How stress affects blood sugar and diabetes risk

Stress is the body’s natural response to physical and mental challenges or pressures. The everyday conversation “How are you?” – “Good, but a little stressed” – is all too familiar to many. Two out of three people in Germany (64%) say they sometimes or often feel stressed – and the trend is rising (DieTechniker, 2021). While occasional stress is normal and can even be motivating, excessive stress is harmful to our health. Also concerning are the projections for type 2 diabetes, a metabolic disorder that will affect about 12 to 14 percent of the German population by 2040 (DZD, 2019). In this article, we explore the possible link between stress, blood sugar levels, and diabetes. 

Table of Contents

• What is stress?
• What happens in the body during a stress response?
• What are the signs of stress?
• Does stress affect blood sugar levels?
• What is the link between stress and diabetes?
• How does effective stress management work?
• Summary

What is stress?

Stress is the body’s natural response to challenges or pressures, which can be either physical (bodily) or psychological (mental) in nature. This response triggers an innate mechanism known as the "fight or flight response." In such moments, the body releases stress hormones—chemical messengers—and mobilizes energy reserves to overcome or escape the challenge (MedlinePlus, 2023).

What types of stress are there?

• Acute stress: This occurs when the body reacts to an immediate challenge or threat. It can be positive—for example, before a competition that motivates and energizes us—or negative, such as during a dog attack that triggers fear and panic. Once the stress situation has passed, the body typically returns to normal without lasting damage, since the stress was short-lived.
• Episodic acute stress: This refers to the frequent occurrence of acute stress. It is common among people with high levels of responsibility or stressful lifestyles. Because the body often lacks sufficient time to recover between acute stress episodes, this type can increase the risk of illnesses such as cardiovascular disease.
• Chronic stress: Ongoing stress is long-lasting and results from persistent or recurring stressors over weeks, months, or years. This form of stress is associated with numerous health problems, including cardiovascular disease, diabetes, autoimmune disorders, and mental health issues.

Source: Cleveland Clinic, 2024

What happens in the body during a stress response?

The stress response begins in the brain—specifically in the hypothalamus—which triggers the release of stress hormones such as adrenaline and cortisol. These hormones prepare the body to react quickly, become more alert, and perform better. This manifests, for example, in elevated blood sugar levels (for more energy), increased blood flow to muscles and vital organs, and faster breathing.

In acute stress situations, the part of the nervous system responsible for relaxation (the parasympathetic nervous system) is temporarily suppressed so that the part responsible for the stress response (the sympathetic nervous system) can take control. Once the stressful situation ends, the body’s relaxation mechanism (the parasympathetic system) becomes more active again, promoting a state of “rest and digest.” The sympathetic and parasympathetic systems work together to keep the body in balance.

However, with chronic stress, the part of the nervous system responsible for the stress response (the sympathetic system) often remains constantly activated, while the relaxing function of the parasympathetic system is suppressed. This imbalance can lead to long-term health problems (Harvard Health, 2024; Chu et al., 2024).

What are the signs of stress?

In stressful situations, the body and mind may be operating at full speed, as long as the stress does not persist too long or feel overwhelming. The following diagram shows typical physical and emotional symptoms of stress. Because every person has a different stress tolerance and develops individual coping mechanisms, the severity and occurrence of symptoms vary from person to person (WHO, 2023).

Source: Mayo Clinic, 2023

Does stress affect blood sugar levels?

Yes, stress has a direct impact on blood sugar levels.

Blood sugar refers to the amount of glucose (sugar) in the blood, which serves as the body’s main energy source for cells. In stressful situations, the body requires more energy in the form of glucose. Stress hormones such as adrenaline and cortisol play a key role by promoting the release of glucose from the body’s energy stores into the bloodstream. Cortisol also reduces the sensitivity of cells to insulin, making it harder for glucose to enter the cells. This leads to increased availability of glucose in the blood to meet energy demands during the stress response. In healthy individuals and during acute stress, blood sugar levels typically return to normal once the stressor has passed (John Hopkins, 2024; Sissons, 2023).

How does prolonged stress affect blood sugar levels?

Prolonged stress leads to the continuous release of stress hormones, which can result in persistently elevated blood sugar levels. Excess cortisol over time can reduce the cells’ sensitivity to insulin, which may lead to insulin resistance. In this condition, the cells respond less effectively to insulin, which normally helps transport glucose from the blood into the cells. Insulin resistance is considered a precursor to the development of prediabetes and type 2 diabetes, where the body struggles to regulate blood sugar effectively. Effective stress management is therefore essential to reduce overall health risks (Yaribeygi et al., 2022).

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What is the connection between stress and diabetes?

