Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
Epidemiology/Health Services/Psychosocial Research

Maintenance of Glucose Control in Patients With Type 1 Diabetes During Acute Mental Stress by Riding High-Speed Rollercoasters

  1. Peter Wiesli, MD12,
  2. Pierre-Alexandre Krayenbühl, MD3,
  3. Oranna Kerwer1,
  4. Burkhardt Seifert, PHD4 and
  5. Christoph Schmid, MD1
  1. 1Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital of Zurich, Zurich, Switzerland
  2. 2Medizinische Klinik, Endokrinologie und Diabetologie Kantonsspilal Frauenfeld, Frauenfeld, Switzerland
  3. 3Department of Internal Medicine, Medical Policlinic, University Hospital of Zurich, Zurich, Switzerland
  4. 4Department of Biostatistics, University of Zurich, Zurich, Switzerland
  1. Address correspondence and reprint requests to Peter Wiesli, MD, Kantonsspital Frauenfeld, Medizinische Klinik, Endokrinologie und Diabetologie, Frauenfeld, Switzerland. E-mail: peter.wiesli{at}stgag.ch
Diabetes Care 2007 Jun; 30(6): 1599-1601. https://doi.org/10.2337/dc06-2102
PreviousNext
  • Article
  • Figures & Tables
  • Info & Metrics
  • PDF
Loading
  • CGMS, continuous glucose monitoring system

Patients with diabetes and health care providers are often confronted with questions concerning psychological stress as a possible reason for glucose excursions; chronic psychosocial stress has been associated with higher levels of A1C and poor adherence to treatment (1,2). Few studies have addressed the effect of acute psychological stress on glucose concentrations in patients with type 1 diabetes, showing no or only minor effects, such as an increase in insulin resistance and slightly delayed decreases in glucose concentrations following moderate stress in the postprandial period (3–5). Since many patients and caregivers have challenged this view, we asked patients with type 1 diabetes to monitor glucose concentrations during a strongly stressing experiment.

RESEARCH DESIGN AND METHODS—

A total of 20 patients with type 1 diabetes (all on intensified insulin treatment) were recruited from a recent study investigating the effect of acute moderate psychosocial stress on glucose concentrations (5). Patients were exposed to acute mental stress by riding on two different rollercoasters within 15 min. The first rollercoaster was a steel coaster starting from a height of 240 feet and reaching a speed of 79 mph with four positive Gs and the second an indoor coaster in absolute darkness. Blood pressure (by an ambulatory blood pressure monitoring device), heart rate (by 24-h electrocardiogram), and salivary cortisol were monitored during a preceding control day without stress application and on the stress testing day. Glucose concentrations were monitored in 5-min intervals by the Medtronic MiniMed continuous glucose monitoring system (CGMS). Capillary blood glucose concentrations were determined in 15- to 30-min intervals by reflectance meter (results not shown, consistent with CGMS data). A total of 10 patients performed the rides in the fasting state. Patients were allowed to drink water and injected their basal insulin as usual. An additional 10 patients were riding the rollercoasters 75 min after intake of a standard meal containing 50 g carbohydrates (with the same prandial insulin dose on both days). The rides were performed between 1:00 and 3:00 p.m. The protocol was approved by the ethics committee of the University Hospital of Zurich; all patients gave written informed consent.

