Stress Induced Diabetes

 

Vaishnav Priti Baludas, Kadam Kavita Shivaji, Kalunkhe Amruta Dadasaheb, Pagar Swati Aappasaheb*, Musmade Deepak Sitaram

SDSPM’s, Nandkumar Shinde College of Pharmacy, Vaijapur, Dist - Aurangabad, M.S, India – 423701.

*Corresponding Author E-mail: swati.pagar2210@gmail.com

 

ABSTRACT:

Many evidences suggested that stressful experience might affect diabetes. The estimate of the actual number of diabetes in India is around 40 million. This means India actually has the highest number of diabetic’s patient of any one country in entire world. No doubt, one of the natural element of life i.e. Stress is a major contributor to the diabetes. Stress can bring many unexpected changes in the blood sugar level; this could trigger symptoms associated with diabetes. Some retrospective human studies have suggested that the stress can participate in Type-1 diabetes, animal studies have shown that stress can cause Type-1 diabetes. impaired glucose tolerance and metabolic disease, however human studies have shown that stress can stimulate hyperglycaemia, insulin resistance. In contrast more consistentevidence support the role of stress in Type-2 diabetes. In recent year the complexities of the relationship between stress and diabetes have become well known but have been less well researched. Some studies have suggested that stressful experience may affect the onset and the metabolic control of diabetes, but finding have often been inconclusive. In this article we reviewed some of this research going on to consider how stress might affect the diabetes and physiological mechanism through which this may occurs and their preventions and management.

 

KEYWORDS: Stress, Diabetes, Hyperglycemia, Insulin resistance, impaired glucose tolerance, physical activity, diet.

 

 

 

INTRODUCTION:

What is Stress?

Simply out, Stress is a state of emotional strain or tension that occurs when we feel that we can't cope with pressure. Stress is a feeling of emotional or physical tension, it can come from any event or thought that make you feel frustrated, angry or nervous. But whenever stress starts for a long time, it may harm your health. Stress weather physical stress or mental stress has been proven to instigate change in blood sugar level which for people with diabetes can problematic1.

 

 

DIABETES MELLITUS:

Diabetes is chronic condition. Diabetes mellitus (DM) is one of the most common non - communicable disease in the world. According to the International Diabetes federation estimate, around 415 million people had diabetes mellitus in 2015 and this number is expected to be rise to 642 million by 2040.

 

India with 69.1 million people is estimated to have the second-highest number of case diabetes mellitus (DM) in the world after china in 20152. DM is continue to increase as a result of rapid cultural and social changes. Which include aging populations, increasing urbanization, dietary changes, reduced the physical activity and unhealthy behaviour3,4.

 

The 'International Diabetes Federation' has also stressed the importance of integrating physiological care in the management of the DM5. Stress may lead to deterioration of glycaemic control through its effect on the neuroendocrine system6.

 

Role of Stress in Diabetes:

Stress is a potential contributor to chronic hyperglycaemia in diabetes. Stress has long been shown to have major effect on metabolic activity. Energy metabolization is a primary result of the fight or flight response. Stress stimulate the release of various hormone, which can result in elevated blood glucose level. If you are experiencing stress or feeling threatened, your body reacts. This is called a fight or flight response. This response elevated your hormone level and causes your cell to fire, during this response, your body release adrenaline and cortisol into your blood stream and your respiratory rates increases. Your body direct blood to muscle and limbs allowing you to fight the situations. Your body may not be able to process the glucose released by your firing nerve cell if you have diabetes. If you cannot converts glucose into energy, itgets build up into the blood stream. This cause your blood glucose level to rise.

 

The stress hormone like cortisol and adrenaline make harder for insulin to work properly, known as insulin resistance. As energy can't get into your cells, your body sugar level increases in your blood stream. Researchers think that high level of stress hormone might stop insulin producing cell in the pancreas from working properly and reduce the amount of insulin they make, in turn, this might contribute to the development of Type-2 diabetes. Stressful experience have been implicated in the onset of diabetes in individual already predisposed to developing disease. As early as the beginning researchers have been discussing the potential link between diabetes and stress since the 17thcentury7.

 

More recent research suggests that people with depression, anxiety, stress have higher risks of developing type-2diabetes8. Mooy et.al. Demonstrates an association between stressful experience and the diagnosis of type 2 diabetes. Thernlund at al. suggested that negative stressful experience in the first 2 years of life may increase the risks of developing type 1 diabetes in children, other factor such as family problems, behavioural problems were also implicated.Swedish study indicates that there was no association between stressful event and the onset of type 1diabetes9.

 

People who experience depression, anxiety, stress or combination of these conditions are at higher risks of developing diabetes10. Stress affect many lifestyle factors, high level of stress may cause a person to engage in unhealthy lifestyle habits. This lifestyle habits can increase a person's risk of developing diabetes.

 Stress can activate the hypothalamic pituitary adrenal axis and the sympathetic nervous system. This can cause hormonal changes, like higher cortisol hormonal level and lower sex hormone levels. The level of this hormone affect insulin level. Cortisol is commonly known as the stress hormone. It can also stimulates the production of glucose in the body and rises a person's blood sugar. Stress may also affect the immune system.

