Cortisol and Type 2 Diabetes: A Complex Relationship
DiabetesType 2 Diabetes

Diabetes and Cortisol: How the Stress Hormone Affects Blood Sugar Management

Diabetes and Cortisol: How the Stress Hormone Affects Blood Sugar Management
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Updated on November 19, 2025
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Stress can make diabetes management even more challenging than it already is, because cortisol, the hormone your body releases in response to stress, makes blood sugar levels rise.

Because diabetes itself can be a stressful condition to manage, it can lead to a vicious cycle in which anxiety or stress raises blood sugar, resulting in even more anxiety or stress. But that also means that efforts to reduce the stress in your life can pay off twice, leading to both a more peaceful existence and blood sugar levels that stay on target.

How Cortisol Raises Blood Sugar

Cortisol is a steroid hormone that’s released by your adrenal glands in response to stress.

 In addition to regulating your body’s stress response, cortisol plays a role in managing your blood sugar, blood pressure, metabolism, inflammation, and memory production.
Although cortisol is often vilified for its association with chronic stress, the body needs this hormone to function properly. “Cortisol is essential for life,” says John Buse, MD, PhD, the director of the University of North Carolina’s Diabetes Center. High cortisol levels serve an important purpose. When faced with danger, the release of this hormone helps you respond to legitimate threats quickly and appropriately.

The problems come when your body manufactures too little or too much cortisol. Too little leads “to a [potentially] deadly disease called adrenal insufficiency,” he says, and too much damages the body as well: “Too much cortisol can cause blood sugar to rise through a variety of different mechanisms, including the way insulin is produced and works in the body,” says Dr. Buse. “It can set off diabetes.”

Cortisol affects glucose levels in several ways. Cortisol:

  • Triggers the liver to produce and release glucose into the bloodstream for energy
  • Causes muscle cells to decrease the amount of glucose they use, leaving more of it in your bloodstream
  • Promotes the release of fatty acids, an energy source that allows the body to make more glucose
  • Decreases the amount of insulin the pancreas releases

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Cortisol, Stress, and Type 2 Diabetes: A Vicious Cycle

It’s natural to experience stress, but chronic or long-term stress can contribute to many different health problems, including struggles with blood sugar management. In fact, research suggests that both mental and physical stress contribute to the onset of type 2 diabetes.

Although underlying reasons for this connection are still being determined, it’s clear that stress can directly affect the body’s insulin secretion. Additionally, the combination of chronic stress and obesity is detrimental to metabolic health, promoting the progression of diabetes.

Cortisol and other stress hormones in the body promote insulin resistance and the accumulation of visceral fat. It increases inflammation in the body, another factor that exacerbates insulin resistance.

At the same time, diabetes itself is highly associated with increased stress and anxiety. People with both type 1 and type 2 diabetes are more likely to feel stressed, hardly a surprise for conditions that have such comprehensive health effects and require such constant vigilance.

In short, chronic stress and diabetes have a bidirectional relationship, meaning each can make the other worse.

Can High Cortisol Explain Diabetes Management Challenges?

The most significant health condition related to high cortisol levels is Cushing’s syndrome, which occurs when the body produces an excessive amount of cortisol because of a tumor on the pituitary or adrenal glands, or when a person is taking high doses of exogenous steroids prescribed by a doctor.

 While Cushing’s syndrome is considered rare, there may be a subset of people with diabetes who also have a mild elevation in cortisol levels, though not enough to be diagnosed with Cushing’s. Buse's research — which hasn’t yet been validated by other researchers or by diabetes authorities — suggests that this condition might explain why some people have such difficulty achieving their blood sugar targets.

“We are increasingly recognizing mild hypercortisolism, described as lower levels of cortisol [than with Cushing’s] but higher than normal,” says Buse. “We associate this state with more difficult to control diabetes.”

Difficult-to-control type 2 diabetes can be defined in varying ways, including the necessity of three or more diabetes drugs, insulin in addition to other diabetes drugs, or at least two diabetes drugs and two blood-pressure-lowering drugs.

 In Buse’s research, 24 percent of study participants had some evidence of hypercortisolism, according to one measure.
Many people with difficult-to-control diabetes are already using the maximum dose of the most effective diabetes drugs available, like SGLT2 inhibitors and the GLP-1 and GIP/GLP-1 agonists.

Buse speculates that higher cortisol levels could explain why some people don’t respond as well to diabetes drugs: “I think what that’s telling us is if your diabetes isn’t well controlled and you’re on multiple diabetes medications, including the most powerful ones we have, there has to be something more going on — not just regular type 2 diabetes.”

How to Lower Your Cortisol Levels

Although cortisol from stress can cause blood sugar management problems, the real risk stems from cortisol that’s elevated substantially beyond what’s observed from stress alone, says Buse. Persistent, consistent cortisol elevation is linked to cardiovascular risk, osteoporosis, and even early death, he says. “It’s a serious problem.”