Diabetes mellitus is an umbrella term for various conditions characterized by chronically high blood sugar levels. Two main forms are distinguished:

• Type 1 diabetes: Type 1 diabetes is an autoimmune disorder in which the immune system destroys the insulin-producing cells in the pancreas. As a result, the body can no longer produce insulin, the hormone responsible for transporting glucose (sugar) from the bloodstream into the cells. Blood sugar levels remain permanently high. People with type 1 diabetes must take insulin externally for the rest of their lives in order to regulate their blood sugar levels.
• Type 2 diabetes: Type 2 diabetes is a metabolic condition in which the body either does not produce enough insulin or the body’s cells are not sensitive to insulin. This leads to elevated blood sugar levels, as glucose cannot be effectively taken up by the cells. Type 2 diabetes often develops due to genetic factors, an unhealthy lifestyle, being overweight, and lack of physical activity. Treatment involves lifestyle changes and medication.

Source: NHS, 2023

I experience a lot of stress—can it cause diabetes?

Stress alone does not directly cause diabetes (here we refer to type 2 diabetes). The development of type 2 diabetes is complex and influenced by multiple factors, as described above. However, stress can increase the risk of developing type 2 diabetes—especially in the presence of other risk factors. Two key mechanisms are important in this context:

• Unhealthy coping strategies: Chronic stress can lead to behaviors used to compensate for stress, such as overeating or excessive alcohol consumption, which can negatively affect blood sugar levels. These additional risk factors increase the likelihood of developing diabetes.
• Reduced insulin sensitivity: With ongoing stress, the release of cortisol promotes the development of insulin resistance. In early insulin resistance, high blood sugar levels are not immediately measurable, as the body tries to compensate by producing more insulin. Over time, the body is no longer able to sustain this compensation, and prediabetes may develop. In this phase, blood sugar levels are elevated but not yet high enough to be classified as type 2 diabetes.

To reduce your risk of diabetes, you should adopt stress management strategies and promote healthy lifestyle habits (Mayo Clinic, 2024).

Can stress worsen existing diabetes?

Yes, stress can worsen existing diabetes. The same mechanisms described above also apply here. Stress hormones increase blood sugar levels and affect insulin sensitivity. Unhealthy coping behaviors such as overeating or alcohol consumption can further aggravate the situation. Additionally, stress may cause people to neglect their self-care, making blood sugar control more difficult and increasing the risk of complications. Effective stress management is therefore particularly important for people with diabetes.

Do people with diabetes experience higher stress levels?

Although this may vary from person to person, people with diabetes must engage in daily self-management tasks such as checking blood sugar levels, taking medication, changing their diet, and maintaining physical activity. These additional responsibilities can contribute to higher stress levels. Moreover, the ongoing concern about the long-term consequences of diabetes and the need to plan ahead—for example, while traveling—can be mentally taxing. Comprehensive education, support from healthcare professionals, and encouragement from family and friends all play a key role in managing these challenges(Purdie, 2020). 

How does effective stress management work? 8 science-based tips

The first step is for each individual to identify their personal stressors—such as the need to please everyone—in order to gain a better understanding of where to start. The following general tips, shown in the diagram, can help reduce stress levels.
A word of advice: Don’t try to do everything at once.

• Time management: Organize your daily routine and set priorities. Effective time management can significantly reduce stress levels by creating a sense of control, allowing time for stress-reducing activities, and improving focus (Aeon et al., 2016).
• Support from friends and family: Maintain social connections and talk to friends and family about your worries and stressful situations. Social support can act as a buffer against stress—intimacy and trust in the relationship are essential. Studies have shown that humor and laughter can reduce stress both in the short and long term (Mayo Clinic, 2023). 
• Regular physical activity: Incorporate regular exercise into your routine, as physical activity can serve as a distraction, boost self-confidence, and improve mood. Studies show a positive correlation between regular physical activity and lower cortisol levels (Mayo Clinic, 2022). 
• Time in nature: Do you have green spaces or even a forest nearby? Use them if you can—spending time in nature can lower cortisol levels and reduce the perception of stress. Natural environments promote relaxation and a sense of calm that can counteract stress (Ewert & Chung, 2018; Paredes-Céspedes et al., 2024).
• Engaging in hobbies: Leisure activities play an essential role in stress management, as they promote relaxation, enhance mood, and boost overall well-being (Mayo Clinic, 2023). 
• Deep breathing and meditation: Deep breathing exercises activate the body’s natural relaxation response, lowering stress hormones, heart rate, and blood pressure. These techniques can be easily integrated into daily life and provide both short- and long-term stress relief (Harvard Health, 2024).
• Saying no & questioning expectations: Learn to say “no” and reflect on your own expectations. This helps you avoid excessive commitments, gain more control, and boost your self-esteem, all of which can reduce stress levels (Cleveland Clinic, 2022).
• Balanced diet: A balanced diet can help reduce cravings, support the immune system, and provide the energy needed to handle stressful events. Avoid excessive consumption of caffeine and sugar (Bremner et al., 2020).

Summary

Stress is the body’s natural response to physical and psychological challenges, triggered by the release of stress hormones such as adrenaline and cortisol. These hormones can raise blood sugar levels and, in the case of prolonged stress, increase the risk of insulin resistance and type 2 diabetes. Effective stress management is therefore crucial to reduce the risk of diabetes and other health complications.