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Does stress affect my risk of getting diabetes?

The perception of stress differs greatly among individuals. What one person may perceive as stressful, another may not. For this reason, stress is quite hard to measure in real-life situations. Artificial measures of accepted stress, such as electric shocks or deprivation of sleep, are very hard to apply to day-to-day life. However, people who report that they are more stressed, regardless of the actual nature of the stress itself, are more likely to suffer from diabetes. Furthermore, it has recently become apparent that measurable physical and psychological stress, such as that caused by sleep deprivation and social stress, is more likely to be associated with the presence of diabetes. This may in part explain the difference in the frequency of diabetes found in people of similar genetic background and measurable physical characteristics (body weight, amount of exercise, etc.) in different regions and societies. Exactly how perceived stress, whether physical, social, or psychological, leads to diabetes is not yet understood.

What other factors increase my risk of getting diabetes?

Besides excess weight, hereditary risk, and lack of exercise, another factor that can increase the risk of developing diabetes is the use of certain medications. Among these medications, the type associated most strongly with increased risk are the steroids (also called glucocorticoids), whose members include prednisone, methylprednisolone, hydrocortisone, and dexamethasone. The steroids belong to a class of naturally occurring stress hormones known as counter- regulatory hormones, which prepare the body to combat stress. They tend to raise blood sugar. Other stress hormones include the so-called catecholamines such as epinephrine (adrenaline) and norepinephrine (noradrenaline), which also raise the blood sugar. Synthetic versions of these compounds, which include some drugs used in weight loss medications, cold and allergy medications, asthma medications, and stimulants, can also cause a rise in blood sugar. Certain types of diuretic pills ("water pills") such as thiazides can also occasionally raise blood sugar, although these pills are commonly and appropriately used in people with diabetes. A certain type of cholesterol-modifying drug known as niacin can raise the blood sugar, sometimes quite markedly. The long- acting ("extended release") version of niacin is less likely to do this. Certain types of medications used to treat psychiatric conditions (the atypical antipsychotics) can lead to a higher frequency of diabetes, although this appears to be largely due to their tendency to cause weight gain. Certain classes of antiviral drugs, especially those used for the treatment of HIV/AIDS, can lead to diabetes.

Among those medications, the type associated most strongly with increased risk are the steroids (also called glucocorticoids).

Counterregulatory hormones

Naturally occurring hormones that prepare the body to combat stress.

Certain classes of antiviral drugs, especially those used for the treatment of HIV/AIDS, can lead to diabetes.

In the case of all these drugs, the prescribing physician needs to consider the potential benefit of the drug in question to the patient and weigh this against the known risks, including the risk of developing diabetes. In many cases, the potential benefit of using these drugs, which may be life-saving, is believed to outweigh the risks and the blood sugar should be monitored and treated appropriately if diabetes occurs. Once the drug in question is discontinued, the diabetes usually goes away and treatment can be discontinued.

 
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