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Understanding the Impact of Stress on Blood Glucose and Insulin

Stress is an inevitable part of life, but its effects extend beyond mental strain. When we experience stress, our body responds by releasing stress hormones such as cortisol and adrenaline. These hormones are part of the body’s “fight or flight” response, which historically helped humans survive dangerous situations. However, in our modern world, chronic stress can wreak havoc on our health, particularly on our blood glucose levels and insulin secretion.

How does Stress affect Glucose, and Insulin?

During periods of stress, cortisol and adrenaline cause the liver to release more glucose into the bloodstream to provide immediate energy. At the same time, these hormones can inhibit or insulin secretion or reduce insulin sensitivity, leading to higher blood glucose levels. This mechanism is beneficial in acute stress situations but can be detrimental when stress becomes chronic.

When blood glucose levels are consistently high, the pancreas needs to produce more insulin to help cells absorb the glucose. Over time, this can lead to insulin resistance, where the body’s cells no longer respond effectively to insulin. This condition can cause higher levels of glucose in the blood and eventually lead to Type II Diabetes, weight gain, and other inflammatory conditions.

How Stress-Induced Changes Can Lead to Weight Gain

Even when following a healthy lifestyle with balanced nutrition and regular exercise, chronic stress can undermine weight management efforts. If our body is in a chronic state or stress and/or agitation, it isn’t going to feel “safe”. Elevated cortisol levels can contribute to weight gain in several ways:

1. Increased Appetite: Cortisol can stimulate appetite, leading to increased food intake, especially of high-calorie, sugary, and fatty foods. When you find yourself running through that Dunkin Donut drive-thru for that late afternoon donut after a stressful day, this would be why! Our body uses a lot of fuel during stressful times. Instead of doing inventory and using what we already have, it makes us feel like we need to eat more. Specifically high carb and sugary foods as this gives us the quickest energy.
2. Fat Storage: High cortisol levels promote the storage of fat, particularly in the abdominal area, which is associated with a higher risk of metabolic diseases. I always think of that outside cat that is preparing for a stressful, cold winter by gaining that extra belly fat. They always put on some weight expecting to lose weight over the course of the winter. This makes sense for them, but not for us.
3. Reduced Muscle Mass: Chronic stress can lead to muscle breakdown, decreasing overall metabolic rate and making it harder to maintain or lose weight. This can be detrimental for people as muscle mass is tied to longevity and overall wellness.

The Role of Continuous Glucose Monitors (CGMs)

When weight gain occurs despite healthy lifestyle choices, it may be useful to monitor blood glucose levels more closely. Continuous glucose monitors (CGMs) provide real-time data on glucose levels throughout the day and night, offering insights into how stress and other factors affect glucose metabolism. I have a whole new appreciation for CGMs after using one myself. It provided insight into our my body responds to stressful situations, a poor night of sleep, and my eating choices better than anything else I had tried previously! If using one, be prepared to be frustrated sometimes as things you thought were healthy your body may not respond to them in a healthy manner.

Normal Readings on a CGM

So what are normal CGM readings? A CGM provides continuous readings, typically every few minutes. Normal glucose levels for most people without diabetes are:

• Fasting (before meals): 70-100 mg/dL (this can vary and many CGMs can be individualized)
• Postprandial (1-2 hours after eating): less than 140 mg/dL
• Overall, maintaining a time-in-range (TIR) of 70-140 mg/dL for at least 70% of the time is considered good control.

Your levels can be affected by stress and food, but can also be affected by other things like sauna use and exercise. I always like to remind patients this as they can sometimes see a spike into the 150s during exercise. This is normal as the body is trying to make sure your body has enough fuel to use.

Types of Continuous Glucose Monitors and Their Pros and Cons

1. Freestyle Libre
   • Pros: No fingerstick calibration, 14-day sensor life, easy to use.
   • Cons: No alarms for high or low glucose levels, requires a separate reader or smartphone app.
2. Dexcom G6
   • Pros: No fingerstick calibration, customizable alerts for high and low glucose levels, integrates with various insulin pumps.
   • Cons: Higher cost, 10-day sensor life, requires a transmitter that needs periodic replacement.
3. Medtronic Guardian Connect
   • Pros: Predictive alerts for high and low glucose levels, integrates with Medtronic insulin pumps.
   • Cons: Requires fingerstick calibration, higher cost, 7-day sensor life.
4. Dexcom G7 (this is my favorite and what I use!)
   • Pros: Improved accuracy, no fingerstick calibration, smaller and more discreet, fast warm-up time, customizable alerts, app integration, integration with other devices.
   • Cons: Can be expensive, sensor adhesion (some have allergies), learning curve (lots of information), battery life, data gaps due to transmission error.

