Emotional stress and diabetic control: a postulated model for the effect of emotional distress upon intermediary metabolism in the diabetic.

The findings of a number of clinical investigators across a wide variety of situations and using a wide variety of observational procedures agree on the disruptive effects of emotional distress upon diabetic control. An integrative model of coordinated neural and hormonal reactions to emotional stress and their additive and potentiating effects on intermediary metabolism is proposed. The end result of these effects, as part of a general fight/flight or defense-alarm reaction, is a strong energy mobilization response (namely, a sharp rise in blood glucose and free fatty acid levels resulting in increased levels of serum cholesterol, triglycerides, and ketone bodies), which the diabetic cannot readily counterregulate. It is further proposed that increased diabetic control, together with lower insulin requirements, may result from the inclusion of stress management procedures as an adjunct to traditional medical treatment. The findings of a large number of investigators supporting these propositions are presented and discussed.