Stress is an inevitable part of life, but its consequences are not just mood swings and mental fatigue. Continual stress makes people produce extra cortisol, a hormone that has a critical role in adapting to short-term challenges, but chronically in high quantities it tends to cause harm to the body causing lots of physical and mental disorders.

The adrenal glands produce cortisol, which helps the body control its "fight, flight, or freeze" response. Cortisol temporarily adjusts blood sugar levels, maintains blood pressure, and assists the immune system, among other functions, in short spurts. But when stress persists, cortisol remains high, and necessary functions of the body are interfered with and rendered more susceptible to disease.

According to one survey conducted by the American Psychological Association, stress negatively affects a third of Americans' physical health. Concerns are reinforced by research where studies have shown 80% of primary care visits are stress-related.

But why does stress have such a profound impact? Elevated cortisol limits the immune system's ability to fight infections, disrupts hormonal balance, and triggers inflammation. Over time, these changes can lead to serious health complications.

Signs That High Cortisol Is Stressing Your Body

Persistent Eye Twitches

Do you have involuntary eye spasms? These harmless but annoying twitches often indicate elevated cortisol. The tiny muscles around the eyes are extremely sensitive to stress, contracting or spasming because of cortisol's stimulant-like effects.

Skin Breakouts and Sensitivity

Your skin often reflects what is going on inside your body, and chronic stress can cause inflammatory skin conditions. Elevated cortisol levels stimulate oil production, which exacerbates acne. It also slows down the healing process, worsens conditions like eczema, and contributes to general irritation of the skin.

Frequent Bloating and Digestive Issues

It also interferes with the body's balance of salt and water, which causes fluid retention and bloating. Excess cortisol also slows down blood flow to the digestive system, which further weakens gut bacteria and causes poor digestion, excess gas, and abdominal discomfort.

Weight Fluctuations

High cortisol stimulates the production of insulin, which can cause blood sugar to drop, making people want to eat sugary, high-fat foods. For many, this becomes an excuse to stress-eat and gain weight. For others, the opposite is true: their appetite disappears under stress, causing them to lose weight.

Unexplained Bruising

If you’re noticing random bruises, elevated cortisol could be the culprit. This hormone weakens skin proteins and the walls of small blood vessels, making your skin more fragile and prone to damage.

Cold Symptoms That Won’t Go Away

Do you feel rundown or experience muscle aches, fatigue, or upset stomach regularly? Elevated cortisol mimics cold-like symptoms. Long-term stress also weakens the immune system, making you more susceptible to infections.

Also Read: Stressed At Work? Your Sleep Might Be Paying The Price, New Study Shows

Vision Problems

Chronic stress can damage your eyesight. Elevated cortisol disrupts blood flow to the eyes, increases eye pressure, and raises the risk of glaucoma. Symptoms like dry eyes, blurred vision, and light sensitivity are also common.

Irregular Menstrual Cycles

Irregular Menstrual Cycles that disrupt the menstrual period. In females, this leads to hormonal distress causing irregular or missed periods. Over time, it may also disturb fertility.

Tinnitus or Persistent Ringing in the Ears

If you hear ringing, buzzing, or hissing sounds without an apparent source, stress might be the culprit. Cortisol affects the auditory system by interfering with blood flow and nerve function and could be the trigger for tinnitus.

Increased Inflammation and Chronic Disease

Increased levels of cortisol contribute to inflammation that can exacerbate conditions such as arthritis and promote the development of heart disease. Chronic inflammation is also associated with mental health conditions, including anxiety and depression.

Long-term Consequences of Increased Cortisol

Left unchecked, high cortisol levels can lead to more than just short-term discomfort. Chronic stress has been associated with serious conditions such as heart disease, psychiatric disorders, and metabolic syndromes. A 2013 study published in JAMA Internal Medicine underlined the link between stress and physical health, with recent research in Neurobiology of Stres supporting these findings.

Ways Managing Stress and Cortisol Levels

Managing stress and cortisol levels is essential for maintaining overall health. One effective approach is practicing mindfulness through meditation or yoga, which helps lower cortisol by calming the mind and promoting relaxation. Regular physical exercise, especially aerobic activities, helps reduce stress hormones and boosts endorphins. Prioritizing sleep is crucial, as lack of rest can increase cortisol levels; aim for 7-9 hours per night.

Another remedy is an overall balanced diet full of anti-inflammatory foods like fruits, vegetables, and whole grains that could manage cortisol production. Finally, it would prevent burnout and chronic stress if proper boundaries were set at work and in personal life.

GLP-1 receptor agonists have established themselves as one of the most sought-after treatment methods to manage type 2 diabetes. Conversations around these drugs often focus on their ability to improve blood sugar control, promote weight loss and support metabolic health. However, what happens after a patient takes the first dose deserves equal attention.

These medications, which include semaglutide, liraglutide and dulaglutide, mimic a naturally occurring hormone called GLP-1. They stimulate insulin release when blood glucose is high, suppress glucagon, slow stomach emptying and promote a feeling of satiety to reduce cravings.

While there are plenty of benefits, GLP-1 medications are not suitable for everyone. Existing digestive conditions, other diabetes medications, kidney function and even retina health can influence how safely a patient responds to treatment.

On World Diabetes Day, doctors explain why starting GLP-1 therapy requires more than checking blood sugar levels, and what patients should know about its complications. They also discuss lesser-known side effects a patient may face after the first dose.

