Some people have been shocked to learn that while sugar is related to diabetes and blood sugar control, eating too much sugar or too many simple carbohydrates does not directly cause diabetes. They’re shocked when they learn that elevated blood sugar is a symptom of poor glycemic control, not the cause. In my experience, people are even more shocked when they learn that experiencing traumatic events during childhood can significantly increase your risk of being diagnosed with both type 1 diabetes and type 2 diabetes. If you’ve experienced early life stress, also referred to as adverse childhood experiences or ACEs, and you’ve been diagnosed with diabetes, the two could very well be related. Research suggests that when we experience trauma during childhood, it changes our brains and bodies in such a way that it negatively impacts our diabetes risk. Trauma during childhood increases our diabetes risk by its effect on our immune systems, our stress responses, and our lifestyle habits.
First of All, What are Adverse Childhood Experience or ACEs Anyway?
Throughout this article, I’ll use the terms “early life stress,” “childhood trauma,” and “adverse childhood experiences” interchangeably. Before we get into the details of how this type of trauma increases our risk for diabetes, I want you to understand exactly what I mean when I use these terms.
That being said, researchers have looked at adverse childhood experiences in relation to a variety of different chronic physical and mental health concerns, and they’ve found that experiencing specific forms of trauma before the age of 18 makes it more likely that we’ll have poor health as adults and that we’ll be diagnosed with many different chronic conditions, including metabolic concerns like diabetes.
Here is a list of the most commonly studied adverse childhood experiences:
- your parents being separated or divorced;
- living with someone who is experiencing depression or another mental health concern;
- living with someone who struggles with addiction;
- seeing your mother or another household member treated violently;
- having someone in your household go to jail or prison;
- experiencing sexual, physical, or emotional abuse;
- feeling like you’re not loved or protected at home;
- and not having enough clothing, food, shelter, or means to obtain necessities during childhood.
I’ve listed the most commonly studied forms of adverse childhood experiences above, but there has also been research done that looked at connections between chronic health concerns and other forms of trauma, such as:
- having a parent or sibling die,
- being in foster care,
- being chronically ill during childhood,
- and more.
How Does Trauma Increase Our Risk For Type 1 Diabetes?
When we experience trauma during childhood, it increases our risk for type 1 diabetes (insulin-dependent diabetes mellitus) by a somewhat different mechanism to the way it increases our risk for type 2 diabetes. Here’s what happens: type 1 diabetes is considered to be an autoimmune disease, and research demonstrates that experiencing 2 or more categories of ACEs significantly increases our risk of being diagnosed with and hospitalized for autoimmune diseases of all forms. In the case of type 1 diabetes, people who have experienced 2 or more ACEs were found to be 70% more likely to be hospitalized for complications related to their autoimmune disease than those who experienced only 1 category of ACEs or none at all.
So how exactly does trauma increase our risk for autoimmune diseases like type 1 diabetes? The answer is found in the stress response and the immune system. When we experience ACEs, our stress response (which is controlled by what’s known as the hypothalamus-pituitary-adrenal axis or HPA axis) becomes hyperactive. In other words, our bodies become so used to releasing stress hormones in response to stressful situations that our bodies begin to overreact to things that may be perceived as stressful. Hyperactivity of the stress response explains why levels of stress-related hormones like corticotropin-releasing hormone and cortisol tend to be higher in ACE survivors than in non-ACE survivors.
When the immune system is consistently activated, it leads to changes within the immune system. These changes include the activation and suppression of various aspects of the immune response and dysregulation of the inflammatory response. If these changes persist, inflammation levels increase and the immune system goes haywire. When those changes occur, it sets the stage for autoimmune diseases like type 1 diabetes.
How Do Adverse Childhood Experiences Affect Our Risk For Type 2 Diabetes?
Adverse childhood experiences increases our risk for type 2 diabetes in a similar, but somewhat different way. As was the case with type 1 diabetes, research on the connection between ACEs and diabetes demonstrates that once we cross a certain threshold as far as the number of ACE categories we have experienced is concerned, our risk of being diagnosed with diabetes significantly increases. This is why the higher your ACE score is, the more likely you are to be diagnosed with diabetes and the more likely you are to experience poor outcomes, such as poorly regulated blood sugar and higher hemoglobin a1c values.
