Have you ever asked your doctor about blood glucose fluctuations, and found them talking about stress — when you were expecting the focus to be on your medications? Can it be that stress really has such a big physical impact on your diabetes?

The answer is a resounding YES. Stress can have a huge physical impact on diabetes, because essentially, stress is sugar.

Before we get into the biological nuts and bolts of that, let’s first break down stress a bit.

The American Diabetes Association makes the distinction between physical stress and emotional, or mental, stress. Physical stress happens when the body is taxed by injury or illness, while emotional stress is the type we most often think of: the boss is a jerk, your checking account is on fumes and your car is making that funny noise again, or your insurance doesn’t want to pay for the type of insulin that works best for you. Ugh!

In our modern times, “worries about the coronavirus, the stock market, and the general disruption of life have added to our stress levels, but we know that stress also can make you more susceptible to respiratory illness,” writes Tara Parker-Pope at the New York Times. Not a comforting thought.

One can further break emotional stress into acute stress and chronic stress. Acute stress is being stuck in a traffic jam. Chronic stress is being stuck in a bad marriage — something that is likely to go on for a long time, and take a huge, life-changing effort to relieve.

All of these stressors, physical and mental, short-term and long-term, absolutely have a physical effect on your diabetes, and do so largely though something called the fight-or-flight response. To understand that, we need to consider the early human.

Remember that early humans were pretty much defenseless creatures — no claws, no sharp teeth, no tough hide, not that all that strong, and not the fastest runners. And they lived in constant danger of being attacked by predators. In short, we were ill-equipped to survive. But somehow our species rose to the top of the evolutionary chain, and came to rule the planet.

One key way we did this was through the development of a “biological turbo-charging system” that can — for a short time — make us stronger and faster than we usually are. When confronted with danger, our bodies pump out the hormone epinephrine (also known as adrenaline) that increases strength to fight with, or speed to flee with. Hence the name fight-or-flight.

As Harvard Medical School experts explain, epinephrine triggers the release of sugar (glucose) and fats from temporary storage sites in the body. These nutrients flood into the bloodstream, supplying energy to all parts of the body.

This biological turbo-charger worked great for Paleo people, and probably also for people in the Middle Ages. And it still does work for modern soldiers confronting enemies, or hikers in the wild who encounter lions, tigers, or bears. But there’s a problem. The body can’t differentiate between danger and stress. Both trigger fight-or-flight.

So today’s most common “danger” isn’t wild animals. It’s the letter from the IRS. There’s no quick resolution — no violent fight, no urgent need to run for miles. Instead, we sit in our sedentary homes and workplaces, our bodies surging with sugar, with no way to burn it off.

That’s how stress messes with diabetes. Acute stress floods us with unwanted (and un-medicated) sugar. Chronic stress is like a leaking faucet, constantly dripping extra sugar into our systems. The impact on blood sugar caused by stress is so significant that some researchers feel it serves as a trigger for diabetes in people already predisposed to developing it.

Beyond the pure physical impact of stress, there’s a confounding mental element: If you are stressed out, your mental bandwidth to deal with complex tasks is reduced. You are less organized, energetic and motivated. So naturally, this impacts diabetes control. When people get stressed out, they’re more likely to eat heavy comfort foods, skip difficult tasks or medications, and to basically ignore their diabetes. This is even more significant when it comes to stress’s first cousin: Depression.

Depression’s negative effect on diabetes control is well-documented, and deadly serious.

There’s a big difference between being stressed or burnt out, and being clinically depressed, according to Dr. Bill Polonsky, founder of the Behavioral Diabetes Institute, in this article on mental health and diabetes.

Depression is a clinically diagnosed or diagnosable medical condition, whereas experiencing stress is not. He explains:

  • Stress is sort of what we all live with every day. There are lots of things that cause us stress. Some are related to diabetes, and some aren’t. Many times diabetes makes these normal stressors more stressful or challenging.
  • Diabetes distress is defined as a range of emotional responses to the specific health condition of diabetes. Symptoms vary, but include: being overwhelmed by the burden of managing a chronic illness, being afraid or anxious about diabetes complications and disease progression, feeling defeated and discouraged when glycemic or behavioral targets (whether realistic or not) go unmet despite one’s best efforts.
  • Depression and distress are different. Many people experience both simultaneously, but diabetes distress is much more related to self-management and glycemic outcomes than depression.

Still, “everyday stress” on its own can certainly derail your diabetes management, and research shows it can even weaken your immune system.

So how can you reduce stress so that it has less of an effect on your blood sugar control?

Well, to some extent that depends on the nature of your stress. Anything in life that is stressing you out that’s “fixable,” you should work to fix. That stupid toilet that runs all night and disturbs your sleep? Get it repaired. That’s easy. But sometimes it’s harder: The boyfriend or girlfriend who always puts you down? Time to break up. Not all that easy to do, although it will improve your health on multiple levels.

Meanwhile, things that stress you out that you can’t fix, but that you can avoid, you should avoid. Your sister drives you nuts? You’re not required to visit her, you know.

Lastly, of course, there are things in life that you can’t fix and you can’t avoid, and these you need to develop ways to deal with. Sometimes this involves changing your mental attitude toward it. Other times it’s the use of stress-relief tools, like exercise to burn off that fight or flight sugar, or hot baths and aroma therapy candles to drown the stress so that your body stops releasing the sugar.

Some of the most tried-and-true stress relief tactics are:

  • Exercise of any kind
  • Outdoor activities in the fresh air
  • Meditation
  • Journaling
  • Enjoying soothing music and candlelit atmosphere
  • Spending leisure time with family, friends, and pets

See this list of 16 Simply Ways to Relieve Stress and Anxiety.

Clearly, stress can have a huge impact on your diabetes outcomes. But all of this is not to say that the medications you’re taking aren’t playing a role in your glucose fluctuations. If your medications are poorly matched to your food intake, they can absolutely be the cause of glucose highs and lows.

Still, don’t discount the fact that stress, in your system, has the same impact as sugar. It needs to be respected by people with diabetes just like any other sugar. Its impact needs to be recognized, acknowledged, and dealt with — especially as we’ve entered into a new era of record stress and stressors.