Dear Warren,
I’m a family doctor who retrained as a somatic psychotherapist specializing in trauma and chronic illness. I’ve been looking at the research linking trauma to many kinds of chronic illnesses with a special interest in type I diabetes and some findings in type 2 diabetes along the way.
I haven’t focused a lot on diet but have been curious about the role of stress and trauma triggers in relation to blood sugar levels and long term complications.
While disordered eating is certainly one effect of trauma, I suspect it is only one of many factors that influence risk for diabetes, blood sugar levels and long-term complications.
I’ve heard from some type one diabetics over the years that their blood sugar levels can vary significantly from day to day even when they eat the same things and do the same things multiple days in a row. I don’t know if this is also true in type 2 diabetes.
One of my theories is that both type 1 and type 2 diabetes reflect states of disordered metabolic physiology and that blood sugar levels (and variability as well as ease of control) are unique to each individual’s history and therefore triggers, just as stressors that trigger symptoms of PTSD are unique to each individual. Some studies support this (see attached).
I’ve also wondered if a younger age of onset reflects greater exposure to stressors / trauma and whether complications in general might be greater in those with a history of more adversity. I've included a few references on this topic as well.
Depression is twice as common in diabetes 1 and 2 (see Holt, below), affecting 1 in 4. QOL is worse, complications are increased, life expectancy reduced. There is a higher risk of diabetes with depression and depression effects are long lasting & recurrent. This may be one effect of trauma that influences eating habits in diabetes as well as in those who do not have the illness.
Attached are a few studies that might be of interest, even though they don’t address diet and eating habits.
Dahlquist, 1991: stress in year before diagnosis is the only factor affecting age of onset
Gonder-Frederick study indicated that IDDM subjects' BG response to an active stressor was idiosyncratic but significantly reliable over time.
Holt: overview of Depression in diabetes
Riazi (a book chapter from 2000): blood sugar levels appear to be idiosyncratic with some individuals having hyperglycemia, others hypoglycemia and some with no response to similar stressors. They also cite a 1950s study by Hinkle (see attached) showing that all individuals have changes in glucose levels in response to stress. The response is just higher in diabetes (p 690)
Yehuda 2015 cites a study (see attached, Yehuda 2009) showing that “there are different responses in glucose use following glucocorticoid injection in those with PTSD compared with unaffected individuals”.