For many years, the medical and scientific communities have acknowledged that there is a relationship between stress and diabetes. Unfortunately, studies examining how and why stress contributes to the development and mismanagement of diabetes have been largely inconclusive. Nonetheless, there are many promising theories illuminating the link between these two conditions.

Stress, defined as a physiological or psychological response to external stimulus, has been linked to the onset of diabetes as far back as the 17th century. Later research asserted that stressors, which could include loss of family members or workplace stress, are related to the onset of both Type 1 and Type 2 diabetes.

A 1995 study found that negative stressors experienced in the first two years of life could increase the risk of Type 1 diabetes in children, alongside additional factors like behavioural issues and a chaotic family environment. A 2000 study also found a link between stress and Type 2 diabetes, going so far as to take into consideration risk factors such as education, physical activity, and alcohol consumption. The latter study focused on subjects whose diabetes was previously undetected, eliminating the possibility that the diabetes diagnosis itself influenced the onset of stressful experiences.

With the relationship between stress and diabetes well documented, many studies began to focus on the physiological effects of stress and how these might be responsible for an increased risk of the disease. A 1997 study by Bjorntorp posits that the psychological effects of stress, such as feelings of defeatism and helplessness, activate the hypothalamic-pituitary-adrenal (HPA) axis. This activation leads to endocrine abnormalities like high levels of cortisol and low levels of sex steroids, which interfere with healthy insulin activity.

The relationship between stress and increased levels of cortisol is another area of interest when it comes to the onset of diabetes. Cortisol is a hormone that is released in emergency situations. It gives the body a burst of energy that, in theory, is supposed to help us escape the situation that spurred the physiological response. However, when cortisol is released due to stress it is not adequately burned off.

Consistent stress leads to consistently high levels of cortisol, which have been shown by studies to have a damaging effect on the brain, resulting in the pre-frontal cortex shrinking and the amygdala expanding. These parts of the brain are responsible for managing emotions like pleasure and fear, and their re-wiring due to cortisol can increase instances of mental illness and depression.

Stress, depression, and other mental illnesses have been known to affect a person’s diet, as food can become a coping mechanism. This is another link between stress, cortisol and the development of Type 2 diabetes, as an unhealthy and unbalanced diet is one of the disease’s leading risks. Cortisol is also physiologically and psychologically linked to weight gain and increased abdominal fat, two aspects of metabolic syndrome that can increase risk of Type 2 diabetes.

The release of cortisol spurs the production of energy into overdrive. The body responds by breaking down protein and carbohydrates, increasing the production of glucose. This process of burning energy can lead to cravings for high-sugar, high-fat foods. It also increases insulin resistance, which is a key factor in the development of Type 2 diabetes.

Another physiological link between stress and diabetes is connected to the brain’s ability to manage anxiety and the metabolic pathway that causes inflammation. A Rice University study found that people with low inhibition, or attention control, were more likely to develop diabetes than those with high inhibition.

Low inhibition is associated with higher levels of anxiety, and anxiety causes the production of cytokines. Cytokines cause inflammation and signal the production of proteins called interleukin-6 (IL-6). IL-6 is responsible for stimulating immune response and healing and has long been connected to increased risk of high blood sugar levels and diabetes.

Though much research is needed to fully explore the relationship between stress and diabetes, there is a strong link between the two that must be acknowledged. Moving forward, studies suggest that medical professionals and diabetes specialists must take external stressors such as poverty, racism, work environment, family life, and other social determinants of health into consideration when preventing and treating diabetes.

Disclaimer: Please note that the contents of this community article are strictly for informational purposes and should not be considered as medical advice. This article, and other community articles, are not written or reviewed for medical validity by Canadian Insulin or its staff. All views and opinions expressed by the contributing authors are not endorsed by Canadian Insulin. Always consult a medical professional for medical advice, diagnosis, and treatment.