Preparing for Lows With Type 2 Diabetes

From diatribe.org

Key takeaways:

• People with type 2 diabetes commonly experience low blood sugar that can be fixed with a quick snack, but taking insulin or sulfonylureas raises the risk of more serious hypoglycemia.
• It’s important to regularly monitor your blood sugar and prepare for unexpected lows with a kit that includes a sugary snack, a medical alert identifier, and ready-to-use glucagon.
• Glucagon is an essential part of any kit, so if you haven’t had a conversation about it, bring it up with your healthcare team.

It’s scary to think about severe hypoglycaemia, but it can happen to anyone who manages their diabetes with insulin or sulfonylureas. 

If you have type 2 diabetes and use one of these medications, you should know what severe hypoglycemia is, how to avoid it when possible, and how to treat it when it occurs. Ideally, these conversations should be happening during check-ups with members of your healthcare team.

“Unfortunately, I think the data tells us that more often than not, conversations about hypoglycaemia are not happening,” said Dr. Rozalina McCoy, an endocrinologist at the Maryland School of Medicine.

This is part of the reason so few people at risk of severe hypoglycaemia are prepared for it if and when it occurs. One study found that only 3.5% of people who treat type 2 diabetes with insulin filled a prescription for glucagon between 2019 and 2023. If no one on your healthcare team has mentioned severe hypoglycaemia or ready-to-use glucagon, it’s a good idea to bring up at your next visit.

Defining severe hypoglycaemia

A hypoglycaemic event is a problematic dip in your blood sugar. All lows should be taken seriously and treated appropriately, but some are more severe than others. Level 1 hypoglycaemia, the mildest form, is typically defined as a blood sugar level below 70 mg/dL. 

Symptoms like dizziness, shakiness, sweating, hunger, and anxiety may occur during hypoglycaemia, but they become more common when levels drop below the level 2 threshold of 54 mg/dL. It’s important to note that some people have impaired awareness of hypoglycaemia and never experience symptoms, leaving them unaware of lows unless they’re using a monitor to track their blood sugar.

Level 3 or severe hypoglycaemia is when your ability to function is impaired, and you require assistance from another person to return to normal blood sugar levels. Often, this is thought of as something that occurs after you’ve reached level 2, but everybody has a different tolerance for lows.

“You can have someone have a blood sugar of 20 mg/dL, and yet they’re young and resilient and able to self-treat,” McCoy explained.

On the other hand, she said that older people, especially those who have developed additional chronic conditions that make daily life more difficult, may require medical attention for blood sugar levels as high as 70 mg/dL. 

When does severe hypoglycaemia occur?

Most cases of severe hypoglycaemia are associated with insulin therapy or sulfonylureas. These medications are very effective at helping your body manage blood sugar, but it’s still easy to run into unexpected circumstances (maybe a delayed or missed meal or strenuous physical activity) that leave you with lower blood sugar than you were anticipating.

“It’s a mismatch between insulin requirements and insulin presence in the body, but it doesn’t mean it was anyone’s fault,” McCoy added.

Monitoring for lows

According to the American Diabetes Association’s (ADA) Standards of Care, everyone who takes insulin should wear a continuous glucose monitor (CGM). These devices help track changes in your blood sugar over time and alert you when you start to go low.

You should discuss your target range with your healthcare provider. Generally speaking, most people with diabetes should be aiming to spend most of their time between 70-180 mg/dL, but McCoy said she advises her older patients who might have a harder time handling a low to treat 100 mg/dL as their lower bound.

If you worry about being overwhelmed by all the CGM data, McCoy suggested thinking about it as an alert for lows. Even if you’re not looking at it that often, a CGM will tell you if you’re consistently going below your target range and may need to adjust your insulin therapy.

A CGM can be helpful for anyone with diabetes, but if someone isn’t taking insulin, then monitoring their blood sugar with fingerstick tests can be sufficient.

“If they’re on a sulfonylurea, they should check whenever they’re not feeling well or whenever they think they might be having a low,” McCoy said.

