Stress and Diabetes: How To Manage
Key takeaways:
- Stress affects your blood sugar more than you might think – certain hormones released during stress can cause blood sugar to spike and make diabetes harder to manage.
- Recognizing signs of stress, like irritability, trouble sleeping, and fatigue, is an important part of learning when (and how) to start incorporating stress management techniques into your life.
- Simple habits like moving your body, getting enough sleep, spending time in nature, and talking to someone can help reduce stress and improve diabetes management.
Stress is a normal part of life – it’s your body’s way of reacting to a challenge or threat. When faced with immediate danger, our body goes into “fight or flight response,” which is a survival mechanism that evolved to keep us alert and escape harm.
The problem is, when stress sticks around too long – like during a busy work week or family conflict – it starts to wear the body down. Chronic stress can lead to various health problems, including diabetes. It can also make blood sugar more difficult to manage for people who already have diabetes.
By understanding how stress impacts your blood sugar, recognizing its signs, and incorporating certain techniques into your daily routine, you can work towards managing stress and improving overall wellness in a way that feels sustainable.
How stress affects blood sugar
When stressed, the body releases two major types of stress hormones: Glucocorticoids (like cortisol) and catecholamines (like dopamine and epinephrine). These hormones work to prime your body so that you can escape a dangerous situation.
For example, imagine you’re on a hike and come across a wild animal. Your brain registers that as danger and sends a signal to your adrenal glands to release stress hormones like cortisol and epinephrine (adrenaline). These hormones then cause a cascade of reactions to help your body run the other direction if needed: Your heart rate and blood pressure increase to push blood to vital organs, the airways in your lungs open wider, and blood glucose is released so that your muscles have energy to work at their peak. In these situations, stress can save your life.
The problem is when this same reaction, albeit to a lesser degree, is triggered over a prolonged period of time. Work stress, relationship problems, financial issues, and a myriad of other situations in day-to-day life can cause the body to have the same reaction as running from a wild animal. But, rather than saving your life, it can actually be quite harmful.
Cortisol, for example, increases glucose production while also making it harder for cells to absorb it, which increases blood glucose levels over time. Adrenaline can make your body less sensitive to insulin, which means glucose builds up if you have diabetes instead of going into your cells.
Studies have shown that over time, stress can lead to insulin resistance and may cause type 2 diabetes. While stress may not directly cause type 1 diabetes, research suggests that it may be associated with its onset in people who are already at risk. That’s because stress can disrupt the immune system, increase inflammation, and harm insulin-producing cells in people at risk of type 1 diabetes.
In people who already have diabetes, stress can make it harder to manage. For example, Julie Heverly, senior director of the Time in Range Coalition at diaTribe, shared that she’s noticed sharp rises in her blood glucose levels as a result of the adrenaline released from public speaking at large conferences.
Heverly said she has learned not to pre-treat these spikes with insulin, as the adrenaline rush is too unpredictable and extra insulin could cause a crash in blood sugar. Instead, she tries to balance her carb and protein intake beforehand to avoid going too high, keeps juice nearby in case of a low, and reminds herself to give her body grace in stressful moments.
Dr. Chhaya Makhija, an endocrinologist and CEO/Founder of Unified Endocrine & Diabetes Care, said that stress and diabetes are deeply connected, and she sees the effects of stress on blood glucose levels in her patients with type 1 and type 2 diabetes.
“A classic example is students with type 1 diabetes preparing for exams or job interviews,” Makhija said. “I often have to adjust their insulin for a few days beforehand because their baseline blood glucose runs higher, simply due to stress.”
Heverly’s and Makhija’s stories are a reminder that diabetes itself is a stressful condition to manage. In fact, diabetes distress is a term used to describe the experience of negative emotions that come from the challenges of living with diabetes.
Recognizing signs of stress
The physical and emotional demands of managing a lifelong condition like diabetes can be incredibly overwhelming, but recognizing the common signs that your body is under physical stress is the first step to knowing how to manage it.
“Stress isn't something you can see, taste, or smell, and it isn't something physical that you can grasp or put your hands on,” said James Jackson, director of Behavioral Health and professor of medicine and psychiatry at Vanderbilt University.
While it can be difficult to pinpoint how stress manifests in your body, there are some signs and symptoms to be aware of including:
- Anxiety and irritability
- Difficulty concentrating
- Headaches or other body pains, like an upset stomach
- Trouble sleeping and/or fatigue
- Loss of appetite, or eating more than usual
Makhija reminds us that stress isn’t always bad. “There’s a type of stress response that can actually help us cope with life’s challenges, especially when we have the right mindset and perspective,” she said.
“But what I often see is the other kind of stress – chronic stress that’s unmanaged or misunderstood. This includes ongoing anxiety, sleep deprivation, unaddressed inflammation, chronic pain, or not dealing with the root causes of illness. All of these can lead to prolonged elevations in cortisol, disrupt our circadian rhythm, and significantly affect blood glucose levels,” Makhija said.
