From adrenaline-soaked excitement to prolonged anxiety, stress can have many faces. Sometimes, it may seem like all of these stressors are working against your diabetes. We’re here to explain how stress affects your blood glucose and how you can gain control.
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In the early days of our evolution, the primary purpose of our stress response was to provide energy reserves for fight-or-flight responses in the event of an emergency. The urban jungle we live in today hardly requires a prehistoric escape, but our bodies still react to daily stress in the same way they did back then. Acute as well as constant heavy stress can cause blood sugar levels to rise.1
Stress is the body's way of responding to threats, challenges, or physical and psychological demands.2 The autonomic nervous system typically triggers the physiological response and can create a cascade of hormones that flood the body, including:
Because of the autonomic nature of our body’s response, sometimes people can be unaware that they are experiencing a stress response. After all, we release stress hormones when we lack sleep or are pressed for time.1 Being overworked, annoyed, or constantly exposed to excessive noise can even trigger a stress response.
Unfortunately, these stress hormones make us more resistant to insulin, and that is the problem for people with diabetes. When stress hormones are involved, most people with diabetes require more insulin to facilitate glucose uptake into their cells.
Additionally, more sugar is released from the liver into the bloodstream during stress, as our brain requires more fuel to function.3 It’s pretty clear how those two processes combined can make it difficult for people with diabetes to manage their glucose levels.
If you record stress-related glucose levels and document stressful events in a diabetes management app, it can help you understand your body's unique reaction, allowing you to track trends with your healthcare professional and adjust therapy proactively.
Stress is a very common phenomenon and is experienced by everyone. An exam, an important meeting, an upcoming doctor's appointment, or lingering anxiety are all things that we deal with on a regular basis. They are so common that sometimes you can look at fluctuating glucose values and think, "What's going on with my body?"
You can try relaxation techniques to lessen the physical impact of stress, but sometimes you may need more insulin, which can be challenging due to stress-related glucose increases.4
Remember that stress hormones can cause insulin resistance.3 Sometimes your standard correction isn’t as effective as you hoped, and you may try additional insulin.4 The risk here, however, is that glucose levels sometimes stabilize as soon as the stress subsides, and then you are left with too much insulin on board, ending up in a low.5
Try to stay calm and check your blood sugar regularly, or watch your trend on your CGM device if you use one.
Important: Allow the insulin time to take effect, and avoid correcting it too quickly. Consult a healthcare professional for specific recommendations and changes to your routine.
The stress response isn’t isolated to just mental or emotional stressors.
Physical illness, inflammation, fever, trauma, and even severe allergic reactions can put stress on the body.1
This is why it’s important to discuss insulin adjustments with your doctor during periods of illness. In fact, most healthcare providers have a general sick-day protocol that can include:6
Stress hormones can significantly impact blood sugar levels, especially when you're sick. Understanding how your body responds to stress on otherwise healthy days can help your doctor tailor a more effective plan for managing your sick days.
Accurate and consistent record-keeping plays a key role in guiding better therapy decisions.
Important Note: If you experience vomiting or diarrhea, your blood glucose levels may drop rapidly due to the loss of carbohydrates at a faster rate than your body can absorb them.
Additionally, if you have type 1 diabetes, always check for ketones in your urine or blood during illness to rule out ketosis7.
Do your thoughts and worries wake you up regularly at night? Do you struggle with insomnia?
Even just one night of inadequate sleep can lead to a reduction in insulin sensitivity.8 Another possible side effect is an intensified hunger pang.
A constant lack of sleep can trigger hyperactivity in the stress system, including elevated adrenaline levels.1,10 This overactivity of the stress system can lead to diseases such as heart disease, stomach ulcers, sleep disturbances, and psychiatric disorders.
Aim to sleep at least 6 hours a night, and watch your glucose values more closely during periods of insomnia. The amount of sleep each person ultimately needs is specific to them.
Stress is also a reaction to physical challenges to the body, so it’s no surprise that exercise can trigger a stress reaction.1 Keep in mind that even positive things, such as intensive sports training, can lead to an "adrenaline rush." This not only means extreme sports, such as skydiving, but also high-intensity or prolonged physical activities, like spinning.
Intense athletic efforts can trigger a stress response in the body, leading to a rapid increase in blood sugar levels. In contrast, regular endurance and resistance training typically doesn't cause stress and the resultant spike.
Frequent physical activity has the potential to enhance insulin sensitivity and improve glycemic control in individuals with type 2 diabetes, offering significant benefits when combined with suitable exercise regimens.11 Tracking your exercise regularly can help you identify target trends and proactively adjust your therapies for them.12 Regular exercise also has a positive impact on mental well-being and stress management.13,14
We mentioned that our brain needs more fuel to function during periods of stress. In fact, the brain typically needs about 100-150 g of sugar per day, but when experiencing stress, this need can increase.15 Do you ever experience food cravings when you’re using your brain intensively? Now you know why.