Hypoglycaemia preparedness

When you go low, the ultimate goal is to get more sugar in your body. Even if you have a severe episode that requires a trip to the hospital, healthcare providers will be treating you primarily with oral carbohydrates or an intravenous (IV) drip of sugar.

If you’re alert and able to eat, then candy, soda, juice, and even honey and sugar packets can all be effective options for raising your blood sugar back to normal levels. Wherever you are, you should always have some sort of sugary drink or snack on hand.

Regardless, there may be times when you go too low too quickly to raise your blood sugar with food. In these cases, emergency glucagon is necessary. There’s also a chance that a hypoglycaemic emergency will move so quickly that you won’t have time to react to it on your own. It’s important to educate people you’re close to about hypoglycaemia and glucagon. 

In case none of them are around when you need help, you should also wear a medical alert necklace or bracelet that clearly states you have diabetes and may be experiencing a low. If you have a car, then you could also put a medical alert cover on your seatbelt. 

When to use ready-to-use glucagon 

The ADA recommends self-administering ready-to-use glucagon if 15 grams of sugar hasn’t resolved your low within 15 minutes, if you can’t keep food down, or if you feel yourself becoming confused or on the verge of passing out. 

If you do need to give yourself glucagon, be prepared to feel sick. Also, make sure to call your healthcare provider or 911. You may still need emergency medical attention or your diabetes medications adjusted.

The ADA also recommends using glucagon if you pass out, but someone else needs to administer it at that point. Make sure your diabetes emergency kit includes glucagon and is accessible and clearly marked for other people. Once again, you should start by making sure that people you’re close to know what glucagon is, how to use it, and where your supply is stored, but you also have to anticipate times when people you’re less familiar with will need to help you.

Make sure your glucagon is clearly labelled as something to use when you’re unresponsive. If you also carry insulin with you, store the two medications in separate containers and make sure the insulin is clearly labelled as something that should not be given to you while you’re unresponsive.

It’s possible that the person who finds you might not be comfortable giving you glucagon. However, McCoy said that a dose of glucagon is unlikely to cause much harm, even if hypoglycaemia isn’t ultimately the reason a person with diabetes has become unresponsive. 

Actual instructions for using glucagon will depend on what type you have. There are currently three options. A traditional mixing kit includes a vial of glucagon powder and a syringe of liquid, and the powder must be dissolved into the liquid at the time of administration. This takes time and creates the possibility for mistakes, so traditional mixing kits are not the best option for an emergency situation.

Instead, it’s better to have ready-to-use glucagon. When you talk to your healthcare provider, ask about Gvoke HypoPens and Baqsimi nasal powders, both of which are readily administered with no mixing required.

How to get glucagon

Glucagon is a prescription medication, so you’ll need to talk to a healthcare provider to get it. Ideally, when you receive a prescription for insulin or a sulfonylurea, you should also get one for glucagon. However, getting started on any new medication may involve a steep learning curve, and discussions about glucagon often slip through the cracks at early medical appointments.

“I’m not perfect. I run out of time, or I start insulin, and then I’m like, ‘Okay, I’ll talk about glucagon at the next visit,’” McCoy said.

If the clinician who prescribed you insulin or a sulfonylurea didn’t discuss glucagon, then ideally your pharmacist would bring it up when you go to fill your prescriptions. Pharmacists are legally obligated to offer consultations to anyone picking up medications, and they should know all of the risks and benefits of medications they’re dispensing. 

If your pharmacist sees your insulin prescription come in without a glucagon prescription, then they should ask you about it. Your pharmacist can also ask your clinician to prescribe glucagon without waiting until your next appointment.

Other members of your healthcare team, including diabetes educators and dietitians, can also get the ball rolling on a glucagon prescription, but if no one brings it up, don’t be afraid to initiate the conversation. For many people, pharmacists may be the best starting point for these conversations because you can walk into a pharmacy and request a consultation without an appointment.

For most people in the U.S., McCoy said that insurance will cover a new prescription of an autoinjector pen or a nasal powder, but coverage varies. If your plan doesn’t cover ready-to-use glucagon and you can’t afford it on your own, you may be eligible for patient assistance programs offered by Baqsimi and Gvoke. 