Constant stress can worsen existing health issues and lead to increased use of substances like alcohol and tobacco. It can also trigger or worsen mental health conditions such as anxiety and depression, which may require medical attention.
If stress becomes persistent and interferes with daily life, it’s important to talk to a healthcare provider and start implementing changes that can help you manage.
Tips for managing stress
Once you know how to recognize the signs of stress, the next step is finding practical ways to deal with it. The following strategies can help with both feeling better in the moment while also supporting overall health and blood sugar management.
Physical activity
Even at light or moderate intensity levels, physical activity has been shown to significantly reduce stress.
“Exercise is another stress reducer, and the good news here is that it doesn't have to be hugely vigorous. You don't have to run a marathon or work out at a gym until you're ready to drop,” said Jackson. “A gentle stroll in the neighborhood – either by yourself or with a friend – can boost your mood, enliven your senses, and empower you to feel equipped to take on whatever challenges are swirling around.”
While it can be hard to manage swings in blood glucose levels with more intense forms of physical activity, there are ways that people with diabetes can fit in “exercise snacks” throughout their day to help combat stress and improve mental and physical health.
Spending time in nature
If weather permits, getting outside can be a surprisingly effective way to relieve stress – and it doesn’t require a big hike or camping trip to make a difference.
“Studies show that activities that expose you to nature even briefly – things like sitting on the patio surrounded by plants or lingering in the park – can create calm and serene feelings and decrease emotional distress,” said Jackson.
Even just a few minutes outdoors can help shift your mindset, lower stress hormone levels, and improve mood. Whether it's a walk around the block or simply enjoying your morning coffee near an open window, connecting with nature in small, consistent ways can offer a much-needed mental reset, especially on high-stress days.
Prioritizing sleep
Getting quality rest is a fundamental part of managing stress, as it helps regulate mood, improve cognitive function, and restore the body’s systems. For people with diabetes, it can be especially difficult to get a good night’s sleep with device alarms and blood sugar fluctuations. A lack of sleep can also increase your risk of other serious health conditions, like stroke and cardiovascular disease.
Incorporating a sleep hygiene checklist that includes a relaxing bedtime routine, limiting screen time before bed, and avoiding caffeine or heavy meals in the evening can help you reach the recommended seven to nine hours of quality sleep per night. By making sleep a non-negotiable part of your daily routine, you can build greater resilience to stress and enhance your overall well-being.
Relaxation techniques
Incorporating relaxation techniques into your daily routine can be a game-changer when it comes to managing psychological stress. Deep breathing, meditation, and yoga can help you unwind and reset, all while supporting your blood sugar management.
Makhija provided a basic example of a breathing exercise that can help when you feel overwhelmed.
“Breathing in for a count of four, then exhaling for a count of four – or gradually extending the exhale to a count of six or eight. These kinds of techniques are incredibly helpful, even in the moment – like when you’re stuck in traffic, about to walk into a stressful meeting, or seeing a high blood sugar on your monitor. I call these ‘calm-on-the-go’ tools, because you can carry them with you and use them anywhere,” she said. Even in the clinic, Makhija has seen patients bring down their blood pressure just by using these breathing techniques.
A recent review found that breathing practices that lasted at least five minutes, were done regularly, and involved human guidance, are a simple, effective, and accessible way to lower stress and anxiety. Apps like Headspace and Calm can be great tools to guide you through guided breathing and mindfulness exercises, especially if you’re just getting started.
Mindfulness-based practices and meditation have also been shown to improve quality of life with diabetes by reducing diabetes distress, anxiety, depression, and even improving A1C.
Make time for hobbies
Spending time on hobbies you enjoy is also a powerful way to reduce stress and recharge. A meta-analysis of people aged 65 and older found that those who regularly engaged in hobbies reported fewer symptoms of depression, felt healthier, and experienced greater life satisfaction.
Engaging in hobbies doesn't have to take up a lot of time, either – even 15–30 minutes a few times a week can make a meaningful difference. Whether it’s reading a good book, tending to your garden, crafting something by hand, or simply listening to music, these activities can help shift your focus away from stressors and give your mind a break.
Talk it out
Sometimes the best way to manage stress is to simply share what you’re going through. Talking with a friend or loved one can help lighten your emotional load, give you a fresh perspective, and let you feel heard.
If you're not comfortable talking to someone you know, speaking with a mental health professional can provide a safe space and helpful tools for coping. You don’t have to carry everything alone – connection is a powerful antidote to stress.
The bottom line
While you can’t always avoid stress, you can choose how to respond to it. From moving your body and getting outdoors to making time for rest and meaningful connection, staying consistent with stress relief strategies can help you build resilience and create space for more calm in your life.
Managing stress isn’t about being perfect – it’s about finding what works for you and giving yourself the grace to keep going, one step at a time.
Learn more about managing diabetes and stress here: