- Psychological stress and poor sleep impair the body's glucose and insulin regulation
- Chronic stress activates hormones that reduce insulin sensitivity, raising diabetes risk
- Sleep deprivation disrupts glucose tolerance and increases fasting glucose and insulin levels
For years, we've been told that diabetes is all about diet and genetics. And it is. But it's not the whole story. There's a growing and consistent body of scientific evidence that shows that psychological stress and disturbances in sleep actively work against the body's handling of glucose and insulin. In other words, two things that many of us just dismiss as a nuisance, stress and poor sleep, aren't just bad for our moods, they also create a biological environment that puts us at risk for developing type 2 diabetes, or make it harder to control our blood sugar if we already have the condition.
How does this happen?
When the body perceives a threat, its major stress systems, primarily the hypothalamic, pituitary, adrenal (HPA) axis and the sympathetic nervous system, are activated. These systems release hormones such as cortisol and adrenaline. These hormones trigger an elevation in blood sugar level in order to supply energy rapidly.
This is great for a sudden scary situation but if the stress is continuous (work stress, taking care of someone, constant anxiety), the cells' insulin sensitivity decreases: they no longer react properly to insulin and glucose levels eventually rise. A number of reviews suggest that stress patterns over a long time are connected to increased insulin resistance and thus, elevated risk of diabetes over time.
The other stealthy offender is sleep. Sleep restriction, disrupted sleep, and irregular sleep timing all compromise glucose tolerance and insulin sensitivity, sometimes within days. Both laboratory research and population research have found that even a partial restriction of sleep increases fasting glucose and insulin levels; over time, this leads to higher HbA1c and an increased risk of developing type 2 diabetes. In other words, when you don't get good sleep, your body just isn't as good at handling the sugar you put into it.
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There's also a vicious cycle here: stress exacerbates sleep problems, poor sleep contributes to stress, and both conditions fuel unhealthy behaviours, staying up late to snack, forgoing exercise, reaching for caffeine or alcohol, which in turn disrupt blood sugar. Indian physicians and health writers have pointed out this cycle again and again: the urban lifestyle, working long hours and getting poor sleep, is now known to be a contributor to the growing diabetes epidemic in India. You can't just bail out a leaky boat while the hole is still there.
What does the evidence say about fixing this?
Two encouraging things:
- Some of these effects are reversible; improving sleep and managing stress can definitely make a difference in insulin sensitivity and glucose control. Sleep extension trials have shown positive results in glucose metabolism, and stress management programs have been shown to decrease fasting glucose and HbA1c levels.
- The pathophysiology is understood to the point that something can be done; assessing sleep quality and evaluating for anxiety and depression should be a part of diabetes management.
Steps to be taken by the patients and healthcare providers
Sleep needs to be treated as if it were another form of medicine. Try to have regular bedtimes and get between 7 and 8 hours of sleep for most adults. Eliminate the use of screens an hour before going to bed. Specialist advice should be sought for shift workers because circadian misalignment is a serious metabolic risk.
Do not wait to stress before you do something about it. Deep breathing exercises alone, a couple of minutes of mindfulness and some quick cognitive strategies can result in a lowered level of cortisol that is released every day. If anxiety or depression is a problem, CBT therapy, together with medications, can be used if it is necessary.
Make working out and following a daily routine your top priority. Research has shown that regular exercise not only enhances the body's response to insulin but also prevents the body from overreacting to stress. Taking a short walk after having a meal has also been found to be beneficial in reducing blood sugar levels.
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Health care providers should always discuss the issues of sleep and stress in the context of diabetes care. Insomnia, mood disorders, and chronic stress should be evaluated and referred to a specialist as and when needed. A combination of lifestyle changes, psychological interventions, and pharmacologic management would provide the most effective results. These small changes in sleep and stress management, and increased physical activity would improve glycaemic control greatly.
Blood sugar is not just a figure on a test result. It reflects lifestyle, biology, and psychology. Even though diet and drug management are the primary focus, if you also get sleep and stress management, you have a huge contributor to poor control that is modifiable but neglected.
(By Dr. Narendra BS, Lead Consultant - Endocrinology & Diabetology, Aster Whitefield, Bengaluru)
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