Diabetes is directly proportional to Stress?
Can stress cause or make diabetes severe? We know that stress can cause all sorts of health problems, but is it possible that it could contribute to the development or enhancement of diabetes. Today we’re going to talk about what stress is? What the stress response is? And we’re going to talk about how all of this relates to the causative factors of diabetes and how it can worsen the condition of an already existing diabetic patient.
I got the idea to write about this topic from a personal experience. My Mom is a patient with mild type 2 diabetes mellitus and we try our best to keep her fasting blood sugar level below 190 mg/dl at least, through prescribed medication, remedies and sometimes long-acting-insulin like Insulin Glargine. One day an incident shocked us, which I cannot discuss, pardon! That was a stressful event for all of us, but it was much more stressful for my Mom, because her condition was getting below the level it was, and when we tested her blood sugar level, it was a whopping 350 mg/dl. So, we immediately got for medical help. The doctor increased the medication and insulin dosage to control the situation and it worked, the blood sugar was down to 260 mg/dl, but after few days, this sudden change in blood sugar contributed to much more severe condition called “Diabetic foot infection”, which is complicated to treat, and it also limits the physical activity of the patient, because it is painful. All the scenario started from that stressful event, it worth discussing stress and its response.
We often hear things about diet, weight and about exercise but very rarely do we hear about stress and most people think of stress as overwhelmed feeling, frustration and having more things to do than there is time in the day then that causes a feeling of stress having multiple things going on at once, which is also right, but stress is much more than that. Stress is anything that increases the demand on the body anytime something happens to the body. When your nervous system detects any sore sort of threat or anything that it has to deal with or pay attention, it creates a stress response and it matters because that’s a physiological reaction that happens in the body.
So let’s discuss the physiological reaction that takes place in a stress condition. In general, stress response starts from our nervous system, it detects the stress and starts sending messages for our body to ramp up its defenses. The adrenal glands have to start working harder. They produce a stress hormone called adrenaline. Adrenaline is an instantaneously acting hormone because there are no synapses between the brain and the adrenal gland so the adrenal gland is in a sense is an extension of our nervous system, there are no connections in between. It has to happen fast, and now when we release some adrenaline then our heart rate, blood pressure, muscle tension, blood LDL cholesterol, and cortisol level goes up. These are the stress responses, at the time if we have any form of significant stress we’re going to exhibit those same behaviors because it’s built-in, we’re wired that way. But the highlight will be on cortisol because of being a link between stress and diabetes.
Cortisol kicks in just a few seconds later the first stuff (Adrenaline rush) happen in milliseconds, but a few seconds later the body also increases cortisol production because when we have stress whether it’s real or imagined, we’re going to want more energy which means more blood sugar. The purpose of cortisol is to increase blood sugar, and why is that in for diabetes? Because it’s about blood sugar, it’s about insulin, and it becomes about cortisol because cortisol raises blood sugar and therefore it also triggers insulin. The thing to understand about stress is that like we said it, we think of stress as emotional stress, but stress is when your physiology responds. We have something called a sympathetic nervous system which initiates all these responses like elevated blood pressure, blood sugar, and hormonal levels.
Stress can also be something that you have experienced recently, or it could be past trauma, and it became a habit that it lasted so long, it became a sort of like your default baseline. These traumas could be of physical, emotional trauma or it could be a chemical trauma could be a long-standing exposure to something toxic so any of these things can cause a sympathetic reaction, a fight/flight response.
Sometimes, a response occurs from chronic stresses that change physiology and go by completely unnoticed either because we’re not paying attention or because it is just so familiar to us like it was already there, and we develop a chronic stress pattern also called sympathetic dominance. We tend to produce cortisol at a higher level for longer periods like higher baseline activity in this sympathetic dominance.
