Can stress and anxiety cause high blood sugar

What happens to my blood sugar levels when I’m stressed?

During stressful situations, epinephrine (adrenaline), glucagon, growth hormone and cortisol play a role in blood sugar levels. Stressful situations include infections, serious illness or significant emotion stress.

When stressed, the body prepares itself by ensuring that enough sugar or energy is readily available. Insulin levels fall, glucagon and epinephrine (adrenaline) levels rise and more glucose is released from the liver. At the same time, growth hormone and cortisol levels rise, which causes body tissues (muscle and fat) to be less sensitive to insulin. As a result, more glucose is available in the blood stream.

When you have type 2 diabetes, low blood sugars from too much medication or insulin are a common cause of stress. The hormonal response to a low blood sugar includes a rapid release of epinephrine and glucagon, followed by a slower release of cortisol and growth hormone. These hormonal responses to the low blood sugar may last for 6-8 hours –  during that time the blood sugar may be difficult to control. The phenomena of a low blood sugar followed by a high blood sugar is called  a “rebound” or “Somogyi” reaction.

When you have type 2  diabetes, stress may make your blood sugar go up and become more difficult to control – and you may need to take higher doses of your diabetes medications or  insulin.

During times of stress, individuals with diabetes, may have more difficulty controlling their blood sugars.

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When you first found out you had diabetes, you tested your blood sugar often. Doing so helped you understand how food, activity, stress, and illness could affect your blood sugar levels. By now, you’ve got it figured out for the most part. But then—bam! Something makes your blood sugar zoom up. You try to adjust it with food or activity or insulin, and it dips really low. You’re on a roller coaster no one with diabetes wants to ride.

Do you know all these blood sugar triggers?

Knowledge is power! Look out for these surprising triggers that can send your blood sugar soaring:

1. Sunburn—the pain causes stress, and stress increases blood sugar levels.
2. Artificial sweeteners—more research is needed, but some studies show they can raise blood sugar.
3. Coffee—even without sweetener. Some people’s blood sugar is extra-sensitive to caffeine.
4. Losing sleep—even just one night of too little sleep can make your body use insulin less well.
5. Skipping breakfast—going without that morning meal can increase blood sugar after both lunch and dinner.
6. Time of day—blood sugar can be harder to control the later it gets.
7. Dawn phenomenon—people have a surge in hormones early in the morning whether they have diabetes or not. For people with diabetes, blood sugar can spike.
8. Dehydration—less water in your body means your blood sugar is more concentrated.
9. Nose spray—some have chemicals that trigger your liver to make more blood sugar.
10. Gum disease—it’s both a complication of diabetes and a blood sugar spiker.

Watch out for other triggers that can make your blood sugar fall. For example, extreme heat can cause blood vessels to dilate (widen). That makes insulin absorb more quickly and could lead to low blood sugar. If an activity or food is new, check your blood sugar before and after to see how you respond.

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If you have type 2 diabetes, you know that certain foods — particularly foods that are high in carbohydrates — can send your blood glucose (sugar) level through the roof. But did you know that there’s a long list of other factors, such as too little sleep, illness, even monthly menstrual cycles, that can sabotage your best efforts to stabilize your blood sugar?

High on that list, though you may not be aware of it, is stress.

Whether it’s related to work, to relationships, or to some other aspect of your life, research has continually shown that emotional stress can cause blood sugar to surge, according to the American Diabetes Association (ADA). And because consistent management of blood sugar is the key to living a healthy life with type 2 diabetes, it’s important to understand how stress affects you and to find healthy ways to cope when mental distress mounts.

That’s especially true right now when the novel coronavirus is top of mind and everyone’s stress level is sky-high. In addition to heightening health worries, the COVID-19 pandemic comes with immense economic and daily living stressors. Whether you’ve lost your job, are working from home, helping your kids with e-learning, or quarantined by yourself, it’s natural to feel stress.

As if stress weren’t bad enough on its own, it can contribute to irregular blood-sugar levels.

RELATED: 6 Ways to Reduce Stress With Diabetes

The Effect of Stress on Blood Sugar

Stress triggers an increase in the body's levels of the fight-or-flight hormone cortisol, as if you were under attack, explains Roger McIntyre, MD, professor of psychiatry and pharmacology at the University of Toronto in Canada. In response, the body releases extra energy into the bloodstream in the form of glucose. (That way, in case you are under attack, you have the fuel necessary to fight or flee.)

