Study Finds Stress May Increase Insulin Needs for People with Type 1 Diabetes

Researchers found that higher stress levels were associated with higher post-meal blood glucose levels for people with type 1 diabetes.

-Danielle Gianferante/GluDanielle


According to a recent study, stress can affect blood glucose levels — but only after eating.

For the University Hospital of Zurich study, forty participants (21 men, 19 women) with type 1 diabetes came into the lab on two separate days for several hours in the late morning through early afternoon.

Group 1 v 2

Figure 1. Study design

Half of the participants were studied while fasting on both study days. This fasting group did eat breakfast at home before coming in, but it was at least 3 hours before the stress test. The other half of the participants drank a standardized meal drink with 44 grams of carbohydrates 75 minutes before undergoing a standardized stress test (details below). Participants in the meal group were given short-acting insulin at the beginning of the meal. Their insulin dose was decided by the participants based on their usual dosing, and, importantly, they injected the same amount of insulin on both study days.

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On the stress day, after being in the laboratory for 75 minutes (the meal group got to eat during this time), participants underwent a standardized psycho-social stress test. This 15-minute test involved a mock job interview in front of a panel of judges, followed by a mathematical test done out loud. The judges are stone-faced (fig. 2) and the participant is videotaped during the test. Blood glucose data was collected via a continuous glucose monitor (CGM) every five minutes.


What did they find?

  • The stress test was associated with increased blood pressure, heart rate, and cortisol levels compared to the control session.
  • After stress, blood glucose levels while fasting was similar to blood glucose levels on the resting control day.
  • However, after the stressful situation, blood glucose levels following a meal stays elevated for a longer period of time (fig. 3) .

Some limitations

Some limitations should be considered while interpreting these results. For instance, this stress test is comparable to relatively short but intense stressful experiences. The effects of prolonged, or lower-level stress on blood glucose may be very different. For example, job stress or stress related to a major life event, such as the loss of a loved one or a divorce, may indeed have effects on both fasting and post-meal glucose over time. Additionally, this is a relatively small sample size, and assessing these differences across the lifespan and between genders may show distinctions in the effect of stress on blood glucose levels.

Social Stress Fig3

Figure 2. While BG in the fasting group is identical between the control day and the stress day, BG after eating comes down more quickly on the control day compared to the stress test day.

What does this mean for you?

These results imply that people with type 1 diabetes may need to adjust their bolus rates if they know that they will be encountering a potentially stressful experience after eating. However, these findings also suggest that basal rates are less likely to be affected by stress, as blood glucose in the absence of food did not seem to be impacted by the stress test.

Reference:  Wiesli, P., Schmid, C., Kerwer, O., Nigg-Koch, C., Klaghofer, R., Seifert, B., … & Schwegler, K. (2005). Acute psychological stress affects glucose concentrations in patients with type 1 diabetes following food intake but not in the fasting state. Diabetes Care28(8), 1910-1915.






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