Stress And Blood Glucose Control

Psychological stress has significant effects on the metabolism on individuals without diabetes by increasing counterregulatory hormones, which could result in elevated blood sugars, among other impacts. In type 2 diabetes it is thought that stress can exert an effect on blood glucose control, either directly through these hormones or indirectly by disruption of the diabetes self-care regimen. Although the laboratory and clinical research to date does not appear to support a consistent stress-blood glucose response across all patients, there is evidence that some individuals with diabetes are "stress responders" (43). Individuals with type 1 diabetes may have idiosyncratic responses to stress, with some showing increases in blood glucose levels and others decreases. However, for type 2 diabetes the effects of stress are more likely to result in increases in blood glucose, secondary to sympathetic activity (43,44).

Evidence from animal models also suggests a role for stress in the onset of type 2 diabetes (45). Ineffective coping (e.g., avoidance, denial, detachment, anger) has been shown to be associated with poorer metabolic control in diabetes and adaptive coping (e.g., active problem solving and ability to obtain social support) with a stress-buffering role (46), highlighting the role of patient perceptions of stressful events. It is unclear whether relaxation training (e.g., biofeedback) produces glycemic benefits in type 2 diabetes (47). Generally, there is a paucity of studies on stress in type 2 diabetes.

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