Adrenaline Spike


Last night, I performed in our church’s advent celebration. I haven’t performed publicly in several years, certainly not since diabetes came along (and has been progressing so quickly this year). It was the first time I’ve noticed a marked change in BG levels due to I’m guessing adrenaline (I get very anxious when I perform, even though I love it). I had mostly meat and vegetables for dinner shortly beforehand, and just before going up to play, my BG had gone from 110 to 148, and by the time I got back to my seat, it was at 170. I do not usually go that high from what I ate.

So, my question is…obviously you won’t always anticipate situations that will cause your BG to rise in response to stress/adrenaline, but have you ever dosed a correction in anticipation of a situation you know will cause a rise, or after you notice it rising (I was hesitant to dose anything when I saw the 148 because I was about to be on stage and wasn’t sure what exactly was going on)? Or do you just wait and correct as needed? Basically, is this something that becomes predictable under certain circumstances you may repeat?


I correct for it all the time. The stress hormones can be very predictable, at least in certain situations.

It takes guts to do this, but if you are 100 and about to perform, and you take a small bit of insulin because you know when you get on stage you will spike…

But wait until you see that it is predictable before doing the preemptive insulin. Once you see that you can rely on the spike to happen (and how much of a spike), then you can start with the preemptive bolus.


I wait until whatever is stressing me out is over. Usually, it’s something I do not want to be interrupted by a low (exam, interview, performance). It’s not worth taking a correction, being wrong, and crashing low.

Occasionally, if I’m really skyrocketing (high BG plus up arrows on Dexcom), I’ll take half a unit every so often just to try to blunt it a bit. But I’d never take a full correction.

Though I do have blood sugar that is somewhat unpredictable (yesterday I treated a low and looked at my CGM 45 minutes later to see I’d skyrocketed to 19 mmol/L). So I never trust that anything will be predictable enough that I can take a correction and know that I won’t go low in the middle of my performance or test or interview. The only thing that is predictable about my diabetes is it’s predictably unpredictable.


Like @Jen , I usually wait until whatever is stressful is over. If my BG is high beforehand, I would give myself a correction, but if it’s in a normal range I would wait. I think that generally stressful situations can be pretty predictable, but there will always be that one time where your BG decides to do something else. Maybe if you are Nick Jonas and you know that you need X units of insulin before each performance you can do it, but unless you are doing the same thing consistently I would wait until after you are done to correct.


Yes, I am a defence lawyer and the minute I stand up and start speaking in court I get a huge spike unless I take more insulin in advance. My spikes are much worse than yours though, I will rise into the 200s or higher easily. The biggest problem I find is that I have to take more an hour or so before the stressful event starts and not after. Once the spike starts taking insulin does almost nothing to lower my blood sugar (but will cause me to crash hours later). I find increasing the basal is the most effective way to deal with this. Are you on MDI or pump? On a pump I would set temp basal increase about 2 hours before the event and for the duration of it. On MDI I use Levemir and take about 2-3 units more in the morning that my usual dose, as well as a unit or 2 of insulin right before the event.


I’ve been attending visitations and funerals this weekend. Lots of mingling with people I haven’t seen in forever, or meeting new people that I’m trying to find the right words to offer condolences to them. I figured this would all drive me high…and it did. I took a preemptive correction dose yesterday…and needed more…and needed more. I was thrilled to keep it 180 and below. Sometimes dynamic social situations peg me at 300. As with all things D, I keep an eye on it as best I can and try to thread the needle. I thought today’s events would be a bit less stressful so I wasn’t as aggressive with my stress dosing…I was wrong. Oh well. Doing my best with it!


We are remarkably like @Scotteric. My son gets huge spikes the moment he gets to school. We also find basal the best tool. We also see little effect from bolus, and big lows afterwards.

We dial in +35% basal 30 minutes before school, then adjust as needed, and complement with bolus.

Like everyone else, I would wait until you have found a pattern before doing anything ahead of time.


Thanks for the input. Performing like this will not be a common occurrence, but I am thinking forward to other stressful situations that may cause similar rises. Sounds like a YDMV as far as the predictability of those rises, so I will wait and see where I fall there.


I’m certain I would’ve had the same problem with school if I was diagnosed younger. How does your son find it affects food boluses? I find I need at least double the amount of insulin I normally need to eat when stressed, and sometimes this is still not enough. It’s not always predictable though so I try to eat low carb or skip lunch if doing something stressful.


My toughest final exam is today, and the score is going to make or break my grade in the class. I’ve been in a continual state of stress since like Wednesday and let’s just say my CGM graphs aren’t looking great. I’ve been running 140% to 150% temp basals, giving nearly 1.5x as much insulin for food, and I’ve still been chilling at like 200 (if I’m lucky) with corrections (sometimes 2x as much insulin as I would normally need) doing almost nothing. I would think that my site was bad but for one, I did a full change just in case and it didn’t have an effect, and also every now and then the insulin decides to work, mostly when I’ve given enough rage boluses to drop me low. At least it’ll be mostly over with today :sweat_smile:

For a shorter stressful event I mostly attempt to give little corrections as I see the rise and fully handle the spike after the stressful activity is over because I am very much on the same page as @Jen in that my stressors are typically events I really don’t want to go low for.


I have exactly this situation. I perform in a church choir, often soloing, but even when I’m just part of the ensemble it doesn’t seem to make a difference: every Sunday my BG is going to trend high. So yes, on Sundays I always set a temp basal pushing my rate up by 150-175% for 3 hours starting with the pre-service rehearsal and running through the end of the service. Pump would allow me to set a different basal profile specifically for this but it’s easier just to do the temp.

Funny thing is that performing gigs on guitar doesn’t do this to me, it’s really just singing. Dunno why.


This is very normal for people with diabetes, maybe even for everyone else to a lesser extent… your body prepares for a fight or flight response, and dumps a bunch of glucose into the bloodstream to make energy available…

Every time I maneuver a ship in very difficult circumstances I can observe this…

The few times I’ve ran in competitive races I have seen it, whereas normally the same exercise would have the opposite effect—- but this was a physiological response triggered by the psychological difference…

Just have to watch and correct, it’s a fact of life with diabetes… or of course if you have a repeatable and predictable pattern to a certain circumstance you can previous in advance to head it off… that becomes kind of sketchy in some circumstances though, so best to only do that when it’s a sure thing IMO

I don’t believe short term elevations like this in these sorts of occasions are very likely to be harmful in the long run… just have to stay on top of it like with anything else…


Hope you delivered your best for the final exam and kicked its ass.


I definitely tried my best!
Also, my CGM graph showed basically a 100 point spike beginning right when the exam started, which is just kinda funny to see.


I was really surprised that teaching my first yoga class did not cause a spike! I actually had to take some carbs and lower my basal rate!! :scream_cat:


Probably because you are so confident in what you are doing!


LOL, I was exhausted mentally and physically after that class and so my girlfriend took me out for an adult beverage and a meal!! :wine_glass:


You are right. He needs a lot more insulin at lunch when he is at school.


I’m a semi-professional poker player. In a poker setting, when you’re running a bluff or all in for all of your chips, there is a tremendous adrenaline spike. Over a 14 hour day in a tournament, this can happen dozens of times. I lean very heavily on my CGM when playing poker, and often almost double my normal basal rates for the day, even though I’ll (hopefully) be sitting in a char for 14 hours.


What a GREAT illustration from real life this is!

My T1D son will be fascinated by your post. He is going to want more stories :slight_smile: