(excerpted from Think Like A Pancreas: A Practical Guide to Managing Diabetes With Insulin by Gary Scheiner MS, CDE, DaCapo Press, 2011)
Last weekend I decided to stay up late and watch a scary movie. It had something to do with super-gross vampires who get their jollies by eating the flesh of unsuspecting hotel guests.
Anyway, after the final gut-wrenching, heart-pumping scene, I decided to check my blood sugar. I’ll be darned – it had risen about 200 mg/dL (11 mmol) during the movie. With blood that sweet, I felt like the grand prize for any vampires that might happen to be lurking in my neighborhood.
As you may be aware, the liver serves as a storehouse for glucose, keeping it in a concentrated form called glycogen. The liver breaks down small amounts of glycogen all the time, releasing glucose into the bloodstream to nourish the brain, nerves, heart and other “always active” organs.
The liver’s release of glucose depends largely on the presence of certain hormones. Of all the hormones in the body, only insulin causes the liver to take sugar out of the bloodstream and store it in the form of glycogen. All the other hormones—including stress hormones, sex hormones, growth hormones and glucagon—cause the liver to secrete glucose back into the bloodstream.
Growth hormone is produced in a 24-hour cycle and is responsible for the blood sugar rise that we sometimes see during the night or in the early morning. The other “stress” hormones, particularly epinephrine (adrenaline) and cortisol, are produced when our body needs a rapid influx of sugar for energy purposes. The glucose rise I experienced during the scary movie was no doubt the work of stress hormones.
Emotional stress (fear, anxiety, anger, excitement, tension) and physiological stress (illness, pain, infection, injury) cause the body to secrete stress hormones into the bloodstream. 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 of us with diabetes, however, stress can cause a significant and prolonged increase in the blood sugar level.
Anxious moments and nerve-racking situations happen to all of us. From speaking in public to test-taking to a simple visit to the doctor or dentist, many events elicit a stress hormone response that causes, among other things, a sharp blood sugar rise.
I once experienced another dramatic blood sugar rise when I was late for an important meeting, hit a pothole and got a flat tire, then discovered that the spare tire was also flat. Without the slightest bit of food, my blood sugar rose almost 300 mg/dL (17 mmol)!
Of course, different events cause different responses in different people. What causes a great deal of anxiety for you might have no effect on someone else.
The key is to look for patterns. Is there something that causes a consistent blood sugar response in a given situation? It can be helpful to record the causes of your high blood sugars in your written records, and then tally the causes to determine whether specific situations account for a large number of high readings.
One of my clients did this and found that high blood sugars were occurring every time he watched a horror movie on TV or saw one at the movies. Apparently, the stress hormone response to the sudden appearances of the knife-wielding maniac was driving his blood sugar up.
Many anxious moments occur spontaneously. However, some can be predicted. And if you can predict it, you can prevent it. If you notice a consistent pattern of high blood sugars during certain events, consider giving yourself a small dose of rapid-acting insulin an hour or two prior to the event. This will help to offset the stress hormones produced in anticipation of the event as well as during the event itself. If you wear an insulin pump, consider raising your basal rate using the temp basal feature. A 60 percent to 80 percent increase for three hours, starting an hour or two prior to the event, can work nicely.
Gary Scheiner and his team of clinicians at Integrated Diabetes Services are available for individual consultations via phone and the internet. Visit integrateddiabetes.com call 1-610-642-6055 for more information.
If you would like to purchase a signed copy of Think Like a Pancreas, call Integrated Diabetes Services directly at (877) 735-3648; (outside the US 1-610-642-6055), or order it through the IDS store here.
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