In general, insurance will cover a glucagon refill every year or after every use. Glucagon doesn’t last forever, so even if you haven’t used yours, make sure to check the expiration date and replace it when necessary. You’ll need a replacement every two or two and a half years depending on which option you choose.

The bottom line

Any person with type 2 diabetes may experience low blood sugar, but people who take insulin or sulfonylureas are particularly at risk for severe hypoglycaemia, which a person cannot resolve on their own without assistance from someone else. It’s important to regularly monitor your blood sugar and prepare for unexpected lows by carrying sugary snacks, a medical alert identification tag, and clearly labelled ready-to-use glucagon. 

Members of your healthcare team should discuss hypoglycaemia and prescribe glucagon if you’re taking insulin or a sulfonylurea, but if they don’t, initiate the conversation yourself. For many people, it may be easiest to start by talking to the pharmacist, who is often the most accessible member of your healthcare team.

https://diatribe.org/diabetes-management/preparing-lows-type-2-diabetes 

8 Great New Year’s Resolutions for People with Diabetes

From asweetlife.org

‘Tis the season for self-improvement! All around the world people will take the opportunity of the dawn of a new year to dwell on the last year’s failures, and promise to make things better. This process comes naturally to people with diabetes – after all, we get report cards in black and white at the doctor’s office. It’s more serious too. When your pancreas can’t get the job done by itself, it’s up to you to make sure you avoid the twin threats of hypoglycaemia and chronic hyperglycaemia.

It takes discipline and hard work to thrive with diabetes, but it’s possible and it’s definitely worth the effort. If you think you’re ready to take your blood sugar management to the next level, here are some ideas that could serve you well in the coming year:

Hit the Weight Room

How many how many times have you rocked the treadmill in January only to fall off the wagon long before the first signs of spring? Make this year different and commit to pumping iron two to three times a week. If you think that lifting weights is just for the bodybuilders among us, you’re out of the loop. Resistance training is now recommended to just about everyone, regardless of age or gender, and is even seen to be of particular benefit to those who need to lose weight. Some of the many benefits include boosted metabolism, improved bone health, and better endurance, and a good weights session can be accomplished with more speed (and less sweat) than miles on the elliptical machine.

And there are some special benefits for a person with diabetes. Resistance training improves insulin sensitivity, and as a bonus, many find that it’s easier to manage glucose levels during a strength-training session than it is during aerobic exercise.

No More Bedtime Snacks

The late-night snack has been a mainstay of the diabetes diet for decades, but now is probably a good time to consider whether you can do without. The research is in – food consumed late at night is particularly unhealthy– and the issue is even more important for people with diabetes, as it may cause your blood sugar to behave unpredictably while you’re asleep and cannot monitor it.

A late-night snack may have been important to avoid overnight lows back when most patients using insulin were on the older generation of long-acting insulins, which lasted less than 24 hours and had distinct peaks. But the modern 24-hour basal largely avoids this issue. If you still need a snack before bedtime to prevent your blood sugar from dropping overnight, you likely need to adjust your basal insulin dosage. “Feeding” your insulin is a good way to eat more than you need to.

Check Your Blood Sugar Twice as Often

Fingersticks: they sting, they’re annoying, and they can be expensive. But perhaps the single most important thing you can do to improve your glucose management is to check your blood sugar more often.
How often do you check now? Make a promise to yourself to double it. The less often you check your blood sugar, the less information you have about how diet and exercise affect you. A single fingerstick after a meal is a mere snapshot of what’s actually happening in your body, and can never give you the type of actionable data you need to optimize your blood sugar control.
Even better? Ask your healthcare provider about a Continuous Glucose Monitor.

Drink Water, not Sugar

This might be the single easiest way to instantly improve your health.
We should all know by now that soda is emptiest of all “empty calories,” basically a scourge on your metabolism, triggering the vicious cycle that causes you to overeat and drive up insulin resistance and then go back for more. Soda contains an unbelievable amount of sugar and essentially zero nutritional value.

