Does Emotional Stress Spike Your Blood Sugar?

A few days ago, Kerri posed this question on Twitter:

I was struck by Jess’ response:

I was always under the impression that it could– stress increases hormones like cortisol and epinephrine, which raises blood glucose– so why would a licensed physician say no?

Well, perhaps he is devoted to evidence-based medicine, I thought, and the data are not strong enough to support that hypothesis.

So I enlisted the help of my friends– Dr. Google, MD and Dr. Google, PhD– to investigate what the experimental data say.

Like much of science, the evidence is….tricky!

Some studies indicate yes:

  • An active stressor (e.g. a timed arithmetic test) led to a significant BG response in insulin-dependent subjects, but passive stressors (like watching a tense film clip) did not. (Gonder-Frederick et al.)
  • One T1 girl prone to frequent and debilitating DKA experienced a rise in glucose and fatty chain acid levels after a stress interview. (The experiment was in regard to beta adrenergic blockade, which blocked these physiological responses after a subsequent stress interview.) (Baker, et al.)
  • Rats with lab-induced diabetes showed a rise in BG when exposed to a cat, with different patterns of spike and drop between Type 1 and Type 2 diabetes. (Chang, et al.)

More studies seem to indicate nope:

The data showing hyperglycemia in physical stress (like stroke or heart attack) is more robust (McCowan, Malhotra, and Bisitrian). So, too, is the link between chronic stress and diabetes. High A1Cs are associated with both life hassles (Cox, et al.) and psychiatric illness. (Lustman, et al.)

But I’m just not convinced by the data regarding acute emotional stress and high blood sugars. One study involved rats. One involved two subjects. The only one that involved a decent sample concluded that “Subjects’ BG response to the active stressor was idiosyncratic,” even if it was statistically significant over time.

On the other hand….the relationships between blood glucose, stress hormones, and emotions are really complicated. Anxiety increases oxidative stress in mice, linked to cardiovascular disease and cancer (Bouayed, et al.) But in people without diabetes, epinephrine can increase blood glucose, which thereby may feed the brain and enhance memory of emotionally strong events (Blake, Varnhagen, and Parent). Oh, and watch out if you’re depressed, because you have a 37% higher risk of developing Type 2 diabetes than adults without depression. (Knol, et al.)

As the scientists conclude in one baller study that measured endocrine response while subjects went skydiving, “Even in a very homogenous group of subjects and under well-controlled conditions, endocrine responses to acute psychological stress show considerable variations.”

And that’s without diabetes in the picture!

 photo skydiving-603646_1280.jpg

Sometimes my blood sugar drops like this!

Medicine is a science. I can understand why Jess’ endo would take the evidence-based route and say that stress does not affect BGs. However….medicine is also art. What if this guy listened patiently? What if he took a moment to stop charting “pt is non-compliant, warned of complications of uncontrolled glucose” and took 2 minutes for open-ended questions?

How does stress affect your diabetes management? What can we do today to make it better?

Until more experiments can enter the annals of medicine, let’s see what happens when n=1.

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18 thoughts on “Does Emotional Stress Spike Your Blood Sugar?

  1. I’ve found every-day stress spikes me (when I worked at a job I hated). However, traumatic stress doesn’t (when Pete was punched and mugged). I don’t know why that is, although in a time of trauma it was nice not to have to deal with blood sugars!

    • I read your Monday Fours post– was it the cable ad traffic job? That does sound horrible! (I mean, so does mugging. Thank goodness your BG didn’t wig out after that!)

      • Yup, that was it. The job wasn’t too terrible but over the years all the good coworkers left and the new ones were terrible. Company morale was awful and I was the only one who cared enough so I did most of the work myself. It was a bad time.

  2. The problem for me arises when stress is present for more than a couple of hours. If it’s a multi-day bender then basal rates have to be increased and insulin/carb ratios are worthless. But that’s just me. I’m not a doctor.

    Thanks for sharing this. And for doing all that research. So thorough!

    • That’s the kind of study I would like to see– both the intermediate amount of stress exposure, and an intermediate response measurement. I hear a lot of people saying something similar. And I wonder if these experiments could be missing a rise in BG happening later. Or perhaps the multi-hour exposure to stress means that people eat, and like that study looking at postprandial vs fasting, experience the delayed drop in BG.

      ANYWAYS, I enjoy doing these dives into data (I wrote a post about the science of racism this fall as well). Thanks for reading and for organizing D-Blog Check Day!

    • What’s EXTRA appealing is that, when I read this, I had just finished watching an X-Files episode in which a mutant…… uh, eats up people’s adipose tissue and spits them out for lunch.

  3. Stress can affect our bodies in so many ways, and many aren’t well studied or have enough known about them. Every ‘body’ is unique and reacts and responds differently to stressors. I say if you feel that stress affects you then it most likely does no matter whta the doctors or the studies say!

    • Absolutely! I hope that there is more scientific inquiry into stress, though. Uncovering the mental and physiological how’s and why’s could be a huge help. PS. Thanks for commenting, I’ve just started reading your blog and wow, you’ve got a fascinating life story :)

  4. Thanks for the shout out! I think it’s safe to say that like everything else, YDMV. Well researched and written – I feel smarter for reading! And I just want to clarify, this doc also told me I had no reason to test for ketones, ever. Hence, my reluctance to trust his medical knowledge :)

    • YDMV indeed, and like I said above– I hope there’s more research into the how’s and why’s of it. As for the ketone strips….I just can’t wrap my head around that. Of course there’s reason to test for ketones. What if you suspect illness? What if you have a high BG and want to exercise? Can he provide a clear reason why he thinks it’s pointless to check for ketones?

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