 

Surwit, Feiglos and Scovem have recently summerised the mechanism by which environmental, emotional or physical stress can affect the glucose metabolism. They reviewed the relationship between the Central Nervous System, Autonomic Nervous System and Hypothalamic adrenal cortical axis in controling the glucose metabolism. The Autonomic nervous system is intimately involved in the regulation of carbohydrate metabolism. The effect of autonomic nervous system on insulin is both facilitatory and inhibitory. Branches of the right vagus nerve innervates the pancreatic islets and the stimulation of beta cells of pancreatic islets facilitate the release of insulin, conversely insulin secretion is inhibited by stimulation of the sympathetic nervous system. This sympathetic and parasympathetic innervation of pancreas modulate the insulin secretion in normal regulation of carbohydrates metabolism. Neurogenic stimulation of the hypothalamic pituitary adrenal axis leads to the secretion of cortisol from the adrenal cortex, which elevates blood glucose and impaired glucose tolerance. Stress induced release of growth hormone can also cause insulin resistance and beta endorphins which can suppress insulin secretion and elevated glucose levels (Guillemin 1978)11.

 

How stress affect the blood sugar level?

The blood sugar level are controlled mainly by two groups of hormones. The first group of hormone reduce blood sugar but Insulin is the only member of this group. The Second group of hormones called counter- regulatory hormone, opposes the action of insulin and increase the blood sugar. (eg. Cortisol, Adrenaline and Noradrenaline).

 

Two types of stress can change blood sugar levels:

·       Physical stress

·       Mental or emotional stress

each type of stress affect blood sugar levels differently. Physical stress generally cause blood sugar level to increase.

Physical stress include:

·       Illness

·       Surgery

·       Injury

 

Physical or emotional stress has mixed effect depending on type of diabetes you have.

 

Type 1 diabetes:

Mental stress can increase or decrease blood sugar level.

 

Type 2 diabetes:

Mental stress generally increase blood sugar level. It is very important to detect high stress level on patients, since the blood sugar will come down only if stress is relieved or controlled.12

 

Stress, Neuroendocrine Axis and Glucocorticoids:

It is known that stress activates hypothalamus-pituitary- adrenal axis. The brain circuits that initiate and maintain stress response are located in the hypothalamus, which include paraventricular nuclei, locus ceruleus and the central sympathetic nervous system13,14. Stress activates the paraventricular nucleus (hypothalamus) in the brain and stimulates endocrine and neural mechanisms leading to an increase in the concentrations of stress hormones viz. glucocorticoids and catecholamines. Precisely, the activated paraventricular nucleus neurons secrete corticotropin releasing hormone (CRH) which regulates the adrenocorticotropic hormone (ACTH) release from the anterior pituitary. ACTH acts on the adrenal cortex to release glucocorticoids15,16. These neuroendocrine changes seem to lack habituation and possibly there was an abnormal hypothalamo- pituitary- adrenal axis (HPA axis) activation in response to repeated stress17. In addition, sympathetic nervous system is activated which releases norepinephrine direct to the circulation and epinephrine from the adrenal medulla. It is demonstrated that glucocorticoids and catecholamines act synergistically during stress.18

 

ACTH; adrenocorticotrophic hormone. CRH: corticotrophin releasing hormone LC/NE: locusceruleus norepinephrine system; PVN: paraventricular nucleus32.

Catecholamine’s act transiently during the initial exposure to stress and at later stages would be accompanied by the secretion of glucocorticoids. Glucocorticoids are generally referred to as stress hormones [19] as their secretion will be high under stressful conditions. Glucocorticoids elicit their action by binding to glucocorticoid receptors (GRs) that regulate various physiological functions viz., inflammation, gluconeogenesis and adipocyte differentiation etc.20 Upon binding with ligand, it is dimerized and translocated into nucleus where it binds to glucocorticoids (GCs) response elements (GREs) and bring out the gene expression of the target genes.

 

The mechanisms of stress induced alterations in glucose metabolism leading to hyperglycemia are also elucidated which involve the changes in different pathways. The chronic stress is reported to cause hypermetabolism characterized by enhanced glycolysis, gluconeogenesis, altered glucose uptake and reduced glycogenesis. Persistent stress predispose to the development of chronic illness accompanied by the metabolic dysregulation.21,22

 

Figure 1: Hypothalamo-pitutary-Adrenal Axis.

 

Fig 2: Neuroendocrine response to stress:

 

Lifestyle and Prevention of Stress Induced Diabetes:

Stress is a part and parcel of our modern, fast-paced lives. Following a healthy lifestyle with adequate exercise, correct diet and regular sleeping hours will keep one physically and mentally fit to face any stressful situation that may arise in one’s life. It is particularly important that a person with diabetes learns how to manage stress, since stress can wreak havoc with the management of diabetes. A healthy social life, taking time out to relax with friends and family is vital in reducing stress levels, thereby reducing the risk of developing diabetes and helping people with diabetes take control of their condition. We have seen many patients who were able to reduce their dose of drugs and several cases like the one described previously, who were able to completely stop all anti-diabetic medications. Find out if stress is the cause of your diabetes, and if yes, please start stress management measures today. You cannot avoid stress but you can certainly manage it!

