The Harvard medical Dictionary defines stress as:

stress: An innate survival response in which certain hormones are released, increasing blood flow to the brain or heart. The stress response leads to an energy surge, enabling a person to flee dangerous situations. Ongoing stress, however, can sap energy and damage health.

And the same dictionary defines stressors as: Stressful events or circumstances that may be real or perceived threats to equilibrium and well-being.

As we can see from these definitions stress can have benefits to our health and well being. Stress keeps us safe, it drives us to perform in competitive settings and gives us thrills of joy and fear to keep us safe.

 

Forms of Stress

We will examine the physiologic impacts of stress on diabetes management as well as psychological impacts. We will also address the impact of acute stressors, those lasting a short time (less than 12 hours) vs chronic stressors (those that continue for days or longer).

Impact of stress on diabetes     Physiologic impact of stress     Psychologic impact of stress   Stressors     Acute     Chronic

 

Acute Stress Management in Diabetes

Physiology: Acute stress and its impact on blood sugar levels

When we are under acute stress our body has a swift survival response. We’ve all heard of the “fight or flight” response mechanisms—and these are engaged when we are under acute stress. In the modern world these are rarely actual physical threats, but near-miss auto accidents, sports injuries or even competitive sports simulate this survival response, even when no actual risk or harm to our bodies is present. Modern humans have also developed a strong connection to our emotional and idealogic selves—and this causes us to have the same stress response to emotional, idealogic or financial threats that we would once have had only to physical threats.

Fight or Flight Sources •Accidents •Violence •Competition •Confrontation •Sudden financial change •Test anxiety •“white coat syndrome” •Running late

 

Adrenal Response

Stress leads to the hypothalamus release of a factor (“corticotropin-releasing factor” or CRF) that leads to the release of adreocorticotropin. This leads to the adrenal release of glucocorticoid hormones, including cortisol.

In acute stress adrenal release is the primary physiologic cause for blood sugar impact. Adrenal response reduces glucose metabolism in favor of lipid and protein metabolism. It also triggers a release of stored glycogen from the liver to fuel the fight or flight response. We also see a marked reduction in sensitivity to insulin during a stressful episode.

•Elevated heart rate •Rapid shallow breathing •Blood flow shunted to core •Hepatic Glucose release •Glucagon release •Insulin resistance •Rise in blood sugar