3.18.14

The Cortisol Conundrum

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Before high school football games, my blood sugar was manic – 110 during warm-ups and then 315 by gametime (I used to pee at least 10 times in the two hours before a game. Great for in-game hydration). Intuitively, I knew stress/adrenaline/anxiety/excitement was responsible, but honestly I just read the number and reacted as best I could. Physicians would always mention adrenaline as the culprit. Was I ever given resources to reign in my excitement? Not exactly.

When I began taking medical school prerequisite courses in college, the dots connected. Cortisol is the X factor of diabetes management. Responsible for the random highs. Responsible for the sugar issues with the flu. Responsible for the elevated sugars before the big presentation.Responsible for elevated sugar after your cup of coffee.Responsible for the 300 number after a two hour run.

Cortisol is, by evolutionary design, one of the fight or flight hormones. When we encounter stress (deadlines, family loss, or just unnecessary anxiety), our body goes all “Let’s run as fast as we can away from this bear” mode, and gives our body the fuel we need to escape in the form of released glucose due to cortisol. We know the glucose doesn’t come from the muscle cells because when our pancreas went on permanent vacation, we lost the ability to tap that reservoir with glucagon (insulin’s opposite). Cortisol comes from the adrenal glands on top of the kidneys, and stimulates the liver to break down compounds into glucose. We already know that we don’t handle excess glucose in the blood well. Thus, usher in the high blood sugar!

Stress is inevitable and a necessary stimulant for action in our lives. Unfortunately for PWD, we need cortisol to live. But, we do have the choice to react from a place of stillness and not a place of unrest. We control our base level of anxiety. We can be mindful of our reactions. If my sugar spikes because of eustress (positive stress that yields a positive outcome), that’s something I can get down with. If my sugar spikes because of distress (especially when I could have reacted differently), that one’s on me.

Bonus thought: Maybe we have an advantage over the normal folks because we get a sign from our bodies notifying us that we’re stressed? That might be a reach.

Have any manic moments of blood sugar caused by the cortisol conundrum? Share it out below!

Former co-founder of DiabetesDailyGrind, Ryan's mission is to motivate others with diabetes to live their own authentic life. Most days, when not in the hospital during his medical residency, you can find him on the bike, surfboard, or yoga mat. He believes in the power of clean eating, and loves his Dexcom.