“When chronically heightened, cortisol works against glucose control even in people who don’t have diabetes,” Dr. McIntyre says. Yet people with diabetes are unable to properly process and store that glucose because of insulin resistance, meaning that glucose accumulates even more in their blood in times of stress.

Everyone gets stressed out at times, but it’s important to understand that there’s a difference between short-term (acute) and long-term (chronic) stress, he says. While life’s inevitable acute stressors — getting stuck in traffic, bickering with a family member — cause a temporary rise in blood sugar, it’s the factors that can lead to chronic stress, such as an unhappy marriage, a cruel boss, or the COVID-19 quarantine, that can cause serious damage.

What’s more, stress can start to undo the routines you put in place to manage type 2 diabetes. “You may start to eat more, change your behavior, or exercise less,” says Renata Belfort De Aguiar, MD, PhD, an assistant professor of medicine in endocrinology at the Yale School of Medicine in New Haven, Connecticut. Campbell agrees: “Not only does long-term stress cause chronic high blood sugar but it can affect how you take care of yourself.” This includes both your physical and mental self.

Diabetes is even considered to be an independent factor in the development of depression, according an analysis published in June 2019 in Preventive Medicine Reviews. That means that if you take two otherwise identical people, the one with diabetes is significantly more likely to struggle with depression.

Is It Only 'Negative Stress' That Affects Blood Sugar?

Even positive life changes can cause blood sugar to swing, says Amy Campbell, RD, a certified diabetes care and education specialist, and a contributor to DiabetesSelfManagement.com. Planning a wedding, moving to a new city, getting a job promotion — such “happy stressors” can also send your fight-or-flight hormones into overdrive.

A past review cited the definition of stress as the “physiological or psychological response to an external stimulus,” regardless of whether that stimulus is good or bad. That means that if you experience a significant change in your life — whether it's positive or negative — it’s a good idea to keep an extra-close watch on your blood sugar.

RELATED: Can Being Stressed Trigger Type 2 Diabetes?

10 Ways to Maintain a Healthy Balance

It's not possible, of course, to eliminate all of life’s headaches. But you can take steps to gain better control over both your blood sugar levels and your stress levels. Start here:

1. When Stress Strikes, Closely Monitor Your Blood Sugar

“When you’re stressed, you should be monitoring and checking your sugars to see if the stress is having an effect or not,” Dr. Belfort De Aguiar says. Simply being aware that stressful situations can affect blood sugar can prepare you to make adjustments. “When you’re under a lot of stress, that’s when you want to be really on top of your blood sugar,” Campbell says. “It’s the time to hone your self-care behaviors.”

2. Fill Your Doctor in on Big Life Changes

If a stressful situation is causing your blood sugar to swing, your healthcare team needs to know. Says Campbell, “Your doctor may temporarily change your diabetes medication or put you on a higher dose. If necessary, he or she can even make a referral to a mental health professional.” Right now, increasingly more primary care physicians, psychologists, and other healthcare professionals are offering telehealth services (covered by insurance the same way in-person appointments are) so that you can get the help you need while maintaining social distancing practices.

RELATED: The Top Telemedicine Apps for the COVID-19 Pandemic

3. If Possible, Eliminate Long-Term Stressors — for Your Health’s Sake 

McIntyre says that too much stress can be a warning that something needs to change. Since long-term stressors affect your long-term blood sugar levels and can cause damage to your overall health, they’re even more worthy of a reevaluation. Is it your job that’s tipping you over the edge? If so, he suggests that you have a conversation with your boss on how to improve your work environment, apply for a transfer, or even start the hunt for a new job.

4. Cut Back on Short-Term Stressors That Can Accumulate

Minor annoyances have only a minor effect on your blood glucose level, but when the annoyances are strung together day after day, that effect can mount, McIntyre says. Be mindful of little things that consistently get under your skin and try to avoid or reduce how often you run into them. For example, if you’re realizing that your highly trafficked commute to work drives you crazy, search for a route with less gridlock, or try getting an earlier start to beat the rush.