 

Tips on Coping with Stress23

Sometimes, the symptoms of stress are subtle and you may not notice them. Stress can take a toll on your mental and emotional well-being, and it can also impact your physical health. Recognizing the symptoms can help you identify stress and take steps to manage it.

 

How To Reduce Your Stress Levels:

 

It’s possible to lessen or limit the stressors in your life. Here are a few things that you can do to manage the effects of different forms of stress.

 

Reducing mental stress:

Meditating can help remove negative thoughts and allow your mind to relax. Consider starting each morning with a 15-minute meditation. This will set the tone for the rest of your day.24

 

Reducing emotional stress:

If you find yourself in an unwanted emotional state, take five minutes to be by yourself. Remove yourself from your current environment. Find a quiet space to focus on your breathing. Put your hand on your belly, and feel it rise and fall. Inhale deep breaths, and exhale slowly and loudly. This will slow your heartbeat down, and help bring you back to a stable emotional state. This act of cantering yourself may improve how you deal with whatever is causing the stress.

 

Reducing physical stress:25

Adding yoga to your daily routine can provide both physical activity and meditation at the same time. Practicing yoga can lower your blood pressure, too. Whether its yoga or another form of exercise, you should aim for 30 minutes of cardiovascular exercise per day. You can do 10 minutes of exercise when you wake up, 10 minutes in the afternoon, and 10 minutes before you go to sleep.

 

Reducing family stress:26

If you’re feeling overwhelmed by family obligations, remember that it’s OK to say no. Your family will understand if you can’t make it to all events. If your stress stems from not seeing your family as often as you’d like, consider having a family fun night weekly or biweekly. You can play board games or participate in outdoor activities. This can include hiking, swimming, or singing up for a fun run together.

 

Reducing work stress:

Stress issues at work can come home with you. Talk to your supervisor if you’re having a hard time at work. There may be options to alleviate or work through any issues you may have. If that doesn’t help, you may want to consider transferring to a different department or even finding new job altogether. Although stress levels elevate when looking for a new job, you may find it settles down with a different position better suited for your skills and personality.

 

Healthline:

 

Tea and diabetes:

Tea is one of the nation’s favourite drinks and research suggests it’s also a healthy drink. Tea brings a number of health benefits including improving insulin sensitivity.

 

Benefits of tea:

Research suggests the following benefits may be enjoyed from tea:

·       Improving insulin sensitivity

·       Maintaining healthy blood pressure

·       Preventing blood clots

·       Reducing risk of cardiovascular disease

·       Reducing risks of developing type 2 diabetes

·       Reducing risks of developing cancer

 

CONCLUSION:

Many research suggests that stress have a negative impact on your body. Whenever we think of the couses of diabetes, we usually think about hereditary factors (family history), overeating or lack of exercise leading to obesity as the most common cause of diabetes. At that time we often tend to forget about important cause of diabetes i.e stress. It is true that high level of stress leads to unhealthy lifestyle habits, which can in turn, increase person's risk of developing diabetes. Stress is a situation that almost everyone faces on a daily basis. Stress has been linked to several ailments chief of which are depression and diabetes. Stress is not a direct cause of diabetes but stress can cause a fluctuation in blood sugar in people with diabetes. Although there is no concrete evidence to substantially prove that stress (emotional) is responsible for diabetes, many healthcare professionals believe that diabetes is case as a result of the changes or rise hormonal level as a result of stress. In this article we have discussed the impact of stress on blood sugar level. Long term stressors have a adverse effects on blood sugar level. The impact of stress on blood sugar varies from one patient to another. Medical studies have shown that physiological or mental stress can elevate blood glucose levels in individual with type 2 diabetes and majority of type 1 diabetes. However glucose level may drops in some people with type 1 diabetes.

 

It is clear that emotional stress (fear, anxiety, anger, excitement, tension) and physiological stress (illness, pain, infection, injury) cause the body to secrete stress hormones into blood stream. For those without diabetes, the stress induced blood sugar rise is followed by an increase in insulin secretion, so the blood sugar rise is modest and temporary. For those which have diabetes, however stress can causes a significant and prolonged increase in blood sugar level. So it is very important to be aware that repeated episode of stress can cause serious changes in blood sugar level making difficult for diabetics to control the condition.If you are stressed for longer periods of time your sugar level will keep building in blood.so regular exercise and relaxation techniques like yoga, meditation and breathing exercise can help you to control blood sugar level during stress condition.When you live with diabetes, what you eat and how much you exercise make a big difference to your health. So get smart about food you choose and the way you move. You will not only get your blood sugar level under control, but you will cut your chances of having a heart attack and stroke, too. So you have to control the stress level then you will come down your blood sugar level.

 

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Received on 26.08.2020            Modified on 30.11.2020

Accepted on 22.02.2021      ©Asian Pharma Press All Right Reserved

Asian J. Res. Pharm. Sci. 2021; 11(2):145-150.

DOI: 10.52711/2231-5659.2021-11-2-9