Impact of Stress on Diabetes: Cause, Effects and Ways to Cope

by Dr. Manjunath Malige, Chief Endocrinologist and Diabetologist, Aster RV Hospital
One of the deadliest health conditions in today’s world is diabetes and one of the major causes of blindness, kidney failure, stroke, heart attacks, and limb amputation. According to a WHO report, there was a 5% increase in premature mortality from diabetes between the years 2000 and 2016. Moreover, in 2019, diabetes has been named the ninth leading cause of death with an estimate of 1.5 million deaths directly caused by this metabolic disease, 40% of which occurred before the age of 70. In recent years during enhanced hostility periods, studies have shown stress is one of the formidable causes of diabetes-related morbidities.

In today's fast-paced life, stress has become an unavoidable trespasser in our everyday lives, affecting not only our mental health but also our physical well-being. It has proven to be especially lethal for the pre-diabetic or diabetes-prone population. Recent research shows that although stress is not a direct root of origin for diabetes, it is indeed a very potent contributor to chronic hyperglycemia in diabetes. The COVID 19 Pandemic and the subsequent lockdown measures have had a tremendous effect on lifestyle and diabetes self-management. According to BMJ Open Diabetes Research and Care, the changes due to the pandemic have caused weight gain, less exercise and as result poor glycemic control in diabetic people around the world.  Furthermore, work-related stress factors are associated with diabetes development in workers with reduced glucose tolerance (Journal of UOEH, 2021). For Type 1 Diabetes, mental stress may either increase or decrease blood sugar levels while in Type 2 diabetic people, it mostly increases blood sugar.

How Does Stress Affect Diabetes?

Research has proven that stress has a significant effect on our metabolism as it stimulates the release of various hormones. This can result in elevated blood glucose levels. When our body experiences stress or feels threatened, it reacts and activates a fight or flight response. Meanwhile, the body releases adrenaline and cortisol into the bloodstream, increasing respiratory rates and running the blood to muscles and limbs. Now if a person has diabetes or is prone to it, their body may not be able to process the released glucose. As a result, their body may not be able to convert glucose into energy, causing a build-up of glucose in the bloodstream. And as a result, the blood sugar level rises.

Ways to Cope

In addition to the general stress people experience in this tumultuous world, individuals suffering from diabetes are more prone to experience negative emotions due to the level of tension caused by the disease. To manage diabetes-related stress, an amalgamation of technology and lifestyle changes can prove to be very fruitful.

Stress Management Coaching Interventions: It has been seen that adults with diabetes in developing regions may be unable to afford conventionally available medical care due to financial issues.  In such cases, rational-emotive cognitive behavioural coaching or RE-CBC can be successfully used as a stress management program for assisting adult learners with type 2 diabetes in reducing stress levels. Present studies have shown that adults who went through RE-CBC have demonstrated significantly reduced stress levels as compared to the waitlisted group.

Mindfulness-based Stress Reduction Intervention (MBSR): In a recent study published in the Iranian Journal of diabetes and obesity, 2021, a low-dose MBSR intervention was delivered in a group format over 4 waves, each wave comprising 8 to 10 hours of 8 sessions over 6 to 8 weeks. Most participants of the study reported positive overall experience with low-dose MBSR and a concluding result has shown that it is a feasible method to control glucose levels in Prediabetic and Diabetic people. However, future studies with random samples are required for a more concrete process.

Physical Activity and Psychological Stress Detection: As diabetes is a chronic metabolic disease, constant glucose monitoring helps in predicting the course of future glucose concentration and making informed diabetes management resolutions. The glucose concentration rate depends on several metabolic and psychological factors, eg. physical activity, acute psychological stress, meals and insulin.  Regular physical activity, meditation, therapy and other healthy lifestyle choices as well as informed meal plans and insulin dosing decisions are significant in reducing stress as well as managing diabetes.

Although it is nearly impossible to avoid stress in the world we live in, it is surely manageable. Stress and diabetes both present us with a scary set of challenges, but it is not impossible to lead a healthy and happy life while fighting this disease. Our life has indeed become very fast-paced and stress-inducing. But this fast-paced world has also taken Medical Science to a whole new improved level. With new metabolic and psychological therapies as well as a resolution to follow healthy lifestyle choices can be mammoth assistance in reducing stress and glucose level in diabetic people.