RESULTS—

Mean ± SD age of 20 patients (8 female) with type 1 diabetes was 37 ± 11 years, diabetes duration 14 ± 10 years, BMI 24.7 ± 4.5 kg/m2, and A1C 7.6 ± 0.9%. Blood pressure, heart rate, and salivary cortisol remained stable for the observed period during the control day. During the rides, heart rate rose from 82 ± 7 bpm at baseline up to a maximum of 158 ± 16 bpm (P < 0.001). Blood pressure increased from 124/79 ± 12/9 to 160/96 ± 17/14 mmHg between the two rides (P < 0.001). Salivary cortisol increased from 6.3 nmol/l (range 2.8–11.4) to a maximum of 19.3 nmol/l (5.6–49.3) 60 min following the ride (P = 0.008). Glucose concentrations of 10 patients investigated in the fasting state remained fairly stable, both during the control and stress testing day (Figure 1A). At the time of stress application, glucose concentrations were 6.2 ± 1.6 mmol/l on control and 6.7 ± 2.3 mmol/l on stress testing day (P = NS). A two-factor repeated-measures ANOVA showed no significant differences in glucose concentrations between the control and stress days. Ten patients were investigated in the postprandial state (Fig. 1B). Baseline glucose concentrations before the intake of the meal on control and intervention days were 7.2 ± 2.2 and 6.6 ± 2.4 mmol/l (P = NS), respectively. Glucose concentrations increased comparably in response to the meal, by 3.7 ± 2.6 mmol/l on the control day and by 3.3 ± 2.0 mmol/l on the stress testing day, and returned to baseline within 3 h after the meal on both days. There appeared to be an attenuated increase in postprandial glucose concentrations during the 30 min before the ride. However, a two-factor repeated-measures ANOVA revealed no significant difference of glucose concentrations between the control and stress days.

CONCLUSIONS—

We found that severe short-lived mental stress, as documented by markedly increased heart rate and blood pressure (reflecting sympathetic activation) and salivary cortisol, barely affected glucose control in patients with type 1 diabetes, consistent with previous reports investigating the effect of moderate mental stress on glucose control (3–5). The maintenance of glucose control (as shown in Fig. 1 only by interstitial but confirmed by less frequent capillary readings) is all the more remarkable since patients with type 1 diabetes are unable to adapt insulin secretion. Our patients (type 1 diabetes duration 14 years, mean age at diagnosis of diabetes 21 years) were unlikely to have relevant residual insulin secretion and were on a fixed insulin dose when they faced a challenge, resulting in an upregulation of insulin-counterregulatory hormones. The latter may contribute to an excellent matching of glucose fluxes (appearance and disappearance) so that glucose homeostasis during acute mental stress can be maintained. However, our study was carried out with patients in reasonable metabolic control and cannot necessarily be extrapolated to the many patients who face mental stress with poor glycemic control or have chronic mental stress.

In the fasting state, glucose concentrations tended to decrease during the control day and remained stable during and following the rides. Thus, a minor effect of mental stress on glucose control cannot be excluded definitively, but it appears that acute short-term mental stress in the fasting state is hardly responsible for clinically relevant glucose excursions. Following the intake of a meal, the increase of glucose concentrations on stress testing day was slightly attenuated, and glucose concentrations tended to remain lower throughout the experiment. The attenuation of the rise in postprandial glucose concentrations failed to reach significance and was noticed 30 min before the rides (i.e., when patients were anticipating the rides) and is possibly explained by increased utilization of glucose by the brain, heart, or respiratory muscles (i.e., by tissues in which the activity is markedly increased in response to stress). Following the ride, the difference in glucose concentrations between the stress and control days became smaller, and almost identical glucose values were observed 3 h after the meal.

In conclusion, most patients with type 1 diabetes exposed to strong short-lived mental stress (i.e., riding on rollercoasters) can keep good glycemic control without adjusting the insulin dose.

Figure 1—
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1—

Glucose concentrations measured by CGMS on the control day without stress (circles) and on the stress testing day (squares) in 20 patients with type 1 diabetes. In total, 10 patients were riding the rollercoasters in the fasting state (A) and 10 patients after intake of a standard meal at −75 min (B). The ride on the first rollercoaster started at time 0 and the ride on the second rollercoaster at time 10 min. Glucose concentrations are shown as change from baseline values (difference from the glucose value at time −45 min in fasting patients and from the glucose value at time −105 min in patients taking a standard meal at −75 min). A two-factor repeated-measures ANOVA revealed no significant difference of glucose concentrations between control and stress testing days, neither in the fasting nor postprandial state.