But fruit juices, even 100% juice, are just about as bad. The same goes for energy drinks and sweetened coffee and tea drinks; it’s pretty much just liquefied sugar, with zero added nutrition. It’s bad for your teeth, bad for your waistline, and simply ruinous for your blood sugar management. Knock it off!

Banish all of these beverages and choose water instead.

A word of warning about diet sodas and other diet drinks: many studies have found that these alternatively sweetened beverages still drive sugar cravings and are otherwise correlated with bad health outcomes. They may have no calories and no immediate blood sugar impact, but they’re not a healthy choice.

Pre-Bolus, Every Time

It’s so easy to forget to pre-bolus for meals, but that little infusion of insulin 20 or 30 minutes before a meal can make a big difference in leveling out your blood sugar. High glycemic variability (wild blood sugar swings up and down) is associated with the development of complications above and beyond what is already predicted by A1C. Endocrinologists are increasingly looking at patients’ time-in-range and standard deviation, and the pre-bolus is one of the most powerful techniques for improving those markers.

Pre-bolusing can be tricky, especially when eating out, when you don’t know exactly when your meal will arrive, or how many carbs it will contain. But then again, cooking your own food and eating more consistently are probably good habits to get into too.

Get Serious about Site Rotation

Whether you use a pump, a pen or an old-school syringe, if you’re using insulin, you are constantly deciding where to stick yourself with the pointy objects that deliver your life-saving medicine. You’re probably been told that rotating those sites is important, but do you really understand why?
When you inject insulin into the same spots repeatedly, you develop lumps of unhealthy fat under the skin, causing the insulin to be absorbed unpredictably. This is called lipohypertrophy, and you may be surprised to learn that it can result in a host of major negative consequences: more frequent hypos, rollercoastering blood sugars, increased insulin needs, and rising A1C.

It’s astonishingly common. Even if you don’t have visible lumps on your body, you may have some measure of lipophypertrophy, and you may be suffering its insidious consequences without even knowing it. Time to take site rotation seriously.

Switch to Glucose Tabs for Hypos

We’ve all done it before: used a low blood sugar as an excuse to snack. Sometimes your brain is screaming “FOOD!” and it seems like there’s no way to hold back. Nothing tastes better than carbs when you really need them, but there’s no surer way to set off another blood sugar rollercoaster than by overindulging yourself and overcorrecting, sending your blood sugar skyrocketing up again.
So why not use glucose tabs? They are precise – no more ransacking the pantry at random. They are fast-acting – unlike chocolates or cookies or ice cream there’s no protein or fat or fiber to slow down absorption.
It’s true, most glucose tablets don’t taste all that great. But, hypoglycemia shouldn’t be an invitation to indulge! Treat it like the serious medical condition it is.

Update Your Glucagon Rescue Plan

Many of us have a glucagon kit lurking somewhere – at the bottom of a handbag or in the back of a closet. It may or may not be expired. Ideally, we never have to use these rescue devices, but because they can save your life, we have to take them seriously.

Who have you trusted with your glucagon rescue kit? Who knows where you keep it, who is trained on its use?

All of these questions are getting a lot easier to answer. Baqsimi, the first nasal glucagon spray, is now on the market, and it will soon be joined by other next-gen glucagon devices that also promise to make hypo rescue easier than ever. The days of nervously mixing and swirling during an acute emergency are over.

This year consider updating your prescription to one of these snazzy new glucagon rescue options, and when you do it, take the opportunity to reengage and retrain family members, friends, co-workers, caregivers and whoever else might be able to help. The new glucagon rescue products are easier to use than ever, which makes a good opportunity to bring even more people into your confidence.

Happy New Year!

https://asweetlife.org/8-great-new-years-resolutions-for-people-with-diabetes/?utm_source=ASweetLife.org+List&utm_campaign=fd9093bce5-ASweetLife+Weekly+Update++-+Nov.+14%2C+2017_COPY_01&utm_medium=email&utm_term=0_5125b14cf8-fd9093bce5-413392997

Diabetes & Stress: How Stress Affects Your Blood Sugar

From diabetesstrong.com

Everyone experiences stress at some point in their lives. And stress can have a drastic effect on your blood sugar — both immediately and in the long run.
Even the fun stress of a roller coaster ride triggers an increased production of hormones like cortisol, adrenaline, and glucagon. Without these hormones, your body couldn’t complete the task of grocery shopping, let alone endure a heated argument with your mother. 

