When blood sugar is detected as lower in a physiological range, glucagon is secreted by the pancreas to promote the release of glycogen from the liver. This same mechanism is how epinephrine (aka adrenaline) raises blood sugar in the body. Epinephrine is released as well during times of acute stressors, such as threats or noxious stimuli. This is directly mediated by the central nervous system (CNS) through the sympathetic nerve system, which stimulated the adrenal medulla.Epinephrine also has several other classic actions beyond glucose release. It raises heart and respiratory rate, and also causes the release of fatty acids into the blood. It is now believed that many symptoms of what used to be referred to as ‘reactive hypoglycemia’ are sensitivities to epinephrine release at times the body internally raises blood sugar.1 People typically report these symptoms as nervousness or anxiety, shaking, trembling, or irritability.Regarding these types of symptoms, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at National Institutes of Health has the following recommendations:
- Being physically active,
- Eating a variety of foods, including meat, poultry, fish, or non-meat sources of protein; starchy foods like rice and potatoes; fruits and vegetables, and dairy products,
- Eating foods high in fiber,
- Avoiding or limiting foods high in sugar, especially on an empty stomach.
Cortisol is also involved in raising blood sugar. Similar to epinephrine, cortisol is released in response to stress. “Almost any type of stress,” according to Guyton’s Textbook of Medical Physiology, “whether physical or neurogenic, causes an immediate or marked increase” in the secretion of cortisol.2 While epinephrine can raise blood sugar by a conversion of protein through gluconeogenesis, this is the primary method by which cortisol acts on blood sugar. This action takes place in the liver, where the necessary enzymes are stimulated by cortisol to convert amino acids to glucose. Cortisol, in addition, aids this process by causing the mobilization of amino acids out of muscle tissue into the blood. Cortisol, in another similarity to epinephrine, causes the release of fatty acids into the blood.
Cortisol has another effect related to blood sugar — high levels of cortisol decrease the response of tissues to insulin. Again, according to Guyton’s Physiology, “for reasons that are not entirely clear, high levels of glucocorticoid reduce the sensitivity of many tissues, especially skeletal muscle and adipose tissue, to the stimulatory effects of insulin on glucose uptake and utilization. One possible explanation is that high levels of fatty acids, caused by the effect of glucocorticoids to mobilize lipids from fat deposits, may impair insulin’s actions on the tissues.”
This little known research, regarding stress and blood sugar, could be a significant factor in how you address both health issues in your practice.Suggesting to patients they take time to relax, eat a healthy diet and balanced meals, including whole foods with quality sources of protein, fat and fiber, will do a lot to give stress response systems a break and help maintain healthy blood glucose levels.
- http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/
- Guyton and Hall. Textbook of Medical Physiology. Tenth Edition. WB Saunders Co. 2000
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