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Stress-Induced Hormone Imbalances Go Far Beyond Insulin in Diabetes


Feb 3, 2014

Stress can play a key role in diabetic hormonal imbalances

Virtually anything from the stress of a long checkout line to the first signs of menopause can trigger hormone imbalances, which reveal themselves through mood swings, fatigue, migraines, memory problems, and a lackluster sex drive.

Imbalances of the hormone insulin--produced by the pancreas to control blood sugar levels--are at the root of both type 1 and type 2 diabetes. For type 1s, insulin levels are low because antibodies destroy the cells that produce it, while for type 2s, cells produce insulin but the body fails to use it properly, so it isn't able to help keep blood sugar in check.

And through insulin and other blood sugar-related hormones such as glucagon, which raises blood sugar levels and works with insulin to keep them stable, and GLP-1 and amylin, which work in tandem to boost insulin production, are the most common hormones associated with diabetes, the complexity of the disease means it impacts many other hormones, as well.

"GLP-1 and amylin, those obviously play a role in the development of diabetes," said Dr. David Bradley, who specializes in diabetes and metabolism at Ohio State University's Wexner Medical Center.

Those initial imbalances, though, have a domino effect of sorts, setting off other hormonal imbalances from stress hormones to sex hormones including estrogen, progesterone and testosterone, making the complications of diabetes that much more far reaching.

The Toll on Women

And despite the risk of erectile dysfunction in men, women may ultimately be impacted more severely by diabetes-related hormonal fluctuations, experts say.

According to Bradley, hormonal imbalances in women--such as increased levels of male hormones and elevated blood sugar levels caused by insulin resistance--can directly impact fertility, a devastating consequence for women who are hoping to start a family.

In many cases, women with type 2 diabetes are often first diagnosed with polycystic ovary syndrome (PCOS), a disease that is also linked to body weight and insulin imbalances and is the leading cause of infertility in women.

Diabetes and PCOS are so closely connected, according to Dr. Stacy Lahti, a doctor of osteopathic medicine at Danville Women's Care in Virginia, because the high insulin levels associated with PCOS in many cases lead to insulin resistance and type 2.

PCOS, which is typified by elevated levels of androgens (also known as male hormones), causes irregular periods, enlarged ovaries that cease to ovulate, and a host of other symptoms ranging from weight gain and skin problems.

Twenty to 30 percent of women with diabetes also have PCOS, Bradley estimates.

Treatments include birth control pills or the diabetes drug metformin, though controlling blood sugar levels through diet and exercise is the preferred option for women who want to get pregnant.

Along with PCOS, women with diabetes are also more likely than men to experience thyroid dysfunction, a disorder that is seen in 5 to 13 percent of all diabetes cases, Bradley said, and also can act as a precursor to the disease.

According to the American Diabetes Association, hyperthyroidism is associated with poor glycemic control and increased insulin requirements.

"All of this continues to form an insulin-resistant state which leads to diabetes," Bradley said, adding that thyroid issues also elevate the risk of coronary artery disease, especially problematic for women since heart issues often manifest themselves in ways that aren't readily diagnosed as heart related, allowing time to exacerbate the complications.

The link between the two has been studied for more than 30 years, and thyroid issues turn up in cases of both type 1 and type 2 diabetes.

The Effects on Men

While men can also experience thyroid issues, a bigger problem associated with hormonal imbalances is erectile dysfunction, a result of not only low testosterone but also a consequence of nerve damage caused by elevated blood glucose.

"Low testosterone in type 2 is related to obesity, and in antibodies in type 1," Bradley said, and while it occurs in about 20 to 30 percent of all men, it can be treated with drugs such as Viagra and Cialis, though the drugs only circumvent the complications, rather than cure them.

Men with erectile dysfunction have damaged nerves, which also puts them at an elevated risk of cardiovascular disease, Bradley said.

And if diabetes is left unchecked, hormonal fluctuations can become more pronounced, exacerbating the problems and creating a Catch-22 of sorts where each one continues to negatively impact the other.

"They do tend to become more prevalent as the diabetes progresses and as you develop more insulin resistance," Bradley said.

That same paradox exists with stress hormones, which are also closely linked to diabetes.

Not only can high stress levels play a role in the development of diabetes, continued stress can lead to worsening symptoms.

Stress hormones are released when we feel a sense of danger, a genetic response born back in caveman days when we would have to run from predators and our bodies would kick in with the "fight or flight" response. The arrival of stress-induced hormones--cortisol and ephedrine among them--causes the body to release a flood of blood sugar so that we have the energy we need to either go to battle or get away.

The problem is, yesterday's predator is today's traffic jam, and we rarely need to fight or run, so that excess blood sugar isn't used, causing blood sugar levels to rise.

For those without diabetes, the body is usually able to keep stress-induced blood sugar in check, but for those with diabetes, the controls are not operating properly, and blood sugar stays high. It can lead to all of the complications that people with diabetes are all tpoo familiar with, including damage to blood vessels, increased risk of heart disease or stroke, vision loss, and kidney damage, and nerve damage that can even lead to amputation.

Also, high levels of cortisol, which often go hand in hand with type 2 diabetes, can cause a host of problems including weight gain, high blood pressure, and insomnia.

You might think stress isn't that big of a deal, but controlling stress can be a key factor in helping to manage blood sugar levels for those with diabetes.

According to a study out of Duke University in Durham, N.C., when stress levels were controlled through relaxation techniques, A1c numbers were lower than in those who didn't distress, and lower than those who used diet and exercise alone to manage stress.

Clearly, controlling stress to prevent the problem from being exacerbated is important, and healthy living is the best defense.

In most cases, Bradley said, diet and exercise were more effective at reducing diabetes-induced symptoms or sending diabetes into remission than medications such as metformin, whether through a diet and exercise program or through gastric bypass, which statistically leads to remission in 60 to 70 percent of all cases, provided participants retain their weight loss.


Categories: Amylin, Cardiovascular Disease, Cortisol, Erectile Dysfunction, Estrogen, GLP-1, Glucagon, Hormones, Insulin, Insulin Resistance, PCOS, Progesterone, Stress, Testosterone



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