In this article, we’ll look at the role of cortisol, adrenaline, and glucagon, and how each of these stress-related hormones can affect your blood sugar.
At the end of the post, we will summarize how all of this comes together to impact the day-to-day lives of people living with diabetes, and what you can do to reduce stress in your daily life.

What is stress?

Quite simply, stress is your body’s response to any situation, event, or change in your life that requires a reaction or adjustment. Stress can develop physically, mentally, and emotionally.
And it’s an unavoidable part of life. Both positive and negative experiences can create a stress reaction in your body and mind.
In some cases, you might experience an event that causes stress with no end in sight. An abusive relationship or an unbearable environment at your work are examples of an ongoing source of stress that a person may struggle to break free from. These types of stress can lead to a state of “distress,” which is putting it lightly if you’ve ever experienced it.
Let’s take a closer look at what stress looks like before we add diabetes to the mix.

The symptoms of stress

Stress can manifest differently in one person from the next. For some, positive or negative stress may produce immediate tears, for example. In others, it may cause them to be silent and speechless. And others may become easily angry and irritable.
Depending on the severity of the stress level, your symptoms can vary. Here are some examples of stress symptoms:

Mild to moderate stress

• crying
• anger
• irritability
• excitement
• high blood pressure
• headache
• lack of appetite
• binge-eating
• acid reflux
• difficulty sleeping
• loose bowels
• muscle tension in your neck
• sweaty palms
• tiredness
• shaking
• trembling
• changes in weight
• lack of sex drive

Severe stress

• chronic headaches
• nausea
• diarrhoea
• severe high blood pressure
• chest pain
• sexual dysfunction
• insomnia
• depression
• panic attacks
• anxiety

Research suggests that stress also can bring on or worsen certain symptoms or diseases. Stress is linked to 6 of the leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide.
Before we move on to how stress can affect your blood sugar and what you can do to reduce stress, let’s take a closer look at the hormones involved in a stress reaction.

What is cortisol?

This hormone is often discussed in a negative light because too much of it can be a sign that your body is under severe mental or physical stress, and is associated with inflammation and weight gain. 
While its primary role is to help your body manage stress, it also affects nearly every organ in your body and is something your body needs 24 hours a day to stay alive, just like insulin.
Without cortisol, you wouldn’t be able to climb a flight of stairs let alone endure the intense stress from losing a loved one, going through a divorce, or having surgery. 
Cortisol also helps your body:

• Manage your blood pressure 
• Manage the function of your heart 
• Reduce your immune system’s inflammatory
• Reduce overall inflammation
• Breakdown sugar (with the help of insulin) to be used for energy
• Manage how your body metabolizes protein, carbohydrates, and fat

Just like your insulin needs change based on what you’re doing and eating, your body’s cortisol production must precisely match your needs during any given moment, too.

How does cortisol affect your blood sugar?

Not only can cortisol contribute to unwanted high blood sugars, but it’s also essential for treating low blood sugars, too. Let’s take a look.

When cortisol levels are high

When cortisol production increases beyond a healthy baseline, it blunts your body’s sensitivity to insulin. This means you need more insulin during those hours in order to keep your blood sugar in your goal range.
While your body does produce cortisol 24 hours a day, there are certain times of day anyone can expect to be producing more, like first the thing in the morning. And that explains why many of us notice we need more insulin in the earliest hours of the day, and with breakfast.
As soon as you wake up in the morning, your body produces a surge of cortisol, explains the Society for Endocrinology. This surge is critical for simply starting your day and functioning fully now that you are awake!
And if your overall baseline cortisol needs increase due to constant, ongoing stress, you’ll notice that your baseline insulin needs increase, too.

