joshua-joseph-and-patientHow does stress impact blood sugar in type 2 diabetes? That’s the question researchers at The Ohio State University Wexner Medical Center and The Ohio State University College of Medicine are closer to answering in a recent study linking the stress hormone cortisol with higher blood sugar levels in people with type 2 diabetes.

The body responds to stress by releasing cortisol into the bloodstream. High levels of chronic stress and depression have been linked to higher levels of cortisol (Joseph and Golden, 2017). One of the known actions of cortisol is to release glucose that is stored in the liver, the process that gives rise to the phenomenon individuals experience behaviorally as the fight-or-flight response. Cortisol also makes it harder for insulin to remove glucose from the bloodstream, a process called insulin resistance.

Joshua Joseph, MD, assistant professor of Internal Medicine in the Division of Endocrinology, Diabetes and Metabolism at the Ohio State College of Medicine and lead investigator in the study, is interested in whether prolonged exposure to stress may trigger a consistent increase in blood sugar levels. Previous studies and reviews undertaken by his team have already shown that higher cortisol levels were associated with higher hemoglobin A1C (a three-month glucose average) in diabetes (Joseph et al., 2015), but this study is the first one of its kind to examine changes in cortisol and glucose over an extended period of time in diabetes.

The study measured and tracked cortisol levels in participants over a six-year period to better understand how changes in cortisol levels influence changes in blood sugar levels.

A healthy cortisol rhythm peaks in the morning, and decreases over the course of the day with lowest levels occurring at night. Dr. Joseph’s study shows that, over the six-year period, participants with type 2 diabetes, who had higher cortisol levels that did not decrease over the course of the day, also had increases in glucose levels, proving the link between cortisol and high blood sugar.

Fortunately for patients, there are ways to make the body more receptive to insulin, which can help to improve blood sugar levels in type 2 diabetes.

“Most people with type 2 diabetes know the importance of exercising regularly, eating a healthy diet and getting plenty of rest. Stress relief is a crucial and often forgotten component of diabetes management,” Dr. Joseph says. “Stress relief with a yoga class, taking a walk, reading a book or listening to music all have been shown to lower cortisol levels, which is important to everyone’s overall health, but especially for those with type 2 diabetes.”

For this published study, Dr. Joseph collaborated with researchers at Johns Hopkins University; University of Maryland School of Medicine; University of California, Los Angeles; University of Michigan; Boston University and the National Institutes of Health’s National Institute on Aging.

*This photo was taken before COVID-19 masking requirements were implemented.