I think we all know how much of a dramatic impact cortisol can have on blood glucose levels.

I am a big believer in that, in order to do something with purpose and clarity, we must understand why.

here is a simple breakdown of how cortisol plays a role in creating insulin resistance.

Blocks Glucose Uptake: Cortisol directly signals muscles and fat cells to become less responsive to insulin. This prevents them from absorbing glucose, keeping blood sugar high and readily available for "fight or flight."

Liver Sugar Dump: Cortisol triggers your liver to dump extra stored sugar into your blood. You have to use extra insulin just to fight this extra sugar.

Simultaneously, cortisol triggers the liver to convert stored proteins and fats into new glucose (a process called gluconeogenesis), so as well as creating resistance, it also produces extra glucose, which is why a significant amount of extra insulin can be required during times of stress.

Insulin Resistance: Cortisol tells your muscles and fat cells to ignore the insulin you inject. Even if you take more doses of insulin, the sugar levels may refuse to budge because the cells are blocked - which is why an increase to basal such as holistic factors like steps and water become vital.

It all turns into a vicious cycle - as sugar and insulin levels chronically rise, the cells become increasingly numb to insulin.

If you are a type one diabetic female, stress hormones impact us to a greater magnitude than our male counterparts.

This is because of how the female sex hormones interact with the body's stress response. We also have less cortisol receptors to slow the system down. So as women, even if something does not feel overtly stressful, it can still have a significant impact on your blood because of the nature of how our bodies deal with cortisol. If you'd like to understand more about how hormones influence insulin resistance and blood glucose throughout the month, our Women's Health & Hormones guide explores this in much more detail.

Now once we can take all of this into account, we can clearly see and understand that periods of stress will often require a more aggressive approach to diabetes management, the usual insulin doses that our bodies respond well to will cease to have the same effect, it may also work more slowly.

In order to combat the negative effects of stress and cortisol on bloods, here are some tips you can utilise to streamline your management.

Increase basal dose, temporary basal increase, resistant profile or use the techniques available to your hybrid closed loop system to make your algorithm more aggressive, such as a lower insulin sensitivity factor on the omnipod.

Increase your rapid insulin doses, manually adding additional units to meal doses, particularly in more resistant and stressful times of day. Understanding how to adapt your basal, bolus and insulin profiles during periods of increased resistance is just as important. Our Digestion, Profiles & Bolusing guide explains this in more detail.

Elongate your pre bolus times, allowing more time for your insulin to kick in and do its job.

Close the gap between micro-doses, since your insulin is taking longer to take effect, you do not want to risk rising between doses.

Aim to keep a nice consistent stream of rapid insulin, every 3-4 hours.

Hydrate like your life depends on it, the moe hydrated we are, the easier it is for excess glucose to be flushed out.

Move your body, light low intensity exercise to help with insulin efficiency. If you'd like to better understand why different types of exercise affect blood glucose differently, have a read of our Exercise & Glucose guide.

Factors which can cause resistance on bloods due to a spike in cortisol which you may forget to account for:

Meetings at work, sensory overload - a constant stream of noise, things like physical discomfort - blurred vision, poor posture or a blocked ear, excessive caffeine and sleep deprivation.

More obvious factors to look out for include things like big life changes such as getting married or moving house, grief, work overload, relationship stress, break ups, finance trouble, big arguments, busy schedules or failing a test.

When these factors become present in your life, it is important to start assessing your data and gaining an understanding of exactly how it changes your response to insulin, so you can start to pinpoint how much extra insulin you need, both basal and bolus, how much slower insulin is to onset so that you can establish your adapted pre bolus times and micro-dose interludes. Applying data aids precision when it comes to making changes. This is exactly what we help our members do inside Elevate. Learning how your own body responds to stress, hormones, food and insulin allows you to make far more confident and informed diabetes decisions.

Something to be mindful of when cortisol is present, is stacking insulin and corrections.

it becomes a risk when you note that bloods are high and not working and so you keep on pushing insulin in, not waiting enough time for your initial dose to do its job, make sure you are physically logging how much and when you last took insulin, stress can blur your memory, this will serve as a visual aid to scan exactly when you did and prevent you from just injecting more without thought, remain conscious of insulin on board when making decisions.

Be mindful of how stress can impact your behavioural patterns, some of these changes can have an inherent effect on your bloods also, if you are someone who skips meals, or maybe leans into food for comfort when stressed, sleeping poorly and being generally less present day to can, call all further the impact of stress and bloods, make sure you have solid coping mechanisms in place. Something I find helpful is to vocalise my actions as I go throughout the day, speaking out loud what I am doing to bring me back to reality and make sure I am making conscious choices, not just letting the day run away from me.

Diabetes can often make stressful situations feel even more stressful.

give yourself time and patience to think things through before acting, to lessen the contribution of worry that diabetes can have on bloods.

As always, there is a lot in a diabetics life that is not within the realm of our control, but we must remain focused on what we can control in order to not let the mental toll get the better of us.

small steps COMPOUND overtime to make big results!

If you found this guide helpful, explore our Type 1 Diabetes Resources Hub for more practical articles covering insulin management, hormones, exercise, nutrition and everything in between.