Type 1 Diabetes and Stress: Are Your Blood Sugars Safe?

There’s not a week that goes by for most of us that we don’t experience some type of stress!

If you’re following this series of posts, you now know how diet, sleep, and lack of physical activity may impact insulin resistance, which then likely makes it more difficult for you to manage your blood sugars successfully.

Next on our list to check off is the domino effect stress may cause, leading to hyperglycemia!

Keep reading to learn why stress may be holding you back from successful blood sugar levels.

C’mon, and let’s go!

The Relationship Between Chronic Stress and Poor Blood Sugar Control

Chronic stress, which means long-term or constant stress, can affect your body in many ways. These stressors can come in different forms, such as:

• Mental
• Emotional
• Physical
• Physiological

In many cases, all of these may be going on at once, which can make things a bit more problematic!

One of the ways it can harm your health is by causing problems with how your body handles sugar (aka glucose).

Imagine your body is like a machine that needs sugar to power on and run effectively.

Insulin is a hormone that acts like a key to let sugar into your cells so they can use it for energy.

When everything works well, insulin helps sugar enter your cells, and your blood sugar levels stay healthy.

But chronic stress can mess up this process!

When you’re constantly stressed, your body releases stress hormones more frequently.

These hormones can interfere with insulin’s job.

It’s like the lock and key system isn’t working properly.

Your cells become less responsive to insulin, so they don’t let sugar in as easily.

As a result, your blood sugar levels can rise, leading toA coup hyperglycemia, which means you have too much sugar in your bloodstream.

This can be a problem because high blood sugar over time can damage your body’s organs and increase the risk of diabetic complications or even a shorter life span.

Chronic Stress and Metabolic Syndrome

A couple ways chronic stress can negatively impact the body is by contributing to insulin resistance and high blood sugars (aka hyperglycemia), which are key factors in developing metabolic syndrome and other diabetic complications.

Let’s explore the various components of chronic stress and some of the specific mechanisms that lead to insulin resistance and high blood sugars.

Understanding Chronic Stress

Chronic stress refers to persistent, long-term stress that an individual experiences over an extended period.

Common examples include:

• work-related pressures
• financial difficulties
• relationship problems
• chronic health conditions (like poor blood sugar management!)
• family issues
• physical injuries, ailments, and even exercising too hard, too often

Chronic stress differs from acute stress, which is a short-term response to a specific stressor, like a sudden threat or danger.

Chronic stress can affect the body and mind in numerous ways, including hormonal, neural, intestinal, and immune imbalances.

Hormonal Changes, Insulin Resistance, and Unstable Blood Glucose Levels

In my sleep and physical activity post, I go over how these lifestyle factors may cause a domino effect of negative hormonal reactions that may influence troubled blood sugars.

Whelp, you can now add chronic stress to this list, too!

One of the central mechanisms through which chronic stress can lead to insulin resistance involves alterations in hormonal balance, particularly the release of stress hormones like cortisol and epinephrine (aka adrenaline).

Here’s how everything goes down:

Hypothalamus-Pituitary-Adrenal (HPA) Axis Activation

When a person experiences stress, their body activates the HPA axis, a crucial stress-response system (1).

The hypothalamus in the brain releases corticotropin-releasing hormone (CRH), which then signals the pituitary gland to release adrenocorticotropic hormone (ACTH).

ACTH, in turn, stimulates the adrenal glands to produce and release cortisol, often referred to as the “stress hormone.”

Cortisol and Impaired Blood Sugar Control

Cortisol plays a central role in regulating glucose metabolism in the body.

Under normal conditions, cortisol helps maintain blood sugar levels by increasing glucose production in the liver and reducing glucose uptake by the muscle and fat cells, while stoping insulin release.

This is an adaptive response that provides extra energy during stressful fight-or-flight situations.

However, when chronic stress leads to sustained elevated cortisol levels, it can lead to several problems, such as (2):

• Insulin Resistance

We now know cortisol can interfere with insulin function in the muscle and fat cells.

It makes these cells less responsive to insulin’s signal to transfer glucose from the blood to the cells, leading to hyperglycemia.

• Increased Gluconeogenesis

Gluconeogenesis normally occurs during fasting states when no dietary source of glucose can be found and blood sugars are dropping (3).

In a healthy, non-diabetic, the liver will release these glucose stores to ensure blood glucose levels are balanced.

The kidney also helps in gluconeogenesis but in much smaller amounts.

If too much is released, a non-diabetic will eventually lower blood sugar levels with their own insulin production.

However, among type 1 diabetics, there is no internal blood sugar balance due to our inability to produce enough insulin.

Cortisol stimulates the liver to produce more glucose through gluconeogenesis.