When cortisol levels are low

On the flip side, without enough or any cortisol you would struggle with constant hypoglycaemia (low blood sugar). 
When a person with diabetes experiences a low blood sugar, cortisol is actually critical to enabling your body to make use of the glucose you consume to bring your blood sugar back up to a safe level.
A severe low blood sugar can nearly deplete your body’s cortisol reserves, which contributes to symptoms of exhaustion even after your blood sugar has returned to a safe level.
If you think cortisol is wreaking havoc on your blood sugar levels, talk to your healthcare team about adjusting your insulin doses to help compensate. And of course, take a look at what areas of your life you could adjust to reduce your emotional and physical stress.

What is adrenaline?

Adrenaline — also known as “epinephrine” — is commonly associated with athletic events, but your body produces adrenaline in response to other events, too. 
An intense argument, a near-miss car accident or a roller coaster ride can all lead to increased adrenaline production.
Adrenaline is your body’s hormonal “flight or fight” response to intense good or bad stress.
This hormone essentially signals to your liver to release glycogen — the stored glucose in your liver. When your body suddenly encounters intense stress, you need extra glucose for energy to endure that stressful event. Without that extra glucose, your blood sugar would drop and you’d simply be lacking the energy necessary to perform during that stressful event.

How does adrenaline affect your blood sugar?

In a non-diabetic body, that surge of adrenaline triggering a surge of glycogen would be accompanied by a surge of insulin, too.
As people with diabetes, we’re missing the “surge of insulin” part, which can easily spike your blood sugar from 120 mg/dL to 300 mg/dL in less than an hour.
Adjusting your insulin for this can be tricky. A quick bolus of insulin using your normal “correction factor ratio” could easily produce little or no effect on the high blood sugar while adrenaline is present.  
Personally, I’ve found that I needed a significant increase in my background insulin doses on the day of a powerlifting competition in order to keep my blood sugar from spiking due to adrenaline. A quick bolus would have no impact and the only thing that would otherwise bring my blood sugar down was when the competition ended and my body relaxed. 
If you’re dealing with predictable adrenaline around a sporting event, for example, talk to your healthcare team about making an adjustment in your background insulin.
If you’re dealing with sudden, unexpected surges of adrenaline because you just got into a car accident, for example, you’ll likely have to try lowering it with a bolus of insulin but may not see it come down for a few hours.

When it’s actually not adrenaline…

One thing adrenaline is often incorrectly associated with is during your workout at the gym. There are other reasons your blood sugar can spike during a typical workout — but unless you’re truly in a competitive environment (rather than just an intense solo workout), it’s unlikely to be adrenaline. 
More likely, you’re breaking down muscle which involves breaking down stored glycogen. Your body then breaks that glycogen down into glucose and cycles it back to your muscles for energy. Without extra insulin on-board, this can easily lead to high blood sugars.

What is glucagon?

Glucagon is another hormone that helps your body endure certain types of stress — including skipping breakfast! 
Glucagon’s role is simple: it tells your liver to release glycogen (mentioned above) which is then converted into glucose and can be used for energy or to purposefully raise your blood sugar.

How does glucagon affect your blood sugar?

Glucagon is actually less associated with emotional stress but does play a role during physical stress when you’ve gone too long without a meal or when you experience a severe low blood sugar.
“The release of glucagon is stimulated by low blood glucose, protein-rich meals, and adrenaline (another important hormone for combating low glucose). The release of glucagon is prevented by raised blood glucose and carbohydrate in meals, detected by cells in the pancreas,” explains Your Hormones.

During a severe low blood sugar…

When you experience a severe low blood sugar, likely below 40 mg/dL, you may seem your blood sugar skyrocket within the hours after, even if you only treated that low with a careful amount of carbohydrates. 
This is your body’s way of saving your life! That surge of glucagon triggers a surge of glycogen which is broken down into glucose and raises your blood sugar. In those of us with diabetes, it simply raises it too high!

