Stress, Adrenaline & Blood Sugar—Lessons from Stage

 Exactly one month ago today, I stood backstage at the Taking Control Of Your Diabetes (TCOYD) conference, heart pounding louder than the audience applause I was about to receive. Despite years of coaching clients on diabetes management, nothing prepared me for the overwhelming wave of stage fright I felt as I walked on stage. My hands shook, my mind raced, and my CGM graph was already trending upward before I’d even said “hello.”

That experience—terrifying as it was—inspired this in-depth exploration of how stress, adrenaline, and anxiety can wreak havoc on blood sugar, and what evidence-based strategies you can use to take back control. Whether you’re about to give a big presentation, face an exam, or simply navigate the daily ups and downs of life with Type 1 diabetes, understanding the science and having practical tools at your disposal can make all the difference.

1. The Physiology of Stress: HPA Axis & Fight-or-Flight

When you experience stress—whether from public speaking or a looming deadline—your body activates the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system. In lay terms, your brain perceives a threat, and signals the adrenal glands to release cortisol and epinephrine (adrenaline).

• Cortisol, the “stress hormone,” peaks about 20–30 minutes after a stressor, promoting gluconeogenesis (the production of glucose in the liver) and reducing insulin sensitivity.
• Epinephrine acts almost instantaneously, mobilizing glucose and free fatty acids to fuel your muscles for “fight-or-flight.”

For those of us with Type 1 diabetes, these hormones can send blood sugar soaring, often unpredictable and stubborn to correct.

2. Acute vs. Chronic Stress: Different Impacts on Glucose

Stress isn’t a one-size-fits-all proposition.

• Acute stress (the surge of adrenaline before a speech) can cause rapid spikes in blood sugar within minutes, followed by potentially dramatic drops once the adrenaline wears off.
• Chronic stress (ongoing work pressure, family conflict) keeps cortisol levels elevated, leading to sustained insulin resistance, higher baseline glucose levels, and an increased risk of diabetes complications.

Recognizing the type of stress you’re facing is the first step toward tailoring your management strategy.

3. My TCOYD Talk: A Real-Time CGM Case Study

On August 9, I clipped in my CGM, bolused for a modest pre-lecture snack, and stepped into a wave of adrenaline. Here’s what my Dexcom trace looked like:

• T-minus 10 minutes: Starting BG ~120 mg/dL; mild pre-talk jitters.
• T-minus 5 minutes: Spike to ~180 mg/dL as epinephrine peaks.
• During intro: BG climbs further to ~220 mg/dL despite no food intake.
• Mid-talk: I delivered my key points as cortisol exerted its effect; BG plateaued around 230.
• Post-talk cooldown: Adrenaline recedes, and BG dips sharply into the 140s.

This real-time data reinforced that stress management is just as critical as carb counting for smooth glucose control.

4. Recognizing Your Stress Triggers

Before you can manage stress-induced glucose swings, you need to identify your personal triggers:

• Public speaking or performance
• Deadlines and work presentations
• Exams and academic pressures
• Personal conflicts or relationship stress
• Financial worries
• Medical appointments or procedures

Keep a stress log alongside your CGM data. Note the event, your perceived stress level (1–10), and the corresponding blood sugar response. Over time, patterns will emerge.

5. Science-Backed Coping Tools: Breathing & Mindfulness

Diaphragmatic Breathing

Slowing your breath to activate the parasympathetic (“rest-and-digest”) system can lower cortisol. Try this simple exercise:

1. Inhale slowly through your nose for 4 seconds, expanding your diaphragm (not your chest).
2. Hold for 2 seconds.
3. Exhale gently through pursed lips for 6 seconds.
   Repeat 5–10 times. Studies show this can reduce cortisol by 10–15%.

Box Breathing

A technique used by Navy SEALs and high performers:

• Inhale (4), hold (4), exhale (4), hold (4).
• Repeat 3–5 cycles to calm both mind and blood sugar.

Mindfulness Meditation

Even a 5-minute guided meditation app session (e.g., Headspace, Calm) can lower perceived stress and blunt cortisol response. Aim for daily practice.

