Why does stress make my blood sugar drop?

Check out this quote from WebMD, "Stress can increase levels of hormones in the body, particularly cortisol, which can make blood sugar rise."

"Hormone release is part of the body's fight-or-flight response, which readies it to take action at the first sign of trouble -- or bolt in the other direction. Cortisol and other hormones release a surge of energy in the form of glucose (sugar), which the body can use to fight or flee."

"That rush of glucose is no problem if your body's insulin response is working correctly. But for people with diabetes, whose bodies can't move glucose as efficiently into cells, it leads to a buildup of sugar in the bloodstream."

So, I don't get it, if cortisol, the stress hormone, raises blood sugar, and if all that glucose in my body is getting built up, then why does my blood sugar (sometimes) drop really low when I'm stressed out? There are times it goes up; but most of the time, it drops really low. I'm always a diabetic, nothing changes about THAT! I always have the same amount of insulin in me, I take the same amount every day. (I only take NPH, I don't take R unless my blood sugar really soars!), so nothing changes THERE! I eat the same kind of food every day (mainly raw non-starchy vegetables to keep from having to take R).

Is there a reason my blood sugar goes really low when I'm stressed out (most times)? This is what I've read on the subject so far, According to Edmund Bourne, your body “burns up sugar very rapidly” in times of stress. Bourne goes on to say, "…your adrenal glands kick in and release adrenaline and cortisol, which causes you to feel more anxious and aroused and also has the specific purpose of causing your liver to release stored sugar in order to bring your blood sugar level back to normal."

"So the subjective symptoms of hypoglycemia arise both from a deficit of blood sugar and a secondary stress response mediated by the adrenal glands."

I'm having a hard time wrapping my bird brain around this concept! If your body burns up energy fast in times of stress, and it gets replaced by the glucose that gets released from your liver (fight or flight), then why does my blood sugar still continue to drop? i can understand if it dropped right away in response to stress, but then went back up after the glucose from my liver kicked in, but for some reason, it continues to drop.

Can it be because the NPH insulin floating around in my bloodstream is keeping my liver from releasing glucose? If that's the case, then isn't being stressed out dangerous for diabetics, especially those who take several types of insulin or are on an insulin pump (which releases insulin continuously)? the whole point of being stressed out (sometimes), rather, the fight or flight response, is to give your muscles the energy to take necessary action (like fight or run away). If the insulin we take is lowering our blood glucose in times of need (such as fight or flight response), then aren't diabetics a bunch of *gasp* sitting ducks?

What about everyone else? Does your blood sugar go up or down when you're stressed out? I especially want to hear from people on insulin pump therapy -- does all that insulin that keeps getting released into your bloodstream let you take action when you need to? Or, does your body fail you when you need it to move the most? Personally, I know, I get weak and shaky and running or defending myself in stressful times is almost impossible! What about you?

tim2000s said:

Some interesting thoughts. I can't say I recognise the symptoms you describe as under stress I tend to see bg levels rise.

It is possible that due to your preference to only use nph, you use more than is really required as a basal and cover up eating with this. This will have the side effect of reducing the effects of glucagon release.

If we look at it from a biological level, Cortisol (like insukin) encourages the GLUT4 receptors to move to the blood to receive glucose into muscles for fight or flight.

It also triggers the alpha cells in the pancreas to release glucagon to encourage the liver to produce glucose. It seems that we then chug away burning glycogen in the muscles and the glucose the liver produces.

In your case, you don't like using R insulin (I assume this is rapid) and live on NPH. Typically, the act of eating in itself generates a glucagon reaction that would normally push your bg up a bit, especially where protein is involved. I suspect that the amount of NPH that you are taking is therefore higher than required for fasting coverage and when your GLUT4 receptors are activated in the stress situation, they remain activated or are over active due to the effect of excess insulin. The other side effect is that the insulin inhibits your liver's reaction to glucagon and stops it from releasing glucose.

Combining the two together results in the lower blood glucose levels and Hypos you see.

If you treated food with small amounts of R and reduced your NPH then I suspect you wouldn't see the same hypo effect in the stress situation.

This is of course a theory though, and I could be completely off track!