If a type 1 diabetic isn’t aware of this, they may not have enough insulin injections to properly respond to it.

To make matters worse, it can be very difficult to measure how much chronic stress may influence your blood sugars with accuracy.

As a result, chronic stress may now lead to additional glucose entering the bloodstream, further contributing to insulin resistance and hyperglycemia.

Adrenaline and Glucose

Chronic stress can also lead to increased release of epinephrine/adrenaline, another stress hormone.

Epinephrine can raise blood sugar levels by promoting gluconeogenesis and reducing glucose uptake by your body tissues as cortisol does (4).

As a result, chronically elevated epinephrine levels may now help cortisol fuel up more insulin resistance. Consider it like pouring gasoline on a fire!

Inflammation and Insulin Resistance

I’ve shared in other posts the one common thing involved in any sickness, disease, or ill condition is chronic inflammation.

Its negative impact on blood sugars is something that should not be ignored.

Unfortunately, chronic stress is just another way to activate this inflammatory response.

Inflammation is part of the body’s natural defense mechanism against harmful stimuli, such as infections and injuries.

However, when inflammation becomes chronic, as is often the case with chronic stress, it can have detrimental effects on insulin function, such as (5):

Release of Pro-Inflammatory Cytokines

Cytokines are small signaling proteins that help cells communicate and coordinate immune responses and inflammation in your body.

Chronic stress can lead to the release of pro-inflammatory cytokines, which are signaling molecules involved in the inflammatory response.

These cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), can interfere with insulin signaling pathways in muscle, liver, and fat cells.

This interference plays a significant role in the development of insulin resistance.

Interference with Insulin Signaling

Pro-inflammatory cytokines can activate a series of molecular pathways known as the JNK and IKK pathways.

These pathways can phosphorylate (chemically modify) key proteins involved in insulin signaling, disrupting the normal response of cells to insulin.

The JNK and IKK pathways are like roadblocks in the body’s insulin signaling system.

Imagine our insulin-key example again.

However, when the JNK and IKK pathways are activated, it’s like these roadblocks appear, preventing the key (insulin) from working correctly.

In the case of JNK, it triggers signals that tell our cells to resist insulin’s instructions.

It’s like someone trying to change the locks on the doors, so the insulin key doesn’t fit anymore leading to elevated hyperglycemia risk.

Similarly, IKK sends signals to activate certain proteins that interfere with insulin function.

As a result, insulin resistance develops, making it more challenging for cells to take up glucose in response to insulin.

More gasoline, anyone?

Behavioral and Lifestyle Factors

Chronic stress can influence behaviors and lifestyle factors that contribute to insulin resistance and hyperglycemia.

People under chronic stress may be more likely to engage in unhealthy coping mechanisms, such as:

Unhealthy Eating Habits

Stress can lead to emotional eating or cravings for sugary and high-calorie foods (6).

These poor dietary choices has a strong association in elevated blood sugar levels.

Physical Inactivity

Chronic stress may reduce a person’s motivation and energy levels, leading to decreased physical activity (7).

Regular exercise is essential for maintaining insulin sensitivity, so being a couch potato can worsen insulin resistance.

Disrupted Sleep Patterns

Stress can interfere with sleep, leading to insufficient or poor-quality rest (8).

We know from part 3 that sleep deprivation can impair glucose metabolism and insulin sensitivity.

Smoking and Alcohol Use

Some individuals turn to smoking or alcohol as coping mechanisms for stress, and these substances can negatively affect insulin sensitivity and blood sugar control, as well (9).

Sympathetic Nervous System Activation

Chronic stress can lead to overactivity of the sympathetic nervous system (SNS), which is responsible for the body’s “fight or flight” response to stressors.

SNS activation can affect insulin resistance and glucose regulation with:

Increased Epinephrine Release

The SNS stimulates the release of epinephrine, which, as mentioned earlier, can promote the release of glucose from the liver and kidneys to reduce glucose uptake from peripheral tissues, contributing to insulin resistance.

Activation of the Renin-Angiotensin System (RAS)

Chronic stress can activate the renin-angiotensin system, which plays a role in regulating blood pressure and fluid balance (10).

Components of the RAS, such as angiotensin II, have been linked to insulin resistance.

Sympathetic Innervation of Adipose (Fat) Tissue

The SNS can directly innervate (connect with) adipose tissue, leading to the release of free fatty acids into the bloodstream.

These free fatty acids can impair insulin action in muscle and liver cells (11).

Psychological Factors

Chronic stress can also have psychological effects that contribute to insulin resistance and hyperglycemia by enabling:

Depression and Anxiety

Chronic stress is a risk factor for mood disorders like depression and anxiety (12).