How to Get a CGM

Obtaining a CGM usually involves the following steps:

1. Consult Your Healthcare Provider: Discuss your need for a CGM and get a prescription.
2. Check Insurance Coverage: Verify if your insurance covers CGMs and understand the cost implications.
3. Purchase the Device: Buy the CGM from a pharmacy, medical supply company, or directly from the manufacturer.
4. Training: Some CGM providers offer training sessions to help you learn how to use the device effectively.

I highly recommend working with your provider or reputable company (like Signos) that will walk you through the use and reading of your CGM. This will prevent you from getting frustrated and will ensure you get the most out of your CGM.

Techniques and Natural Remedies to Reduce Stress

Now that we know the affect that stress can have on our glucose and insulin levels, managing stress is essential for maintaining balanced glucose levels and preventing weight gain. Here are some techniques and natural remedies that can help reduce stress:

1. Yoga and Meditation: Regular practice can lower cortisol levels, improve insulin sensitivity, and promote relaxation.
2. Physical Activity: Engaging in regular exercise reduces stress hormones and improves overall metabolic health.
3. Mindfulness Practices: Techniques such as deep breathing, progressive muscle relaxation, and mindfulness meditation can help reduce stress.
4. Herbal Supplements: Adaptogenic herbs like ashwagandha, rhodiola, and holy basil can help manage stress and support adrenal health.
5. Adequate Sleep: Prioritizing sleep and maintaining a consistent sleep schedule can reduce stress and improve metabolic function.
6. Balanced Diet: Eating a diet rich in whole foods, healthy fats, and lean proteins can support stress management and overall health.

By understanding the connection between stress, blood glucose levels, and insulin secretion, and by utilizing tools like CGMs, individuals can take proactive steps to manage their health more effectively. Incorporating stress-reducing techniques and natural remedies can further support this journey towards better health and well-being.

Written By: Roxanne Oliver, DNP, APRN, FNP-BC

*The information contained in this post is for information only. It does not replace routine follow-up and/or care with a certified and licensed medical provider

References

American Diabetes Association. (2021). Understanding insulin resistance. Retrieved from https://www.diabetes.org/diabetes/insulin-resistance

Cryer, P. E. (2018). The pathophysiology of hypoglycemia in diabetes. Diabetes Care, 34(Supplement 2), S165-S171. doi:10.2337/dc11-s218

Dedov, I., Maslova, O., & Suntsov, Y. (2020). Continuous glucose monitoring in diabetes management. Diabetes Therapy, 11(3), 509-526. doi:10.1007/s13300-020-00786-8

Fisher, M. (2016). The role of cortisol in stress and the effects on glucose metabolism. Endocrinology and Metabolism Clinics of North America, 45(1), 55-68. doi:10.1016/j.ecl.2015.09.005

Freestyle Libre. (2023). Freestyle Libre 14 day system. Retrieved from https://www.freestylelibre.us/

Dexcom. (2023). Dexcom G6 continuous glucose monitoring (CGM) system. Retrieved from https://www.dexcom.com/

Helgeson, V. S., Escobar, O., Siminerio, L., & Becker, D. (2017). Relation of stressful life events to metabolic control among adolescents with diabetes: 5-year longitudinal study. Health Psychology, 36(11), 1061-1071. doi:10.1037/hea0000491

Medtronic. (2023). Guardian Connect CGM system. Retrieved from https://www.medtronicdiabetes.com/products/guardian-connect-continuous-glucose-monitoring-system

National Center for Complementary and Integrative Health. (2020). Yoga: In depth. Retrieved from https://www.nccih.nih.gov/health/yoga-in-depth

Rawshani, A., Rawshani, A., Franzén, S., Eliasson, B., Svensson, A. M., Miftaraj, M., & Gudbjörnsdottir, S. (2018). Mortality and cardiovascular disease in Type 1 and Type 2 diabetes. New England Journal of Medicine, 376(15), 1407-1418. doi:10.1056/NEJMoa1608664

Thayer, J. F., Yamamoto, S. S., & Brosschot, J. F. (2018). The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. International Journal of Cardiology, 141(2), 122-131. doi:10.1016/j.ijcard.2010.09.047

Van der Kallen, C. J., van Greevenbroek, M. M., Ferreira, I., & Stehouwer, C. D. (2017). The association of central fat mass with all-cause mortality and cardiovascular disease is dependent on inflammatory properties of adipose tissue: The Hoorn study. Diabetes Care, 30(11), 3035-3040. doi:10.2337/dc07-1075