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Commentary: High stress levels a silent culprit behind diabetes

Diabetes is a multi-faceted disease that can be caused by other factors apart from the consumption of sugary drinks or sweet treats, says NTU’s Professor Bernhard Boehm.

SINGAPORE: Whether it is replying to a work email or playing the next game of Candy Crush, you might want to keep your smartphone away till you are done with your meal.

Though those dopamine hits might distract you from the day’s woes, those online games may be actually be inducing more stress hormones in your body.

We often think of consuming too much sugar as the key cause for diabetes, but research has shown that lifestyle habits too can induce stress hormones and lead to diabetes.

READ: Want to fight the sugar problem? Start counting calories, a commentary

Classic stress hormones such as cortisol and catecholamines, if secreted often enough when our body reacts to stress, can create insulin resistance. And insulin then becomes less effective in controlling the blood glucose levels.


Most people think of stress as acute stress. 

This is when the body enters the classical “fight or flight” mode – like when your heart races as you prepare to give a big presentation at work or when you get stuck in traffic. At this stage, your body releases glucose to prepare you to fight or to escape.

But chronic stress can also lead to diabetes. For instance, in situations where people are saddled with prolonged financial difficulty or have to hold down a challenging relationship, their alarm system is constantly activated, the pancreas struggles harder to produce enough insulin to combat the amount of glucose your body releases.

A focused man working on a sticker-covered laptop in a coffee shop. (Photo:Unsplash/Tim Gouw)

The human body has a very sensitive stress recognition system because evolution has made us biologically designed to respond to stress.

If there are too many interruptions around you – such as when you are using your smartphone to watch a video while you eat – your stress hormones will rise, more glucose will be produced, and if your pancreas cannot release enough insulin, you stand at higher risk of diabetes.

Overtime, your system gets exhausted and become less sensitive to insulin. So your blood sugar levels after a meal will take much longer to return to normal levels when you are stressed.

And when sugars build up in your bloodstream, that could unleash a whole host of health problems. Not only will your weight begin to increase. You also start to have trouble sleeping. It could also cause harm to your heart and muscles.

An individual becoming less insulin sensitive because of stress could form the basis for the development of diabetes – apart from having an unhealthy diet.


A dysregulation of stress hormones provides an important biological link between stress, depression and Type 2 diabetes.

Diabetes is a long-drawn battle in Singapore, with one-third of Singaporeans likely to have this chronic disease in their lifetime. The Republic is just behind the US, which has the highest prevalence of diabetes in developed countries.

In 2016, the Singapore Government declared a “war on diabetes” and rolled out strategies – ranging from promoting good eating habits to better disease management – in an attempt to educate its citizens about this lethal health condition.

(Photo: Pixabay/stevepb)

The Ministry of Health has also proposed four measures: First, banning the sale of higher sugar pre-packaged drinks. Second, imposing a tax on manufacturers and importers of such drinks. Third, slapping on a mandatory front-of-pack nutrition label on these drinks. Fourth, placing wider restrictions or banning the advertisements of high-sugar drinks.

But tackling sugar is not enough to solve this pressing issue of growing diabetes prevalence.

READ: Reclaiming control over diabetes, one device at a time, a commentary

Today, one in nine people – or more than 400,000 people - aged 18 to 69 has diabetes.

We are seeing a dramatic increase in Type 2 diabetes in the 18 to 40 age group, particularly in Singapore. It is not just an elderly disease anymore.

Diabetes will continue to be a problem if nothing is done. The number of diabetics under the age of 70 is expected to rise to 670,000 by 2030 and one million by 2050.


We need to reassess the way we treat diabetic patients in Singapore, especially in younger patients, instead of just seeing it as a war on sugar.

Studies in recent years have shown us that diabetes is not just a glucose-centric disease but a multi-faceted one that can be caused by other factors apart from the consumption of sugary drinks or sweet treats.

READ: Not just sugar - You might be eating your way to pre-diabetes and not even know it

Healthy diets with less sugar can help but prevention strategies must also consider other factors that make diabetes more likely.

We don’t just have to bring down the glucose in blood; we also need to tackle blood lipids, cholesterol and blood pressure – meaning we need to help people get active to bring down their body mass index and enhance weight loss.

(Photo: Unsplash/i yunmai)

We also need to help diabetics manage high cholesterol – to lower smoking and alcohol consumption.

And we also need to help people participate in prevention care activities – with appropriate checks in the eyes and kidneys for early warning signs

READ: Unable to look sideways? Unusual signs of diabetes often unnoticed, ignored or denied, a commentary

We need to manage the chronic disease better ourselves as individuals. Even if it can be managed, through insulin jabs for instance, failing to tackle its root causes will lead to a steady deterioration and result in devastating complications such as kidney failure, nerve damage and heart disease.


Diabetes is a chronic disease that requires a comprehensive and sustained suite of treatment strategies. As with any chronic disease or non-communicable disease, self-management is a key element in successful treatment and improvement in health outcomes.

(Photo: Unsplash/rawpixel)

Understanding the information and having the capability to translate the information into positive self-care behaviours are chief components in diabetes education. 

Well-informed diabetic patients and their families, in turn, can act as ambassadors and support a wide range of healthy living activities within the community.

Managing our stress levels can be a good first step to tackling diabetes.

Professor Bernhard Boehm is the Ong Tiong Tat Chair Professor of Diabetes Research, Professor of Metabolic Medicine and Scientific Director of Metabolic Disorders Research Programme at the NTU Lee Kong Chian School of Medicine. 

Source: CNA/nr(sl)