These conditions are associated with changes in hormone levels we’ve discussed that may worsen insulin resistance.

Poor Adherence to Medications and Self-Care

Individuals under chronic stress may have difficulty adhering to medication regimens and self-care practices, such as monitoring blood sugar levels and following dietary recommendations.

Gut Dysfunction

Chronic stress can significantly impact multiple bodily systems, including the gut, and lead to insulin resistance and hyperglycemia.

Here’s a more detailed explanation of how this process unfolds:

Stress Response

When we experience chronic stress, our body enters a constant state of alertness.

The brain signals the release of stress hormones like cortisol and adrenaline.

This response is meant to help us deal with immediate threats, but chronic stress keeps these hormones persistently elevated.

Gut-Brain Axis Activation

The gut and brain are closely connected through the gut-brain axis, allowing them to communicate.

Stress activates this axis, and the brain’s response can impact the gut in several ways.

I go into more detail on how the gut-brain axis and stress may impact type 1 diabetes in this post.

Gut Microbiota Imbalances

Stress hormones can disrupt the balance of our gut microbiota, which are the trillions of microorganisms residing in our intestines.

Chronic stress can shift this balance, leading to gut dysbiosis.

Dysbiosis means there’s an unhealthy shift in the composition of gut microbes, with potentially harmful species taking over.

In other words, there are more bad gut microbes than good ones, which may cause a host of problems including but not limited to immune dysfunction!

You can read more about type 1 diabetes and gut dysbiosis here.

Gut Inflammation and Permeability

Dysbiosis often leads to gut inflammation and increased permeability of the intestinal lining, a condition known as leaky gut.

This heightened permeability allows substances like bacterial toxins and undigested food particles to enter the bloodstream.

You can explore more factors that influence leaky gut and its association with type 1 diabetes in this article.

Systemic Inflammation

As these toxins and particles make their way into the bloodstream, they can trigger systemic inflammation throughout the body, affecting organs and tissues far from the gut, including the liver, muscles, and fat tissues.

Insulin Resistance Development

Chronic inflammation plays a pivotal role in disrupting insulin signaling pathways in muscle, liver, and fat cells.

As a result, these cells become less responsive to insulin, leading to insulin resistance.

When cells don’t respond properly to insulin’s instructions, they don’t efficiently take in glucose from the bloodstream, causing hyperglycemia.

Hormonal Changes (Again!)

Stress can also directly interfere with hormone regulation, including insulin.

Elevated stress hormones can disrupt the body’s ability to regulate blood sugar, further contributing to hyperglycemia.

Feedback Loop

Elevated blood sugar levels can create a feedback loop, exacerbating the stress response and perpetuating the cycle of chronic stress, gut dysbiosis, inflammation, insulin resistance, and hyperglycemia.

This complex interplay between chronic stress, gut health, inflammation, and insulin resistance highlights the importance of managing stress and promoting a healthy gut to maintain optimal blood sugar levels.

Strategies like stress reduction techniques, regular exercise, a balanced diet, and probiotic-rich foods may help mitigate the negative effects of chronic stress on our overall well-being.

In summary, chronic stress may lead to gut dysfunction that may also cause the previously mentioned cascade of inflammation, hormone disruption, and vicious cycle of insulin resistance worsening.

All of this may lead to more difficult ways in trying to control your blood sugars!

Socioeconimc Factors of Health

I’m hoping you’re now starting to see a trend in how it’s not just one thing that makes blood sugars difficult to manage.

It’s a lifestyle.

It’s intention.

Better blood sugars don’t just happen by accident or by just having “enough” insulin!

I know that was a lot to take in with how many different ways chronic stress may influence unstable blood sugars but I want you empowered with how these strings may be pulled!

If you’d like to empower someone else with this knowledge, please share this post with them.

And if you’d like a deeper dive into how chronic stress directly impacts your gut health, you may check that out here.

Summary

• Stress comes in many forms. Not the least of which include: emotional, mental, physical, and physiological. Physiological stress is the more consistent form of stress among those with autoimmune conditions.
• Chronic inflammation and disrupted cortisol levels are present in every illness, sickness, or disease.
• Specific ways chronic stress affects those with blood sugar disorders are:
  • Increasing blood sugars due to cortisol (stress hormone, among others) activating the release of stored glucose from the liver. If this is done routinely, the long-term effects cause or worsen insulin resistance.
  • Impairing a host of hormones that are connected to insulin resistance.
  • Overactivity by the immune system and your “fight or flight” response can also induce insulin resistance and affect your gut health.
• Chronic stress, regardless of its origin, can also influence many behavioral choices that can negatively impact optimal BG management.

 

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