When cortisol acts in, its job is to decrease the utilization of glucose and makes it happen by resisting the binding of insulin with the cell so that glucose cannot be taken up by the cell for energy production, this is called insulin resistance. Even though cells will not take up glucose for metabolism due to insulin resistance, cortisol acts on the liver to shift gears from carbohydrates metabolism to fats metabolism, protein metabolism, and gluconeogenesis to pile up glucose in the bloodstream hence raising the blood sugar. The rise in blood glucose, in turn, stimulates secretion of insulin. The increased blood insulin, however, is not as effective in maintaining blood glucose as they are under normal conditions. High levels of cortisol reduce the sensitivity of many tissues, especially skeletal muscle and adipose tissue, to the stimulatory effects of insulin on glucose uptake and utilization. During this period, when the blood sugar level is 50 percent or more above than normal then it is called adrenal diabetes because the tissues and cells are resistant to the effects of insulin. And when the stress is removed then everything gets backs to normal gradually.
But in the case of sympathetic dominance, cortisol keeps on raising the blood sugar and insulin level in the blood. Over time, the pancreas struggles to keep up with the high demand for insulin, glucose levels in the blood remain high, and the cells cannot get the sugar they need and eventually leads to diabetes mellitus type 2. For a patient with diabetes type 2, cortisol inducing stress is life threating even though there is no sympathetic dominance. In case of sympathetic dominance, the pancreas can get exhausted of overproduction of insulin and can lose its ability to secrete more insulin and leads to diabetes type 1. Hence impact of the stress matters.
Studies have shown that cortisol and high blood sugar level can suppress the wound healing process and compromises the immune system as well. In a short time, cortisol can boost our immunity by limiting inflammation. But over time, our body can get used to having too much cortisol in your blood and decreases the body’s white blood cells that help fight off infection, which makes a diabetic patient vulnerable to a diabetic foot infection. About 15 percent of diabetic patients develop diabetic foot infection, and most of the cases lead to amputations. So, we can say that the more stress you take on yourself, the more you are vulnerable to a disorder like diabetes, or if you are already dealing with a problem then stress can worsen it whether it is diabetes, arteriosclerosis or whatever, stress is directly proportional to stress.
Today, we live in a fast-paced and stressful world but this world is not valuable than our health. We have seen what stress can do to our health, so it is good to learn to manage stress and live a healthy lifestyle to stay away from complications like diabetes. We can manage stress by avoiding Caffeine, Alcohol, and cigarettes because they can raise cortisol level in our blood. Indulging in physical activities like exercising, and taking parts in athletics can solve most of the health problems. Have a positive social circle, talking to someone can work by either distracting you from your stressful thoughts or releasing some of the built-up tension by discussing it. Try relaxation techniques like meditation and yoga, increase your spiritual powers, learn how to find solutions to your problem, and most importantly manage your time. At times, we all feel overburdened by our ‘To Do’ list and this is a common cause of stress. Accept that you cannot do everything at once and start to prioritize and diarize your tasks, and in the end try to read some good books like The Boys in the Boat by Daniel James Brown and 12 Rules for Life by Jordon B. Peterson.
References:
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· Taves MD, Gomez-Sanchez CE, Soma KK. Extra-adrenal glucocorticoids and mineralocorticoids: evidence for local synthesis, regulation, and function. Am J Physiol Endocrinol Metab. 2011 Jul;301(1):E11–24. doi: 10.1152/ajpendo.00100.2011. Epub 2011 May 3. PMID: 21540450; PMCID: PMC3275156. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275156/
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· Itani, H.E.S., Gandoura, N.A., Ahmed, T. and Ahmad, R.M., 2015. Impact of psychological stress on wound healing for patients with diabetic foot ulcers. Diabetic Foot, 1(1). URL: https://pdfs.semanticscholar.org/fe11/b5533ef6ddb57403d10d503e5369adf07e8b.pdf
· © SkillsYouNeed (2017): https://www.skillsyouneed.com/ps/stress-tips.html
· Introduction To The Human Body, 10th Edition, Chapter 16
· Guyton and Hall Textbook of Medical Physiology, 13th edition, Chapter 78, 79
