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December 23, 2002

Stress

Question from Atlanta, Georgia, USA:

Recently, my 10 year old son went through a few days of high blood sugars and increasing his NovoLog or his NPH would not bring his sugars down. The day that he delivered an oral project at school his blood sugars immediately came back down to his normal levels. Obviously, stress had something to do with his increased levels. Can stress be a large a factor in increasing blood sugars? Does stress cause the secretion of a chemical that prevents insulin from working? Why didn't the increase in insulin counteract the blood sugar levels?

Answer:

Yes, stress can lead to higher glucoses. In a person who does not have diabetes, “extra glucose” is available for energy for whatever might be needed (running away, fighting the infection when you’re not eating, etc). The are many “stress hormones” and the main ones, adrenaline (epinephrine) and cortisol both cause the glucose levels to go up by causing the liver and the muscles to release stored sugar.

Why didn’t extra insulin do the trick? Perhaps for a variety of reasons: more stress hormones relative to the amount of insulin you provided (i.e. your usual “correction” dose may be inadequate); stress led to increased appetite also contributing to higher glucose (some people eat when nervous); if the glucose levels were high enough to evoke the production of ketones, ketones tend to cause a degree of insulin resistance. Many endocrinologists prefer to give Regular insulin for high glucose levels associated with ketones, rather than Humalog or NovoLog.

I hope that helps, but the main message is be aware of how your child responds to stress and to insulin when ill, stressed, etc.

DS