Everyone with diabetes can benefit from efforts to manage stress in healthy ways. Prioritizing adequate sleep, getting regular physical activity, maintaining close social ties, and adhering to daily practices like deep breathing can all help regulate your nervous system.

 Improving your mental health is likely to make your diabetes management more successful, too.

If you’re doing your best to manage type 2 diabetes and still falling short of your blood sugar management targets (especially despite the help of a drug like semaglutide or tirzepatide), Buse recommends talking to your healthcare provider about being evaluated for hypercortisolism.

Testing for high cortisol levels is best done with a low-dose, overnight dexamethasone suppression test.

 This diagnostic involves taking 1 milligram (mg) of dexamethasone, a medication that should suppress endogenous cortisol levels, before bed and then getting a blood draw the following morning. The test result of the blood draw tells your doctor whether your body is able to suppress excess cortisol production properly.
Doctors may also check late-night salivary cortisol swabs or assess urinary cortisol collections over a 24-hour period.

 If a tumor is suspected (if one is not on exogenous steroids), or if you have multiple abnormal tests and signs and symptoms of hypercortisolism, you should be referred to an endocrinologist for further evaluation.
If you have diagnosable hypercortisolism but are not a good candidate for surgery, or if symptoms return after surgery, mifepristone (Korlym) is approved by the U.S. Food and Drug Administration to treat high blood glucose levels caused by the condition. Not everyone is a good candidate for the drug, however, so this treatment route requires a thorough discussion with your prescriber.

The Takeaway

  • Stress and diabetes form a vicious cycle: Diabetes management can cause stress, and the stress hormone cortisol can directly raise blood sugar, which might stress you out even more.
  • Cortisol is an essential hormone, but excessive amounts can trigger or worsen diabetes by increasing blood glucose levels through multiple mechanisms.
  • Research links mild hypercortisolism (elevated cortisol levels that don’t reach those of Cushing’s syndrome) to difficult-to-control type 2 diabetes that resists even the most powerful medications used to treat the condition.
  • Taking proactive efforts to reduce your cortisol levels, either through adopting stress-reducing lifestyle habits or seeking medical help for chronic stress, might help ease your diabetes management.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Adrenal Hormones. Endocrine Society. January 24, 2022.
  2. Thau L et al. Physiology, Cortisol. StatPearls. August 28, 2023.
  3. Ingrosso DMF et al. Stress and Diabetes Mellitus: Pathogenetic Mechanisms and Clinical Outcome. Hormone Research in Paediatrics. March 20, 2023.
  4. The Mental Health Effects of Type 1 Diabetes. The Ohio State University. June 13, 2025.
  5. Diabetes and Mental Health. Centers for Disease Control and Prevention. May 15, 2024.
  6. Buckert M et al. Cross-Sectional Associations of Self-Perceived Stress and Hair Cortisol With Metabolic Outcomes and Microvascular Complications in Type 2 Diabetes. Frontiers in Public Health. May 14, 2024.
  7. Cushing Syndrome. Cleveland Clinic. December 27, 2022.
  8. Buse JB et al. Prevalence of Hypercortisolism in Difficult-to-Control Type 2 Diabetes. Diabetes Care. April 18, 2025.
  9. Cortisol. Cleveland Clinic. February 17, 2025.
  10. Dexamethasone Suppression Test. Mount Sinai.
  11. Cushing Syndrome. Mayo Clinic. June 7, 2023.
  12. Korlym-Mifepristone Tablet. National Library of Medicine DailyMed. September 25, 2025.
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Anna L. Goldman, MD

Medical Reviewer
Castle Connolly Top Doctor

Anna L. Goldman, MD, is a board-certified endocrinologist. She teaches first year medical students at Harvard Medical School and practices general endocrinology in Boston.

Dr. Goldman attended college at Wesleyan University and then completed her residency at Icahn School of Medicine at Mount Sinai Hospital in New York City, where she was also a chief resident. She moved to Boston to do her fellowship in endocrinology at Brigham and Women's Hospital. She joined the faculty after graduation and served as the associate program director for the fellowship program for a number of years.

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Jessica Migala is a freelance writer with over 15 years of experience, specializing in health, nutrition, fitness, and beauty. She has written extensively about vision care, diabetes, dermatology, gastrointestinal health, cardiovascular health, cancer, pregnancy, and gynecology. She was previously an assistant editor at Prevention where she wrote monthly science-based beauty news items and feature stories.

She has contributed to more than 40 print and digital publications, including Cosmopolitan, O:The Oprah Magazine, Real Simple, Woman’s Day, Women’s Health, Fitness, Family Circle, Health, Prevention, Self, VICE, and more. Migala lives in the Chicago suburbs with her husband, two young boys, rescue beagle, and 15 fish. When not reporting, she likes running, bike rides, and a glass of wine (in moderation, of course).

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