When you eat a strict low-carb diet…

During a ketogenic diet, your body is actually going to produce more glucagon throughout the day in order to get more glucose because your body cannot function on ketones alone. 
Your brain requires a second-by-second delivery of glucose in order to function! 
Does this mean you can’t follow a ketogenic diet? No. But it does mean you may notice your background insulin needs actually increase when you cut your carbs that low. This doesn’t happen to everybody but it’s important to keep in mind if you try a ketogenic diet just to see your insulin need skyrocket. 

When you skip breakfast…

Intermittent fasting is all the rage right now, but there are a few things you need to know if you’re experimenting with this trendy nutrition approach as a person with diabetes.
When you skip breakfast, your body is going to produce more glucagon during those fasting hours because — again — your brain needs glucose in order to function! 
This doesn’t mean you can’t practice intermittent fasting, but it does mean you’ll need to take extra boluses of insulin during those fasting hours to compensate for that additional glucose.

Summary: How stress affects your blood sugar

In short, stress will generally cause your blood sugar to rise. It will also be difficult to bring it down because of the insulin resistance created by stress hormones and the production of glucose from your liver’s response to adrenaline.
The larger majority of stressful situations aren’t something we can easily predict, but once you’re experiencing stress, you can predict that your blood sugar might spike.
Remembering to check your blood sugar during and after stressful situations is an important part of diabetes management, but don’t add to your stress by expecting to be able to easily correct any high blood sugars during a stressful state.

How to deal with stress as a person with diabetes

In general, there’s only so much you can do to prevent the blood sugar spikes from different types of stress hormones because we can’t always predict stress. 
However, if you’re dealing with predictable stress or ongoing stress, definitely talk to your healthcare team about an adjustment in your insulin doses that can help tamper those stubborn high blood sugars.

For those unexpected bursts of stress and rapid spikes in your blood sugar:
You should use your established “correction factor” to determine an appropriate dose of insulin to bring the blood sugar down.
But keep in mind: it’s very likely your blood sugar will sit at that higher level (especially in those with type 1 diabetes) until your body has recovered from the stressful state. When those stress hormones are pumping and adrenaline is causing your liver to produce more glucose, it can be very difficult to “get ahead of it.”

For ongoing stress during a period of your life: 
If you know the next few months are going to be stressful because of a promotion at work, a divorce, the death of a loved one — for example — then a simple increase by a few units in your background insulin dose can have a big impact on staying in your goal blood sugar range.
Don’t underestimate how much ongoing stress can affect your daily insulin needs. Even on the “normal” days during a stressful period of your life, your body is still coping with that ongoing stressor.

How to reduce your stress levels

Learning what helps you manage, reduce, and relieve your overall stress level is a vital lesson. Sometimes the simplest thing can help you take a deep breath, lower your blood pressure, lower stress hormones, and release the physical and mental grip of stress.
Here are a few ideas for reducing your stress levels:

Reducing stress in the moment

• Close your eyes and take deep inhales and exhales for 30 seconds
• Go for a walk
• Exercise to get your heart rate UP which causes your central nervous system to relax
• Go for a drive
• Watch your favourite stand-up comedy
• Make a to-do list to get everything off your mind
• Clean your house
• Call a friend
• Create a “voice memo” like your own private therapy session
• Dance to your favourite music

Everything that makes you calm down, makes you smile, or helps your body relax will have a positive effect on your stress level.

Reducing ongoing stress

Reducing ongoing stress usually requires a significant change in your situation or lifestyle. The causes of ongoing stress are different from person to person, but here are a few ideas for how you can help reduce ongoing stress:

• Identify your biggest stressor and ask yourself: what can I change about this?
• Make time to see a therapist weekly/biweekly
• Make time for regular exercise — a daily walk can do wonders!
• Use a meditation app to at least stop and breathe deeply for 2 minutes every day
• Get your house/office clean-up and organized (with help) so your “space” is clear
• Create weekly to-do lists to manage responsibilities and acknowledge productivity
• Look for a new job, sending out two applications per week
• Leave an unhealthy relationship (get help from friends if needed!)

Managing ongoing stress is difficult because in many cases you cannot just walk away from it. Take a deep breath and step back to see the bigger picture around this stressor. There are always going to be things we can control and change, and things we cannot.

https://diabetesstrong.com/diabetes-stress/