01 September 2020

Stressful days, worse blood sugar control for people with diabetes

A new study found that the stress hormone cortisol is linked to higher blood sugar levels.

  • Stress can make the management of diabetes a lot harder
  • This is because stress causes the secretion of cortisol, which pushes up blood sugar levels and lowers insulin
  • It is all part of the body's 'fight or flight' response

When something as routine as grocery shopping might lead to a deadly Covid-19 infection, stress is inevitable – and that extra tension can make it harder for people with diabetes to manage their disease.

The reason? The stress hormone cortisol is linked to higher blood sugar levels, according to a new study.

Under stress, the body releases cortisol, which leads to an increase in blood sugar and a decrease in insulin (the hormone that helps process that sugar).

Cortisol levels naturally fluctuate

"This is all part of the fight-or-flight response. You need sugar if you want to run from, let's say, a bear. To prepare for that, your body needs to make energy, so it releases cortisol," explained study author Dr Joshua Joseph. He's an endocrinologist at the Diabetes and Metabolism Research Center at The Ohio State Wexner Medical Center, in Columbus.

Cortisol levels naturally fluctuate. They're highest in the morning as you rise, and usually fall at night, Joseph said. But in people with diabetes, cortisol levels stayed steadier throughout the night, his team found.

The researchers noted that past studies have linked stress and depression to a steadier cortisol level.

The study included data from more than 2 000 participants, aged 45 to 84, who were followed over six years. The investigators found that people with diabetes who had steadier cortisol levels (indicating stress) tended also to have higher blood sugar (glucose) levels.

"Cortisol is driving glucose changes, and it does make diabetes much harder to control. Naturally, cortisol levels should be going lower in the evening. But people with stress have higher cortisol levels and blood sugar at night. Cortisol also makes you want to eat, and when you're stressed, you're not reaching for the carrots and broccoli – you're reaching for high-carbohydrate, high-sugar foods," Joseph said.

Inability to use insulin effectively

Over time, higher blood sugar levels can lead to serious complications of diabetes, such as vision problems, heart disease and kidney disease. Joseph said it also appears that constant higher blood sugar levels might make people more susceptible to complications from a Covid-19 infection, though there aren't yet studies to prove it.

Dr Akankasha Goyal, an endocrinologist at NYU Langone Health in New York City, reviewed the new study findings. She described cortisol as a "double whammy".

"It increases glucose production, and it decreases insulin from the pancreas," she said. "And, in patients with type 2 diabetes, at baseline, their bodies are unable to use insulin effectively and their glucose levels are higher."

Goyal said the study is proof of what many patients already knew: that stress can worsen blood sugar control. The findings may help motivate people to take steps to control their stress, she added.

"Stress relief is medication without side effects," Goyal said. "Exercise if you can. Walk, yoga, tai chi or lift some dumbbells. Do mindful activities, paint, read a book – anything that slows down and quiets the mind."

Ease your stress

Joseph and other researchers at Ohio State are recruiting diabetes patients for a study to see if mindfulness practices improve blood sugar management. People with diabetes need to focus on stress relief as part of managing their disease, he said.

"To ease stress, maintain healthy social support, get regular exercise, sleep seven to eight hours a night, practise mindfulness, meditation, yoga, listen to music and eat a healthy diet," Joseph suggested.

The study was published online in July in the journal Psychoneuroendocrinology.

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Diabetes expert

Dr. May currently works as a fulltime endocrinologist and has been in private practice since 2004. He has a variety of interests, predominantly obesity and diabetes, but also sees patients with osteoporosis, thyroid disorders, men's health disorders, pituitary and adrenal disorders, polycystic ovaries, and disorders of growth. He is a leading member of several obesity and diabetes societies and runs a trial centre for new drugs.

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