6. Physical Movement: The Micro-Break Advantage

Movement is a potent strategy to increase insulin sensitivity and lower stress:

• Pre-event stretches: Gentle neck rolls, shoulder shrugs, and leg stretches for 2–3 minutes before a stressful task.
• Walk during layovers: A 10–15 minute stroll increases glucose uptake by muscles, reducing post-flight or pre-talk highs.
• In-office micro-breaks: Stand up, march in place, or do calf raises every hour. These tiny bursts of activity can improve insulin sensitivity by up to 50% for the next hour.

7. Preemptive Carb & Insulin Strategies

When you know a stressor is coming, consider strategic insulin adjustments:

Pre-bolus Timing

• For adrenaline spikes, delaying your bolus until after the initial rush can prevent early lows.
• Alternatively, a small “buffer” bolus 10–15 minutes before the event can blunt the peak if cortisol tends to rise slowly.

Snack Planning

• Complex carbs + protein/fat—like a small turkey wrap or Greek yogurt with nuts—can provide steady fuel without a rapid spike.
• Estimate 10–15g carbs to mitigate a moderate stress-induced dip.

Correction Factor Tweaks

If you know a presentation spikes you by +50 mg/dL, adjust your correction factor proactively. For example, if your CF is 1:50 and you expect a +50 jump, consider a 1-unit correction 10–15 minutes beforehand.

8. Using Technology Wisely

CGM Alerts

• Raise low alerts during stress events to avoid stacking corrections on a post-stress drop.
• Set high alerts to catch sustained cortisol-induced highs—don’t wait until 250 mg/dL.

Pump Features

• Temporary basal rates: Increase by 10–20% during known stress periods.
• Bolus calculators: Use them but override if you know stress will alter absorption.

9. Nutrition Hacks for Stress Days

1. Magnesium-rich Foods: Bananas, spinach, and almonds support nervous system health.
2. Adaptogenic Teas: Ashwagandha or chamomile can lower cortisol—steep a cup pre-event.
3. Hydration + Electrolytes: Stress can dehydrate you; aim for 8 oz water/hour and consider a pinch of salt or low-sugar electrolyte tablets.

10. Psychological Support & Self-Compassion

• Normalize your experience. Anxiety around health events is common—talk about it with peers or a therapist.
• Journaling: Write down your fears before an event to unload your mind and lower cortisol.
• Celebrate small wins. A stable day, a successful talk, or a post-stress BG within range are victories.

11. Building Your Personalized Stress Plan

1. Identify triggers with a stress–BG log for 2 weeks.
2. Choose 2–3 coping tools (breathing, walking, snack plan) and practice them daily.
3. Pre-schedule “stress prep”—15 minutes before a known event, do your breathing or a micro-walk.
4. Review & refine weekly based on CGM and log data.

12. Community and Advocacy

• Share your story to reduce stigma around stress and T1D.
• Encourage workplaces to incorporate “diabetes-friendly” break times.
• Support groups (TCOYD alumni, local meetups) provide peer tips and camaraderie.

Conclusion

Standing center stage at TCOYD, my pulse racing and CGM alarm faint in the background, taught me that stress management is as crucial to glucose control as any bolus or basal adjustment. By understanding the science of stress hormones and employing practical breathing, movement, and nutrition strategies, you can transform anxiety from a blood sugar foe into one more factor you can anticipate—and conquer.

Whether you’re speaking to a boardroom, taking finals, or simply facing the daily pressures of life with T1D, these tools will help you thrive. Remember: it’s not about eliminating stress—that’s unrealistic—it’s about managing your response so you stay in range, feel empowered, and show the world what you can do.

Diabetes is tough, but so are you. So remember, you’ve got this.

Stay fun,

Madi Cheever, MPH, RD, LDN, CHES
Type One Type Fun

‼️DISCLAIMER: although I am a healthcare professional, this post is not intended to be medical advice. This is simply me sharing some of what I know, but your body may not respond in this way so please make sure you are chatting with your diabetes educator and/or doctor first ‼️ or bring me onto your care team 😘