The brain sends signals for more fuel, and typically, our liver plays a regulatory role in managing the release of more glucose. However, most people also find themselves grazing and snacking more often, which can lead to higher blood glucose levels and the need for additional insulin adjustments.
Managing your diabetes can often feel like walking a tightrope, and adding in stress management can feel daunting. But we are here to reassure you that you can do it!
As always, keep calm, regularly check your blood sugar, or watch the values and trends in your CGM, if you use one. If you take insulin, let it run its course when you make small corrections. Keep good records, use your diabetes record app to track your stressors, and let your healthcare practitioner guide you on good therapy choices.
Techniques that can be used to reduce stress are even more wide-ranging than the types of stress themselves.17 Try to incorporate exercise into your everyday life—without getting stressed about doing so, of course. Regular exercise can also help reduce stress.13,14
Meditation is easy to incorporate into everyday life and can help eliminate negative thoughts. For example, try meditating for 10–15 minutes first thing each morning. This helps relax the mind and sets you up for a positive mental attitude to start the day.
A recommended practice for managing stress, particularly in situations such as commuting on public transportation, is mindfulness meditation. Examples of mindfulness techniques include concentrating on the breath or engaging in a mental "body scan." Such meditation helps anchor oneself in the present moment, fostering a sense of calm and awareness.
Here’s an example of what this might sound like: “Focus your attention on your feet. It’s normal for distracting thoughts to appear, but as soon as you notice them, return your attention to your feet,” then gradually move your attention further up your body. There are also wonderful audio experiences that take you on mental journeys to a mountain lake or the sea.
In addition to meditation, try options such as Jacobson’s progressive muscle relaxation technique or autogenic training.
Progressive muscle relaxation involves tensing and relaxing certain muscle groups in sequence. The benefit is that some techniques can be applied almost anywhere subsequently.
Autogenic training is based on autosuggestion. It relies on a comfortable body position where the muscles can completely relax. You should then perform the exercises, which involve silently repeating short statements in your head.
For instance, you can move down your body in your mind, right leg, left leg, then right arm, left arm, etc., imagining that your limbs are getting progressively heavier (as though you’re lifting them out of water).
If certain situations make you feel emotionally stressed, try to take 5 minutes out and leave your current environment. Find a quiet place where you can spend these 5 minutes focusing on your breath.
Even this kind of brief exercise is beneficial, as the respiratory system works hand in hand with the nervous system.19 By slowing down our breathing, we can reduce tension in the nervous system and the number of stress hormones released.
Being stressed and (usually unconsciously) holding tension in our bodies can also cause chronic headaches and back pain.1 Combining relaxation techniques with physical exercise can reduce physical stress.
Mindful movement practices, such as Yoga, combine physical exercise with meditation. They can also lower your blood pressure.20 Whether it’s yoga or another type of exercise, you should strive to do 30 minutes per day. Whichever technique you choose, consider attending a course or online training to guide you through these exercises.
Do your family responsibilities sometimes leave you feeling overwhelmed? You love your family, but it’s okay to admit you can’t meet everyone’s needs all the time. It’s perfectly okay to say no—your family will understand.
Talk openly about how you're feeling. If your stress comes from not spending enough quality time together, try planning dedicated “family time.” A weekly or biweekly family night—playing board games, cooking together, or just catching up—can make a big difference. Outdoor activities like bike rides, walks, swimming, or day trips are also great ways to reconnect and recharge.
There are many work-related stress factors: your workload, a lack of structure, or problems with your colleagues or managers. Depending on the problem, consider speaking to your manager. There may be ways to alleviate or resolve problems that you experience frequently.
If your concerns have been ongoing for a long time, consider whether relocating to a different department or even finding a new job could be a better long-term solution. Although looking for a new job is likely to increase your stress further, it may be reduced when you’re in a new position that suits you better.
It’s also easy to take your work problems home with you, and this can lead to sleep disorders. Find balance in your private life through relaxation techniques, sports, socializing with friends, creative cooking, or enjoying the outdoors. Also, try to “train” your thoughts before going to sleep by focusing on (even the little) things that you enjoyed during the day or that you plan to do.
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Before making any changes to your lifestyle or medication, please speak to your healthcare professional to check that it is suitable for you.
This content is provided for general information only. It is not intended to amount to advice on which you should rely – you must obtain professional or specialist advice from your healthcare professional before taking, or refraining from, any action on the basis of the content. Although we make reasonable efforts to ensure that the content is up to date, Roche makes no representations, warranties or guarantees, whether expressed or implied, that the content is accurate, complete, up-to-date or that it should be relied upon.
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