to negative stressors, and positive stressors (happiness, excitement, arousal, etc). And for non-diabetics, the risk of developing insulin-resistance or type-2 diabetes increases when he/she is exposed to stress repeatedly.
Interestingly, diabetes can also induce stress. Once a person is diagnosed with diabetes, he/she could feel overwhelmed by it emotionally. Fear and concern of whether he/she will be able to manage the condition properly, or the various adjustments or compromises he/she will have to make in his/her life now, can introduce a lot of stress. This will accelerate the progress of diabetes in him/her.
For all the above reasons, it is important that one should manage stress well, to prevent the onset of diabetes, or manage it better once it has set in. The following guidelines will help. While these are aimed at diabetics, they are very relevant for non-diabetics too.
Remember the connection between stress and blood-sugar at all times. Purchase a glucometer, and monitor your blood-sugar during times of stress.
There are various stressors (positive and negative) that will come up in the life of a diabetic. Keep your doctor updated about any major stressor that is coming up shortly. He/she will adjust the medication, so that the expected blood-sugar swings are managed well. You could also take counselling on how to handle the situation.
An abusive marriage, a nasty boss, a toxic friend, unfriendly neighbours/landlord, a vehicle that keeps breaking down – you could have one or more of these stressors in your life. They are not worth the health risk you face in the long run. It’s best to eliminate them at the earliest in the best interest of your health. Move on from a bad marriage, change your job or vehicle. While this may seem daunting initially, you will be able to handle it eventually.
Short-term stressors, if not addressed quickly, become long-term stressors. A problematic piece of furniture, your route to the workplace that has bad traffic, etc…. everyone has these. Change your driving route, dispose off that furniture, make that purchase which is long due, stop procrastinating in small matters…..and see the good effect it has on your health.
When you are stressed out, go in for a massage or manicure, do deep-breathing, listen to music, take a small walk…the list is endless. The secret is to discover what works best for you. Only, be careful to not start a wrong habit such as binge eating, unhealthy snacking, excessive drinking, unnecessary shopping etc, at times of stress. They will add new stress over time.
There is a lot of research to prove that techniques like mindfulness, yoga, deep-breathing, meditation, are all effective in calming the person down and overcoming stress. Some of these have been published in the Journal of Diabetes Research. Try one or more of these. They don’t cost anything and are very easy to do.
Physical exercise is critical for type-2 diabetics. Exercise helps reduce blood-sugar levels by reducing insulin resistance and increasing insulin sensitivity. You must do 4-5 hours of light running, jogging, swimming, cycling or weight-training, per week. For non-diabetics, exercise helps reduce irritability so the person is able to manage stress situations better.
Type-2 diabetes sometimes go through what is called a “diabetes burnout,” after being overwhelmed with the effort required to manage the condition. They could skip taking their medication or stop monitoring blood-sugars levels regularly. This is dangerous. Join diabetes support groups that are found online and offline. Here, fellow diabetics share tips and tricks for managing the condition better.
Diabetics need to follow certain routines in their life. Eating on time, eating often, eating healthy, taking medication regularly, taking them on time, checking blood-sugar levels regularly, etc. This can seem daunting. The best way to overcome this is to be organized. Keep a journal (paper or soft-copy) where all this information is entered. Then you don’t have the hassle of remembering them.
People in general, and diabetics in particular, who sleep 7 to 8 hours per day are known to have better control over their blood-sugar and stress levels. The restorative power of sleep is one of the best weapons in the battle against either stress, or diabetes, or both.
Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
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