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Ya know, years ago (err, 9 years ago, to be exact), when I got out of ICU (for the second time) after 2 bouts of DKA, my (then) endo put me on a whopping 40 units of Lantus and as much R (regular, but you can call it rapid!) as needed (sliding scale) and my blood sugar was always high. I did get an allergic reaction to the Lantus, though and went off. I was diagnosed with type 1 diabetes 15 years ago -- my (then) doctor put me on 30 units of NPH twice a day and R as needed (sliding scale), and my blood sugar was high all the time! I mean seriously dangerously high, in the 300s and 400s (US measure) on a regular basis, no matter how much R I took with meals -- and absolutely NO hypos! After the Lantus scare 9 years ago, I went back on MDI of NPH and R with meals as needed and again, my blood sugar was very high. My (then) endo put me on 40 units of NPH twice a day and R as needed (sliding scale) and my blood sugar was better, but not by much and the worst part -- I started gaining a ton of weight (average 3 lb / month). It took some doing, but I finally managed to bring my blood sugar and A1c down by tweaking my insulin and redoing my meal plan complete. I forgot everything my doctor ever told me, went low-carb and completely omitted processed and preserved foods from my diet. I don't eat very much meat (in the form of poached or roasted chicken breast or boiled eggs); besides, meat makes me nauseous! So, I stick to mainly raw non-starchy vegetables and treat hypos with fresh fruit. I went from taking 40 units of NPH and as much R as needed with meals to now taking 24 units (twice a day) of NPH and 0 R with meals and my blood sugar is finally cooperating and my A1c went from 11% to 6% - in a matter of 6-9 months. I've been eating and treating this way for a year and a half and combat sudden spikes in BG (due to hormonal imbalance, but never due to bad food!) with exercise, which reduced inflammation (hey, we're human -- we get inflamed sometimes!), which fights insulin resistance and lowers blood sugar naturally. But, I was always concerned by the amount of NPH I take. Like I said, they started me on 30 units of NPH twice a day 15 years ago, changed it to 40 units of Lantus once a day 9 years ago and right back to 40 units of NPH, which gradually I reduced to 24 units of NPH twice a day and 0 R. I asked my doctor and the nurses and even my pharmacist if they think I'm taking too much insulin, and they all agreed taking 40 units was on the high (extreme) side, but even 40 units twice a day plus as much R as needed didn't help control my BG when I was eating "normal" meals. Do you suppose 24 units of NPH twice a day is still too much? I tried taking less than 24 units twice a day of NPH, but it made my BG very very high and R did not help control it! Basically, the only thing that seems to work with my body (and crazy lady hormones--I'm premenopausal at 40!) is the 24 units of NPH twice a day, 0 R and "rabbit food." Any suggestions? Thanks so much!

tim2000s said:

Have you been offered any of the newer fast action insulins such as Apidra or NovoRapid?

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Actually, my insurance only covers Humulin R -- but that doesn't really matter because I've tried several different fast-acting insulin over the years including Humulin R, Novolin R and Humalog, and unless I eat rabbit food, not one fast-acting insulin works to lower my blood glucose (with normal every day food). But, I'm still curious -- do you suppose taking 24 units of R twice a day is still too much (given that I don't take any R)? I hear some type 1 diabetics say they take like 12 units of basal insulin and very little bolus and they still manage to keep their blood glucose under 100 mg/dl all the time -- even if they eat "forbidden" foods like pizza and oatmeal! What am I doing ... wrong? Why does my body require so much NPH and doesn't really respond to R? I haven't eaten processed or preserved food in a year and a half -- could I still be *gasp* inflamed?! It seems like I'm insulin resistant some days, which is hard to believe, seeing as I eat so healthy! I realize there's a lot more to it than that. I don't take any other meds (expect the NPH) and I always eat the same food (mainly leafy greens); I wonder if my premenopausal hormones might be doing this to me! Can't complain, though. I suppose the main thing is my blood glucose is under control if I'm not under stress! I just wish I didn't have to keep it up by eating rabbit food. Sometimes it would be nice to eat a sandwich like normal diabetics! LOL Alas, no bread for me ... or lunchmeats ... or dressing ... or condiments ... or *sigh* But back to the original question -- do you think 24 units of NPH twice a day is still too much? Can I do better? (Mind you, I don't want to have to take fast-acting insulin.) Thanks.

ronialive said:

when I am stressed initially my blood sugar goes up but then as a result of that and after the liver has released its stored then it takes it back. as a result of that the blood sugar falls and usually rapidly. for example- I have gone into and interview at 24 and come out at 1.8- obviously I didn't get the job.

Some people's bodies are slower to take it back and others act fast.
this is what was explained by my consultant anyway.

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Hmmm, I'm not sure I'm understanding this right...
...you're blood sugar initially goes UP, then goes DOWN?
I don't get it *scratching head*
But, I'm sure that's how it happens, so...
...awe, I'm sorry you didn't get the job.