RELATED: Stress Can Affect More Than Your Mind

5. Arm Yourself With (Healthy) Quick Fixes

The toll stress takes on your health largely depends on how you react to it, Campbell says. Identify things that help you cool off, and keep them ready-to-go in your back pocket. “Maybe you treat yourself to a massage or a manicure,” she says. “Or maybe you just talk to someone.” Okay, a professional massage might not be possible at the moment, but maybe you have a significant other who can lend a hand. Focusing on your breath is another simple way to calm your mind and body, wherever you are. If you have an Apple device, open the free Breathe app, and let it help you slow and deepen your breath.

6. Practice Mindfulness to Promote a Feeling of Calm

Whether you choose deep-breathing exercises, meditation, or yoga, mindfulness techniques are designed to help you reduce stress.

A short-term randomized controlled trial of 60 people with type 2 diabetes found that those who used mindfulness-based stress reduction techniques saw improved fasting blood sugar and A1C (two measures of blood sugar management) and lower levels of anxiety and depression. Researchers published those results in 2018 in the Journal of Diabetes Research.

Explore a variety of relaxation techniques, Belfort De Aguiar suggests, to find one that works for you. If you have trouble winding down, apps such as Headspace and Calm (which offer free trials) are popular, budget-friendly options for learning how to practice mindfulness.

RELATED: How Diabetes and Anxiety Are Connected

7. De-Stress by Working It Out on a Regular Basis

Physical activity is crucial for people with type 2 diabetes for many reasons. In particular, exercise lowers blood sugar by increasing insulin sensitivity (meaning that the insulin does a better job of processing glucose), according to a joint position statement from the American College of Sports Medicine and the American Diabetic Association. But a good workout is also a great way to blow off steam and rein in stress levels.

Even a quick walk can help — says Campbell, “Not only will getting out and walking remove you from a stressful situation, but it can help improve your mood.” (During COVID-19, just be sure to keep your six feet of social distancing space.)

A study published in June 2018 in the Journal of Exercise Rehabilitation shows that any form of regular movement, regardless of exercise limitations, reduces feelings of stress.

8. Seek Support in Reducing Stress

Living with type 2 diabetes can be intrinsically stressful. Called “diabetes burnout,” overwhelm and fatigue caused by blood sugar testing, carb-counting, insulin administration, doctor visits, and other facets of diabetes management can negatively affect both physical and emotional health, according to the ADA.

Take advantage of your support circle. A family member, friend, or other source of support who will listen to you can make a big difference in the way you manage stress, Campbell says, adding, “You can also talk to a counselor or join an online support community.” The ADA recommends diabetes support groups as a way to connect with people who understand what you’re going through and to share management and coping advice. Check out The ADA Mental Health Provider Referral Directory to find nearby groups that, when the pandemic is over, you can join in person.

RELATED: How Diabetes Support Groups Can Change Your Life

9. Stay Organized to Improve Your A1C and Lower Stress

Staying organized about all the aspects of your care — doctors’ appointments, at-home blood-glucose monitoring, medication schedules — can help with overall diabetes management. According to past research, maintaining solid organizational practices are linked to lower chronic cortisol levels, and finding a diabetes-management routine that works for you will also reduce the risk of health complications.

10. Recharge Your Batteries by Getting a Good Night’s Sleep

Plenty of research shows that lack of adequate sleep can lead to emotional strain — for example, a study published in the Journal of Neuroscience shows that sleep deprivation is a contributing factor to anxiety disorders. What’s more, poor sleep may cause blood sugar levels to swing: In a large study published in Diabetes Care, people with type 2 diabetes who slept less than 4.5 hours per night had higher blood sugar levels than those who slept 6.5 to just over 7 hours a night. Sleeping too much (more than 8.5 hours) was also associated with higher blood sugar. “Getting enough sleep can help your diabetes management,” Campbell says. If you’re not sleeping well at night, discuss the matter with your doctor.

RELATED: Why Sleep Matters When You’re Managing Type 2 Diabetes

The Wrong Way to Deal With Stress When You Have Diabetes

Food, alcohol, self-pity: These unhealthy “coping” mechanisms do more harm than good. “When we’re stressed out, we turn to unhealthy food — comfort food — and we may start eating a lot of sweets,” Belfort De Aguiar says. These are the wrong ways to cope with stress.

Also, find ways to reach out and find social connection with your loved ones. Campbell also warns against keeping your emotions bottled up inside. “Be sure to share your stress,” she says, “even it just means having someone listen to you vent.”

Additional reporting by K. Aleisha Fetters.

For more on dealing with diabetes burnout, check out Diabetes Daily's article "How to Get Out of a Diabetes Rut"!