As with type 1 diabetes, we believe the increased risk of being diagnosed with type 2 diabetes is partly related to the unwanted changes that occur in the HPA axis and stress response. Here’s the part that is slightly different: we also believe the increased risk is partially due to obesity and suboptimal health behaviors such as living a sedentary lifestyle, being overweight, and using alcohol and/or recreational drugs (all of which ACE survivors are at increased risk for as a result of the trauma).
Certain conditions also compound our increased risk for type 2 diabetes as ACE survivors. For example, of all of the individuals who participated in the study I referenced earlier, those who had also been diagnosed with chronic post-traumatic stress disorder (PTSD) or who were diagnosed with PTSD and another chronic health concern were at the greatest risk of being diagnosed with type 2 diabetes. In another study, those who displayed some symptoms of PTSD but who did not meet the criteria to be diagnosed with the disorder (e.g. not enough PTSD symptoms) did not show a significantly increased risk of being diagnosed with diabetes, again supporting the theory that there is a threshold of childhood adversity beyond which we experience increased risk for various chronic health concerns. In other words, our bodies can handle some stress very efficiently, but when we experience high stress in early life while our brains and bodies are still developing, it can be difficult for the body to compensate enough in order to meet the demand and the more stress (or categories of ACEs) we experience, the greater our risk of having problems with our HPA axes and stress responses and the greater our risk of being diagnosed with chronic health concerns like diabetes becomes.
Finally, adverse childhood experiences can also indirectly increase our risk for diabetes because they increase our risk for mental health concerns such as schizophrenia, bipolar disorder, and even difficult-to-treat depression for which atypical antipsychotics are frequently prescribed. The FDA currently requires that all atypical antipsychotics carry a warning that they increase the risk for high blood sugar and diabetes; however, they don’t all increase our risk equally. One review suggested that the atypical antipsychotic olanzapine (Zyprexa) may increase the risk of diabetes most significantly, clozapine (Clozaril) a moderate amount, and risperidone (Risperdal) and quetiapine (Seroquel) may increase our risk the least out of all of the atypical antipsychotic medications studied.
Atypical antipsychotics are not the only way that prescribed pharmaceutical medication can indirectly increase our risk for diabetes as ACE survivors. Recent research also suggests that medication commonly prescribed to treat depression, such as serotonin-specific reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), may also increase the risk for metabolic syndrome, which includes high blood sugar or diabetes, obesity, insulin resistance, high insulin levels, high triglycerides, and low high-density lipoprotein (HDL) cholesterol.
Is it Possible to Combat the Effects of Childhood Trauma?
If you are in fact an ACE survivor, the information I’ve shared so far can be disheartening, but don’t worry; here comes some good news! Even if the trauma you’ve experienced has altered your hypothalamic-pituitary-adrenal axis and stress response in such a way that it has predisposed you for poor blood sugar control and diabetes, there are things you can do to support your HPA axis and your body in general so that you can decrease your risk of chronic disease or address chronic diseases you’ve already been diagnosed with.
In the case of diabetes, it requires hard work and lots of effort, but it is possible to improve your outcomes, support optimal HPA axis function, and, in many cases of type 2 diabetes, normalize your blood sugar control. If you’ve read this article and you’ve experienced adversity during childhood, I encourage you to be proactive about your health and take the first step to reducing your chronic health risk: Take the ACE Assessment to find out your ACE score. When you take the assessment, I’ll also send you my Adverse Childhood Experiences and Overall Health Risk Report, which contains important information about how your ACE score can affect your risk for mental health concerns, autoimmune conditions, cardiovascular disease, reproductive concerns, and other health concerns, and important tips you can implement right away to help you minimize your risk for these types of concerns.
If you already know your ACE score, I encourage you to request and download our ACE Defying™ Bundle where you’ll learn about the four types of physiological stressors that can lead to even more HPA axis dysregulation and further compound the effects of the ACEs you’ve already experienced. I’ll share some tips to avoid that compounding so you can begin decreasing your risk for chronic disease.