When we talk about insulin resistance, the conversation often centres on food, weight and exercise. These are important parts of the picture, but they are not the whole picture.

Insulin sensitivity is also influenced by sleep, inflammation, genetics, hormonal changes, muscle mass, medications and importantly, the way the body responds to stress. For some people, improving diet and exercise makes a significant difference. For others, particularly those moving through prolonged periods of physical or emotional strain, metabolic health may not improve as expected until stress is addressed. 

Stress is rarely the sole cause of insulin resistance however your stress response is closely connected to blood sugar regulation and can be one of several factors reducing insulin sensitivity over time. It’s prolonged/chronic stress that makes the biggest impact. 

What is insulin resistance?

Insulin is a hormone produced by the pancreas. One of its main roles is to help glucose move out of the bloodstream and into our cells, where it can be used for energy or stored for later.

When we eat, food is turned into glucose, raising our blood glucose levels.  Insulin is released as a response to these blood glucose levels and the glucose is then able to be taken into the cells of the body for cellular energy. 

Insulin resistance is when the body's cells become less responsive to insulin, which means that more insulin needs be released to have the same effect of bringing glucose into the cells for energy

This higher than required release of insulin can go on for many years, all while blood glucose remains unaffected. Over time however, the blood glucose eventually cannot be maintained and it begins to rise despite insulin being present. Insulin resistance is the path to type 2 diabetes, however so many people feel the effects of this before it may progress to type 2 diabetes. 

Some of the key signs and symptoms of insulin resistance are abdominal weight gain, energy issues (usually seen as daily slumps in energy after meals), hormonal issues (especially seen in PCOS), acne, high liver enzymes on pathology and trouble conceiving due to poor ovarian signalling. 

As we see in many cases of PMOS/PCOS, there isn’t always weight issues when there is insulin resistance.

How stress contributes to insulin resistance

When the brain perceives stress, the hypothalamic-pituitary-adrenal axis (HPA axis) helps signal the release of cortisol and other stress hormones. Short term, this is an adaptive response and very helpful for dealing with the stressful situation at hand. Cortisol helps make energy readily available by encouraging the liver to release more glucose into the bloodstream. This means the body has fuel straight to the bloodstream without needing to eat food. The brain and muscles can then respond effectively to the perceived stress.

The trouble with this mode of action is that when it occurs too often over a long period of time. In a way, it is the same as eating a food that releases glucose straight into the blood (such as a carbohydrate). This is why you might be eating really well (low GI, high protein, at regular intervals) and still be experiencing insulin and glucose issues. 

I see this occurring a lot with busy mums. Often the effect is twofold as they are often skipping meals and not eating enough protein as well as being tired and stressed trying to look after children. Once we regulate eating patterns and food choices, insulin begins to regulate and the symptoms of insulin resistance ease off. 

Another group that I see lot of is the PCOS/PMOS client with high stress. There is often a lot of frustration over the fact that they have overhauled their diet and are putting in the work to combat the effect insulin resistance is having on their bodies and hormones however they are not seeing the results. Once we address the stress in their lives, they really begin to see a turnaround in their symptoms. In fact, there is a pocket of women whose PCOS/PMOS is driven almost entirely by stress. In a consultation we always identify the key drivers for your symptoms, as it is different for everyone. 

The research also supports this connection between stress and insulin resistance. In an observational study of 766 workers, higher work-related stress was associated with higher cortisol and greater insulin resistance (measured using their HOMA-IR scores). Higher cortisol was also associated with higher fasting glucose, waist circumference and insulin resistance, even after abdominal obesity was taken into account.

Chronic stress can also affect insulin sensitivity indirectly. During stressful periods, we may sleep poorly, skip meals, rely too much on caffeine, exercise less or reach for convenience foods that provide rapid energy. You can therefore see how stress is so involved in our metabolic health.

Who might be impacted by stress related insulin resistance?

• New mothers
• Carers
• Shift workers
• Perimenopausal women
• Chronic pain sufferers
• Anyone under high or chronic stress (physical or mental/emotional)

How do you know if you have insulin resistance?

If you feel you are doing all the “right” things eating well, exercising, being told your hormones are “normal” but you remain tired, hungry, prone to energy crashes or unable to shift abdominal weight, you might consider if you are experiencing insulin resistance. Symptoms alone can not identify insulin resistance but the following signs and symptoms might give you some clues about if you should investigate insulin resistance further:

• Hunger soon after eating
• Strong sugar or carbohydrate cravings
• Shakiness, irritability or fatigue when meals are delayed/skipped
• Sleepiness or brain fog after meals
• Increasing weight around the abdomen
• Difficulty losing weight despite positive changes
• Skin tags or darker, velvety skin around the neck or underarms
• High triglycerides, fatty liver or elevated blood pressure
• Irregular cycles, acne or increased facial hair (often associated with PCOS/PMOS)
• A history of gestational diabetes
• Family history of type 2 diabetes

To truly identify insulin resistance we need to know both your fasting glucose and your fasting insulin. Your HbA1c is another test often used to assess how your body interacts with glucose. 

What can we do to improve insulin sensitivity?

The goal is not to simply “remove stress”. If we could do this we all would! It is to reduce any unnecessary physiological strain and improve the body’s ability to cope with stress and to recover.

Regular meals containing protein, fibre, healthy fats and complex carbohydrates can help create steadier blood sugar levels. Including adequate protein at breakfast is particularly useful first step in regulating blood sugars. This is especially important if you are only having a coffee first thing in the morning. 

Movement is also important, however this needs to be weighed up with the stress that you are already experiencing and the type of exercise you plan on doing. A high intensity cross fit for a busy mum for example, is often causing more stress on the body and worsening cortisol levels.  Walking is a great first place to start if you are unsure, especially after meals as this will actively regulate your blood sugars. 

Sleep is always important. Research has shown that even several nights of broken or inadequate sleep can reduce insulin sensitivity. Supporting sleep and circadian rhythm may involve morning outdoor light exposure, regular sleep and wake times and a calm dark environment before bed.

In clinic, we also use herbal medicine to help your body better deal with the stress in your life, as well as support your hormone balance and help regulate blood sugar fluctuations. If you suspect you have insulin resistance, or that stress might be impacting your blood sugar balance, I would LOVE to help you. It is such an encouraging area to work on as it only takes a few small changes to start feeling the effects.