Most people living with diabetes know they need to watch what they eat, stay active and take their medicines on time. But there is another factor that often goes unnoticed until blood sugar readings start behaving unpredictably: stress.A difficult day at work, a sleepless night, family worries or even constant exposure to bad news may not seem directly connected to glucose levels. Yet the body treats emotional stress much like a physical emergency. It releases powerful hormones designed to help us survive. While this response was once useful for escaping danger, today’s everyday stressors can keep those hormones switched on for far too long.The result? Blood sugar can remain higher than expected, even when diet and medications haven’t changed.
Why stress hormones push glucose into the bloodstream
The human body is programmed to protect itself. When the brain senses stress, it activates what scientists call the “fight-or-flight” response. Within moments, stress hormones such as cortisol, adrenaline and noradrenaline are released. Their job is simple: prepare the body for immediate action.Dr Rahul Baxi, Diabetologist at Bombay Hospital, explained, “Diabetes management is a multi-faceted process, and most individuals just think of exercise and diet as important and forget about factors like stress, which can significantly impact one’s blood glucose levels. Stress hormones like cortisol, adrenaline and noradrenaline are released which flood the body with these stress hormones and prepare it for the ‘fight-or-flight’ response by heightening alertness and providing a surge of energy, which, in turn, floods the body with glucose, hiking blood glucose levels. If the body stays in a continuous state of stress, glucose levels shoot up and it becomes difficult to get them under control.”This glucose release is not a mistake. It is an emergency backup system. During genuine danger, muscles need quick energy to run or defend the body.The problem is that modern stress rarely involves physical escape. Instead, it comes from deadlines, financial concerns, traffic jams, relationship problems or constant notifications. The hormones rise, glucose enters the bloodstream, but there is often no physical activity to use that extra fuel.Over time, repeated episodes of stress can make blood sugar harder to manage.
Cortisol: The stress hormone that often gets blamed
Social media is full of advice on “lowering cortisol.” Some of it is helpful. Much of it is not. Cortisol is an essential hormone. The body needs it to regulate metabolism, blood pressure, sleep-wake cycles and immune responses. The issue is not cortisol itself but when stress keeps cortisol levels elevated for long periods.Dr Baxi explained, “The stress hormone cortisol has a particularly important role to play when it comes to glucose levels. We have three glands, the adrenal, hypothalamus and pituitary glands, that control the release of cortisol into the body. Each gland stimulates the other using different hormone signals to regulate cortisol in the blood. Issues occur when the three glands fall out of balance, which can be caused by stress. This hormone stimulates the liver to release stored glucose into the bloodstream.”He added an important note of caution.“Recently, there has been a lot of focus online on the role cortisol plays and many unscientific opinions have flooded online spaces, advising people on how they can get their cortisol under control. However, if one is experiencing stress and high glucose levels, the best option is to get in touch with a healthcare professional who can diagnose the situation and suggest the best possible treatment.”
Sometimes the biggest trigger is not illness, but life itself
Stress does not always come from dramatic events. Sometimes it arrives quietly. It can be the worry of moving house after decades in the same neighbourhood. It can be caring for an ageing parent, adjusting to retirement or worrying about children living far away.Dr Baxi recalled one such experience from his practice, “I remember an elderly patient with diabetes who lived in a busy neighbourhood and was unable to take regular walks. When her son suggested moving to a gated community, the thought of leaving the home she had known for over 40 years caused her tremendous anxiety. Her stress levels soared, and so did her blood glucose readings. After counselling, she agreed to move. In her new community, she began walking daily in the park, met new friends and built a strong social circle. Within months, her stress reduced significantly, and her glucose levels improved. It was a powerful reminder that managing diabetes is about much more than medication, it is also about emotional well-being, social support and the environment we live in.”The story highlights something medicine increasingly recognises: health is influenced not only by prescriptions, but also by the places people live, the relationships they build and the emotional safety they experience every day.
The hidden cycle that makes diabetes harder to control
Stress does not simply raise glucose once and disappear. It often creates a loop.Dr Baxi said, “While short-term stress is manageable, chronic stress can cause serious harm to blood sugar levels, as it keeps the body in a perpetual state of ‘fight-or-flight’, thereby increasing glucose levels in blood. Work pressure, lack of sleep, excessive screen time and disrupting your circadian rhythm can lead to stress build-up in the body. Additionally, people with diabetes may be more sensitive to stress, as they worry about managing their condition and the potential complications that come with it. This creates a vicious cycle, where stress leads to higher blood sugar, and high blood sugar, in turn, increases stress and anxiety.”Poor sleep can increase stress hormones. Higher stress may push glucose up. Elevated glucose can leave people feeling tired, worried or frustrated. That emotional strain can increase stress even further.Breaking this cycle often requires addressing both physical and emotional health together rather than treating them as separate problems.
Managing stress is part of managing diabetes
For many people, stress cannot simply be removed. Jobs remain demanding. Family responsibilities continue. Traffic still exists. But the body’s response to stress can often be improved.Dr Baxi shared another example, “I often see patients in high-pressure professions struggle to control their diabetes despite following treatment plans. One patient who worked full-time in the stock market spent his days tracking market swings, making rapid decisions and worrying about losses. The chronic stress kept his glucose levels persistently elevated. When we worked on stress-management strategies, set boundaries around market hours and incorporated regular exercise into his routine, his blood sugar control improved noticeably. It was a clear example of how work-related stress can directly affect diabetes management.”He emphasised that stress management deserves the same attention as diet and medicines.“For effective diabetes management, stress has to be kept under control. Yoga, breathing exercises, a proper sleep schedule, having hobbies, along with medicinal support and therapy, if required, can go a long way in helping get stress levels under control. Modern life has many stressors that one simply cannot avoid, thus, having a proper strategy to deal with stress is important. For people with diabetes who are under stress due to any reason, even a simple thing like planning their day or driving in heavy city traffic can shoot the stress hormones through the roof, making it hard for them to manage their blood glucose levels and stress levels.“He concluded, “Managing diabetes goes beyond medications. It requires a balanced approach that prioritises mental well-being, healthy routines and stress management to support better blood glucose control and overall quality of life. The existence of free and clean third spaces that can encourage people to be active, help build communities and nurture hobbies are very important for ensuring long-term control of chronic conditions like diabetes.“Perhaps that is the biggest takeaway. Blood sugar is influenced by more than food. It also reflects how the body responds to the pressures of everyday life. Looking after mental well-being is not separate from diabetes care, it is an important part of it.Medical experts consultedThis article includes expert inputs shared with TOI Health by:Dr Rahul Baxi, Diabetologist, Bombay Hospital.Inputs were used to explain how stress hormones affect blood sugar, the science behind cortisol and glucose regulation, and why persistent stress should be evaluated by a healthcare professional.