This study was designed to assess physiologic responses to experimentally induced psychological stress in adolescents with Type 1 diabetes mellitus. In the morning prior to insulin and breakfast, plasma glucose, lactate, glycerol, beta-hydroxybutyrate, growth hormone, cortisol, glucagon, free insulin, epinephrine, norepinephrine, heart rate, and systolic and diastolic blood pressure were determined in 31 adolescents with Type 1 diabetes before and after three 10-minute stressors (cognitive quiz, family interaction-disagree, and family interaction-neutral) administered over 80 minutes. Glycosylated hemoglobin measurements were used to divide the subjects into thirds to constitute good (N = 10, M = 7.8%), fair (N = 10, M = 10.9%), and poor (N=11, M=13.3%) metabolic control subgroups. At baseline, significantly higher levels of lactate, diastolic blood pressure, and heart rate were observed in subjects in poor control, compared with those in good control. Although increases in subjective ratings of anxiety and cardiovascular responses to stress were observed across all subjects, significant metabolic and hormonal changes as a result of acute stress were not observed. Furthermore, stress reactivity did not differ between the three metabolic control subgroups. Similar results were obtained when the baseline value for plasma glucose on the day of testing was used to form three metabolic subgroups. Under the controlled conditions of this study, the results do not support the hypotheses that short-term, experimentally induced psychological stress acutely worsens metabolic control or that physiologic responses to such stress are greater in poorly controlled adolescent patients. Implications for future research are discussed, focusing on methodological issues pertinent to determining the role of stress in diabetes.
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Developmental and Educational Psychology