The Diabetic Ratchet Effect: Why People with Type-1 Can’t Afford to Get Stressed Out

It’s time to be out the door with our 9-year old son. But instead of Jonah having his boots and jacket on… he’s still in the bathroom. Why has he been in the bathroom that long? Constipation? He poos like an elephant. Day-dreaming? Probably.

These types of small conflicts can easily trigger stress hormones like cortisol. The problem with cortisol is that it raises blood sugar. “Cortisol counters insulin by encouraging higher blood sugar and stimulating gluconeogenesis, the metabolic pathway that synthesizes glucose…” explains an article in the Dartmouth Undergraduate Journal of Sciences.

Once the situation is remedied – son out the door – the stress hormones should go down. If it’s I who got stressed, my body simply release insulin and lowers the blood sugar. But if Nicole got stressed then this lowering of blood sugar doesn’t happen. With type-1 diabetes, her blood sugar may not continue to rise, but it ain’t going down either.

I call this the Diabetic Ratchet Effect. A ratchet only turns one way. Your blood sugar will stay up until it’s time to safely inject a corrective dose of fast-acting insulin. If you just had a shot, then you’re looking at five hours before you can even start to get rid of that elevated blood sugar level.

In short, if you have type-1 diabetes, releasing cortisol should be reserved for real life-and-death situations that actually require high blood sugar levels. If you’re in the middle of an earthquake and need to carry two children on your back… then let the blood sugar rise! That sugar will go to immediate use. Your body will ferment it into quick energy to move your muscles.

But a little boy taking too long on the toilet? That doesn’t require super-human endurance. Cortisol and glucose aren’t the solution for a absent-minded prince lazing on the throne. So how do you stop cortisol from being released? It may seem like a hormonal response completely out of our control. If you have kids, you’re going to have cortisol, right? Same goes for nasty customers, bad co-workers, a mean boss, too much work, too many to-do items… These things are stressful, and thus they stimulate cortisol automatically. Don’t they?

Actually, the way I see it, cortisol is actually the wrong tool for most of these challenges.  A high blood sugar will not help you get your son out the door, a bill paid or your boss to lower his expectations. What’s worse, coritsol release comes with constriction of blood vessels. Constricted blood vessels reduces blood flow to the brain. This is really too bad, since a properly functioning brain is usually just the tool for these types of problems.

One simple definition of stress is anything that requires you to adapt. Sometimes adapting means putting down a book you and running for your life. Most of the time, in our modern world, it’s not that exciting. It usually requires thinking of ways to handle the new (unwanted) situation and then trying out the best idea.

In many ways, people with type-1 diabetes have extra motivation to both avoid stress and respond to stress better. The Diabetic Ratchet Effect means that without even touching a carbohydrate their glucometer readout can double. This can be a great prod to stay calm at all times. Such a state could lead to above average physical and mental health.

Yet that cortisol response feels so natural… so primal. How do we stop it when we can’t always avoid stressful stimuli? Well, interestingly, there is a “on-off switch.” We may flick this switch to the on position subconsciously, but we can turn it off consciously. The switch is our breathing pattern.

Most of the time our breathing is on autopilot. Rarely do people ever switch to manual control if they see it going off course. And, often, when they do take over the controls, they only make it worse (since they have no idea how good breathing looks).

Based on my research over the last six months, I think breathing may be more important than diet, when managing blood sugars and type-1 diabetes. Knowing how to identify when you’re breathing pattern is triggering the release of cortisol and the suppression of insulin is the first step. The second step is knowing the proper breathing pattern to lower the cortisol and increase perfusion of insulin. In the next post I’ll share with you some of what I’m discovering.

Until then, put that diabetic ratchet back in the toolbox. Save it for beating up a mugger or outrunning a tsunami.

Thinking outside the type-1 matrix,
–John C. A. Manley

P.S. To see how well you’re breathing habits are you can take this test: DIY Body Oxygenation Test: Instructions for People with Type-1 Diabetes

P.P.S. For research and studies on how breathing determines your overall health, I highly recommend starting with Breathing Slower and Less by Dr. Artour Rakhimov. Available from, and

About the Author: John C. A. Manley researches and writes about alternative treatments for type-1 diabetes and its many complications. His wife, Nicole, of 15 years has had type-1 diabetes for four decades. Together they have lowered her HgbA1c below 5.5%, regained thyroid function, increased kidney function and reversed gastroparesis. Read more about their journey out of the T1D matrix or subscribe to their Diabetic Dharma blog..