While it is well known that India has the unfortunate distinction of being the diabetes capital of the world, and genetics, diet, exercise are implicated in its causation and progress, what needs to be better understood is the undeniable link between chronic stress and the development (or worsening) of Type 2 diabetes. Often referred to as stress-induced diabetes, the connection links psychological and physiological stress with a breakdown in glucose metabolism. The effect that stress hormones have on the functioning of the pancreas and other metabolic processes is complex yet crucial.
The human body’s innate response to any disruptive event (whether physical, emotional or environmental) is hard-wired to be a fight-or-flight one. This is what we normally refer to as the stress response. The sympathetic nervous system controls this response through the release of hormones like cortisol and adrenaline. These increase glucose levels in the blood, in a bid to provide energy for the fight or flight. Simultaneously, there is a down-regulation of insulin receptors to avoid rapid glucose elimination from the blood stream. When this stress response is temporary, this does not cause any long-term impact on metabolism.
However, if the stress is prolonged, it leads to a persistent secretion of cortisol, resulting in elevated high blood glucose, insulin resistance, and inflammation. Over time, these factors increase the risk of developing and worsening diabetes.
Pancreatic function in diabetes is already compromised by inadequate or ineffective insulin production. High cortisol levels reduce the sensitivity of cells to insulin, prompting the pancreas to secrete more insulin and over time, this leads to decline in normal pancreatic function and inflammation.
Recent research proves that this link between stress and diabetes is strong. One study cites a 45% higher risk of developing type 2 diabetes in those who undergo chronic stress. Other studies have implicated stress in contributing to hypertension, higher mid-segment obesity and abnormal cholesterol levels, along with high blood sugar – a condition doctors refer to as metabolic syndrome – to which Indians are genetically prone.
Obviously, this leads to reduced productivity, higher number of sick days, absenteeism, presenteeism and an unfavorable impact on professional and personal quality of life.
The lifestyles of urban India are laden with constant stress. It is estimated that one-third of all Indians are impacted by stress and anxiety. With the Indian Council for Medical Research declaring that 101 million diabetics and 136 million additional live in India, the role that urban stress plays cannot be overstated and the potential numbers that would be added to these populations could be catastrophic.
Unfortunately, it is not possible to eliminate all stress nor to eliminate all diabetes. What can be and needs to be done increasingly is to ensure stress management. This will help in ensuring that the body and mind remain in prime condition to deal with the deleterious effect that stress play on the body. Some of the techniques that help in better response to stress-induced increases in blood glucose are:
- Regular exercise: Physical activity helps to reduce cortisol levels, improve insulin sensitivity, and lowers blood sugar. Walking, running, swimming or cycling can be especially beneficial.
- A healthy diet that cuts down on processed foods that contain added sugars, and includes fresh fruits, vegetables, lean protein and micronutrients can help optimum maintain blood sugar levels.
- Sleep – no element of a healthy lifestyle is more ignored than the necessity of 7-9 hours of quality sleep. Sleep deprivation increases cortisol levels.
- The practice of mindfulness, which includes self-awareness, meditation and deep-breathing exercises, help lower cortisol levels, increases the ability to respond favorably to stress, and improves emotional well-being.
- Stress is not an individual problem nor is the preparation for responding to it. Conversations with and confiding in family, friends, or even mental health professionals can help alleviate stress.
We live in a world where there is a constant barrage of stress-inducing events and situations coming at us from a multitude of sources. Our inability to deal with these is affecting health and wellbeing at a large population level. Understanding stress, its link with diabetes and adopting a holistic approach to health care is needed urgently.
(The views expressed are personal)
This article is authored by Dr Vikram Vora, medical director and chief health officer, International SOS.