Acknowledgments

The study was financially supported by an unrestricted grant of Roche-Disetronic Switzerland.

We thank Dagmar Holm and Monika Voggenreiter for analyzing the blood pressure data, Clemens Kirschbaum for cortisol analysis, and Frank Enselait for analyzing the electrocardiograms.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 2 March 2007. DOI: 10.2337/dc06-2102.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted February 21, 2007.
    • Received October 11, 2006.
  • DIABETES CARE

References

  1. ↵
    Lloyd CE, Dyer PH, Lancashire RJ, Harris T, Daniels JE, Barnett AH: Association between stress and glycemic control in adults with type 1 (insulin-dependent) diabetes. Diabetes Care 22:1278–1283, 1999
    OpenUrlAbstract
  2. ↵
    Hains AA, Berlin KS, Davies WH, Parton EA, Alemzadeh R: Attributions of adolescents with type 1 diabetes in social situations: relationship with expected adherence, diabetes stress, and metabolic control. Diabetes Care 29:818–822, 2006
    OpenUrlAbstract/FREE Full Text
  3. ↵
    Kemmer FW, Bisping R, Steingruber HJ, Baar H, Hardtmann F, Schlaghecke R, Berger M: Psychological stress and metabolic control in patients with type I diabetes mellitus. N Engl J Med 314:1078–1084, 1986
    OpenUrlPubMedWeb of Science
  4. Moberg E, Kollind M, Lins PE, Adamson U: Acute mental stress impairs insulin sensitivity in IDDM patients. Diabetologia 37:247–251, 1994
    OpenUrlPubMedWeb of Science
  5. ↵
    Wiesli P, Schmid C, Kerwer O, Nigg-Koch C, Klaghofer R, Seifert B, Spinas GA, Schwegler K: Acute psychological stress affects glucose concentrations in patients with type 1 diabetes following food intake but not in the fasting state. Diabetes Care 28:1910–1915, 2005
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top
Diabetes Care: 30 (6)

In this Issue

June 2007, 30(6)
  • Table of Contents
  • About the Cover
  • Index by Author
Sign up to receive current issue alerts
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Diabetes Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Maintenance of Glucose Control in Patients With Type 1 Diabetes During Acute Mental Stress by Riding High-Speed Rollercoasters
(Your Name) has forwarded a page to you from Diabetes Care
(Your Name) thought you would like to see this page from the Diabetes Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Maintenance of Glucose Control in Patients With Type 1 Diabetes During Acute Mental Stress by Riding High-Speed Rollercoasters
Peter Wiesli, Pierre-Alexandre Krayenbühl, Oranna Kerwer, Burkhardt Seifert, Christoph Schmid
Diabetes Care Jun 2007, 30 (6) 1599-1601; DOI: 10.2337/dc06-2102

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Add to Selected Citations
Share

Maintenance of Glucose Control in Patients With Type 1 Diabetes During Acute Mental Stress by Riding High-Speed Rollercoasters
Peter Wiesli, Pierre-Alexandre Krayenbühl, Oranna Kerwer, Burkhardt Seifert, Christoph Schmid
Diabetes Care Jun 2007, 30 (6) 1599-1601; DOI: 10.2337/dc06-2102
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • RESEARCH DESIGN AND METHODS—
    • RESULTS—
    • CONCLUSIONS—
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Tables
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Suboptimal Use of Cardioprotective Drugs in Newly Treated Elderly Individuals With Type 2 Diabetes
  • Disparities in Diabetes Care Between Smokers and Nonsmokers
  • Risk Factors for Mortality Among Patients With Diabetes
Show more Epidemiology/Health Services/Psychosocial Research

Similar Articles

Navigate

  • Current Issue
  • Standards of Care Guidelines
  • Online Ahead of Print
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Clinical Diabetes
  • Diabetes Spectrum
  • Scientific Sessions Abstracts
  • Standards of Medical Care in Diabetes
  • BMJ Open - Diabetes Research & Care
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.