Chapter 6
Sometimes, even when you think you’re doing everything right,
your blood sugars may not respond as you expect. Often this will be
due to one or more of the biologic curiosities that affect diabetics.
The purpose of this chapter is to acquaint you with some real phenomena
that can confound your plans, but which you can frequently circumvent
if you are aware of them.
Part 3 of 5
STRESS
AND BLOOD SUGAR
Sustained Emotional Stress
For years, many physicians have been blaming emotional stress for the
frequent unexplained blood sugar variations that many patients experience.
This is an evasive and possibly self-serving diagnosis. It puts the
responsibility for unexplained variations in blood sugar on the patient’s
shoulders and leaves the physician with no obligation to examine the
treatment regimen. Certainly there is no question that stress can have
adverse effects upon your health. I have reviewed more than a million
blood sugar entries from many patients, including myself. One common
feature of all this data is that most prolonged emotional stress rarely
has a direct effect upon blood sugar. This kind of stress can, however,
have a secondary effect by precipitating overeating, binge eating, or
indulgence in kinds of eating that will increase blood sugar.
I know many diabetics who’ve been involved in stressful marriages,
divorces, loss of a business, slow death of a close relative, and the
countless other sustained stresses of life we all must endure. These
stresses have one thing in common: they aren’t sudden but usually
last days, or even years. I have yet to see such a situation directly
cause blood sugar to increase—or, for that matter, decrease. An
important thing to remember during sustained periods of life when everything
seems out of control is that at least you can control one thing: your
blood sugar.
Adrenaline Surges
Many patients have reported sudden blood sugar spurts after brief episodes
of severe stress. Examples have included an automobile accident without
physical injury; speaking in front of a large audience; taking very
important exams in school; and having arguments that nearly become violent.
I am occasionally interviewed on television, and I always check—and,
if necessary, adjust—my blood sugar immediately before and after
such appearances. Until I eventually became accustomed to such appearances,
my blood sugar would inevitably increase 75-100 mg/dl, even though on
the surface I might have appeared relaxed. As a rule of thumb, from
personal experience and from observing my patients, I would say that
if an acute event is stressful enough to start your epinephrine (adrenaline)
flowing, as indicated by rapid heart rate and tremors, it is likely
to raise your blood sugar. Epinephrine is one of the counterregulatory
hormones that cause the liver to convert stored glycogen to glucose.
This is part of what is often called the “fight or flight”
response, your body’s attempt to provide you with enough extra
energy either to overcome an enemy or run like heck to get away. Type
2 diabetics who make a lot of insulin are less likely to have their
blood sugar reflect acute stress than are those who make little or none.
An occasional blood sugar increase after a very stressful event may
well have been brought on by the event. On the other hand, unexplained
blood sugar increases extending for days or weeks can rarely be properly
attributed to stress. I know of no instances where prolonged emotional
stress caused abnormal blood sugars in diabetic or nondiabetic individuals.
Therefore, if you experience a prolonged unexplained change in your
blood sugar levels after extended periods of normal blood sugars, it
is wise to seek out a cause other than emotional
stress.
General Anesthesia
If not treated with special dosing of insulin, type 1 and most type
2 diabetics with previously level, normal blood sugars may experience
a blood sugar increase during surgery that is accompanied by general
anesthesia.
Insulin Resistance Caused by Elevated Blood Sugars
There are at least five causes of insulin resistance—inheritance,
dehydration, infection, obesity, and high blood sugars. Insulin’s
ability to facilitate the transport of glucose from the blood into liver,
muscle, fat, and other cells is impaired as blood sugar rises. This
reduced effectiveness of insulin, known as insulin resistance, has been
attributed to a phenomenon called postreceptor defects in glucose utilization.
If, for example, 1 unit of injected or self-made insulin will lower
your blood sugar from 130 to 90 mg/dl, someone with insulin resistance
caused by elevated blood sugars may require 3 units to lower it from
430 to 390 mg/dl.
Consider what might happen if I, a type 1 diabetic, am fasting and
inject just enough long-acting insulin to keep my blood sugar at 90
mg/dl for 18 hours. If I eat 8 grams of glucose—enough to raise
my blood sugar to 130 mg/dl—the chances are that, because of the
elevated blood sugar, my blood sugar won’t just rise to 130 mg/dl
and remain there. It will continue to rise slowly throughout the day,
so that 12 hours after I consumed the glucose, my blood sugar might
actually be 165 mg/dl. Insulin resistance, at least for type 1 diabetics,
occurs as blood sugar increases, and so elevated blood sugar should
be corrected as soon as it’s feasible. Delay will only permit
it to rise higher. Because type 2s still produce some insulin, their
bodies are more likely to correct the blood sugar rise automatically.
We will discuss dehydration as a cause of insulin resistance in Chapter
21. Infections are discussed at the end of this chapter and also in
Chapter 21.
Reprinted from Diabetes Solution New and Revised 2003 Chapter
6
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PHENOMENA PECULIAR TO DIABETES THAT CAN AFFECT BLOOD SUGAR
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We would like to thank the publisher Little Brown and Company and
Dr. Richard K. Bernstein, for allowing us to provide excerpts from Diabetes
Solution.
Copyright © 2003 by Richard K. Bernstein, M.D.
All rights reserved. No part of this book may be reproduced in any form
or by any electronic or mechanical means, including information storage
and retrievalsystems, without permission in writing from the publisher,
except by a reviewer who may quote brief passages in a review.
Author’s Note
This book is not intended as a substitute for professional medical care.
The reader should regularly consult a physician for all health-related
problems and routine care.
