Could STRESS give you diabetes?
It’s not just the overweight who are at risk. Increasingly, experts are asking . . .
The popular image of a patient with type 2 diabetes is someone who’s overweight, with a couch-potato lifestyle.
It’s a stereotype that makes salesman Dave Dowdeswell furious.
The father-of-two, now 48, developed the condition at the age of 44 when he had a 32 in waist and weighed only 12 st — almost ideal for his 5 ft 9 in height. As a keen windsurfer and diver who also walked his dog every day, he was physically fit. There was no family history of type 2 diabetes, and he doesn’t even have a sweet tooth.
In fact, Dave ticked none of the normal risk-factor boxes, such as being overweight or having a waist of 37 in or more. So how did he become one of almost three million people in the UK with type 2?
his doctors believe the trigger was stress. In the 12 months before he began to feel unwell, he had witnessed his 19-year- old daughter Gemma being knocked over by a car and breaking her neck after a family meal out; his thriving paint- spraying business had collapsed because of falling trade and teetered on the verge of bankruptcy, and his beloved bulldog died.
Then, in November 2010, Dave unexpectedly lost his 70-year-old father to cirrhosis of the liver. ‘That really hit me for six. he went into hospital and never came out,’ says Dave, who lives in Portsmouth.
‘he went downhill so quickly and I couldn’t believe it when he died. We were close and it hit me so badly.’
Within a week Dave started to feel ill himself. ‘I was suddenly needing to get up two or three times a night to have a pee.
‘I was also drinking around two pints of orange juice in one go, and I couldn’t wait to finish a meal so I could have a drink of water or orange juice as I felt so thirsty.
‘We were on a scuba- diving holiday in egypt at the time, but my wife Adriana said: “As soon as we get home, I think you should get yourself to the doctor.” ’
he dutifully did and the doctor decided to test him for diabetes. A blood test revealed that his sugar level was sky-high — 28, when it should have been 7 at most. The doctor diagnosed type 2 diabetes.
‘I couldn’t understand why me,’ says Dave. ‘I asked the doctor “what caused this?” and he said “it could be the stress”. I thought about my year and realised that must be it.’
STreSS
is a known trigger for many conditions, from skin complaints such as psoriasis to irritable bowel syndrome. But increasingly studies suggest that it may also be linked to type 2 diabetes, no matter how healthy your lifestyle.
research published in the journal Psychosomatic Medicine last September found that those under extreme pressure at work were 45 per cent more likely to develop the condition than those under minimal pressure. The results were based on a 13-year study of 5,000 men and women.
Type 2 diabetes occurs when the body does not produce enough insulin or becomes less sensitive to its effects. Insulin acts like a key to allow sugar into cells and if, for example, someone is overweight that key works less well.
One theory is that the stress hormone cortisol may also alter the body’s sensitivity to insulin.
‘Stress leads to a rise in cortisol, a steroid hormone, and sometimes when you give individuals steroids (drugs that resemble cortisol) at a high dose, this impedes the action of insulin,’ says Naveed Sattar, professor of medicine at the University of Glasgow.
‘So when we do a risk score to see how likely someone is to develop type 2 diabetes, we do ask if they are on steroids, as this can increase their risk.’
While Professor Sattar is not convinced that this means stress itself is a direct cause of diabetes, other experts believe it is.
Professor Andrew Steptoe, a psychologist and epidemiologist from University College London, says his research shows that people with type 2 diabetes react to stress differently — but whether this is what caused their diabetes or is a result of it, is not clear.
In a study of 420 adults, his team found that those with type 2 took longer to recover from a stressful event — their blood pressure and heart rate took longer to return to normal than those without diabetes. The results were published in Proceedings of the National Academy of Sciences.
‘everyone responds to stress with an increase in pulse rate, blood pressure and release of stress hormones,’ says Professor Steptoe.
But there was a difference in the length of this response between the healthy participants and those with type 2 — ‘ Ninety minutes after a stress experience they still hadn’t returned to normal levels, unlike the healthy participants’.
FUrTherMOre,
Professor Steptoe found that the type 2 diabetics had higher levels of cortisol. ‘It might be that they are more exposed to stress, or that they are in a state of high-level activation of the stress response.’
Next he plans to follow up healthy people in the study who also showed a prolonged response to stress, to see if they develop type 2.
Professor Steptoe says further research is needed, but adds that we may need to rethink the risk factors for type 2 diabetes and include stress among them.
People with type 2 seem to think there is a strong correlation between stress and the onset of their condition.
A survey of more than 500 patients for the online forum
diabetes.co.uk found that 78 per cent believed their condition was brought on by, for example, stress in the workplace, long hours, the breakdown of a marriage or a family bereavement.
Often, adopting a healthy lifestyle is the first course of action for those newly diagnosed with type 2 diabetes, to help get their blood sugar back into normal range. But for Dave, who had no need to lose weight or get fitter, controlling his diabetes was initially harder.
‘It took a year to stabilise my blood sugar levels,’ he says.
‘They put me on metformin and other drugs but my blood sugar only went down a bit, so now I also have Byetta injections that increase the amount of insulin my body produces — I inject it once in the morning and once at night, and that’s got my blood sugar down.’
he has also ensured that his lifestyle is as straightforward and stress-free as possible.
‘I am enjoying life — thankfully my daughter recovered — and trying to avoid stress where I can. I have given up my business and sell log cabins in a garden centre now — it’s not a stressful job and suits me very well.
‘But what really annoys me is that people think you can only get type 2 if you are really unhealthy and have a huge beer belly. They insinuate that it’s somehow my fault and that I need to get off the sofa and stop eating so many doughnuts.
‘If I can get type 2, anyone can.’