Who Can And Cannot Take GLP-1 Drugs To Manage Diabetes?

Also read: Why Does Type 2 Diabetes Increase The Risk Of Alzheimer’s Disease? Neurologist Explains

Before initiating GLP-1 treatment, doctors need to understand a patient's overall health, diabetes as well as medication history. This includes checking HbA1c levels, blood glucose patterns, kidney function and any history of pancreatitis, gallbladder disease or gastrointestinal problems.

Dr Bibhu Anand, Internal Medicine Specialist at Sir Ganga Ram Hospital, told HealthandMe that treatment decisions must be made according to the patient’s history.

He said, "We see the patient's HbA1c, blood glucose profile, kidney function, medicine history, and medicine prior to the first dose in detail. We specifically identify patients already receiving insulin or sulfonylureas, as these doses may require modification to reduce the risk of hypoglycemia.”

Patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 are generally advised against using these medications.

Dr Anand said that those with a history of pancreatitis, severe gastrointestinal disease or gallbladder problems may also need assessment. The objective is generally to establish whether the benefits outweigh the risks.

GLP-1 GI Side Effect Or Diabetic Gastroparesis?

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Nausea, bloating, vomiting, constipation and diarrhoea are among the commonly reported gastrointestinal effects of GLP-1 medications. These symptoms are expected in the initial weeks of treatment or after an increase in dose. However, constant digestive discomfort in someone with diabetes should not be neglected.

Dr Richa Chaturvedi, Senior Consultant and Endocrinologist at Indraprastha Apollo Hospitals, Delhi, told HealthandMe that diabetic gastroparesis can cause symptoms that closely resemble gastrointestinal side effects due to GLP-1 drugs.

Gastroparesis develops when nerve damage related to diabetes affects food movement through the stomach. Patients may experience frequent nausea, early fullness, vomiting food consumed several hours earlier and unpredictable blood glucose levels. Unlike discomfort due to medicines, these symptoms may already exist before treatment begins.

"The key difference lies in the onset and pattern of symptoms. GLP-1 medications slow gastric emptying, meaning food remains in the stomach longer. This can cause nausea, bloating, belching and early fullness, particularly when treatment begins or the dose increases. These symptoms may settle as the body adapts."

Dr Chaturvedi emphasises that gastrointestinal symptoms should be assessed before starting treatment, especially in patients with chronic diabetes.

A gastric emptying study can be done if symptoms suggest gastroparesis. GLP-1 medications are generally not recommended for patients with severe gastroparesis, as they can further delay stomach emptying and affect nutritional intake.

Pancreatitis, Gallstones And Dehydration Risk

Also read: Semaglutide May Lower Fetal Oxygen Levels During Pregnancy, Sheep Study Finds

Although mild digestive discomfort may improve as the body adjusts to treatment, certain symptoms require immediate attention.

Severe pain in the upper abdomen or pain radiating towards the back, can indicate pancreatitis. Repeated vomiting, an inability to retain fluids, significant dizziness, reduced urination and upper-right abdominal pain accompanied by fever are other warning signs.

Dr Chaturvedi explains that pancreatitis has been reported during GLP-1 treatment, although it is uncommon and a causal relationship has not been established.

She said, “Gallbladder complications, including gallstones and inflammation, have a more established association with GLP-1 treatment. Rapid weight loss is an important contributing factor, as it can increase the likelihood of gallstone formation. Changes in gallbladder emptying may also play a role.”

Another concern is kidney injury due to dehydration. Persistent nausea and vomiting can reduce fluid intake, potentially affecting kidney function, particularly in patients who already have kidney disease.

Patients should therefore not dismiss severe abdominal pain or prolonged vomiting as routine side effect of the drug.

Diabetics Need Eye Testing Before Starting GLP-1 Therapy

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Digestive complications are not the only concern after starting GLP-1 medications. For patients with diabetes, retina health also warrants attention.

Dr Parul Maheshwari Sharma, Principal Director and Head of Ophthalmology at FMRI Gurgaon, told HealthandMe that a rapid improvement in blood glucose levels can sometimes cause an initial, temporary worsening of diabetic retinopathy. This phenomenon is known as early worsening of diabetic retinopathy.

Dr Sharma explained, “When blood sugar levels fall substantially over a short period, changes in retinal blood flow and vascular regulation may affect blood vessels that are already damaged. The concern is particularly relevant for patients with poorly controlled diabetes, high baseline HbA1c levels or pre-existing retinopathy.”

Patients with long-standing or poorly controlled diabetes, existing retinopathy or high HbA1c levels should ideally undergo a dilated retinal examination before initiating treatment, especially when substantial glucose reduction is anticipated.

Rare Vision Complication Patients Should Know About

Another emerging area of concern is non-arteritic anterior ischaemic optic neuropathy (NAION), a rare condition caused by reduced blood supply to the optic nerve that can result in sudden, permanent vision loss.

Some observational studies have reported an association between GLP-1 medications, particularly semaglutide, and NAION. However, a direct cause-and-effect relationship has not been established, and the evidence is still evolving.

Dr Sharma explains that this condition is different from diabetic retinopathy. While retinopathy affects the blood vessels in the retina, NAION involves damage to the optic nerve due to reduced blood supply.

Patients should be aware of warning signs such as sudden, painless blurring or loss of vision, particularly in one eye. Patients experiencing sudden visual changes should not wait for symptoms to resolve on their own.

She said, “Other symptoms include dark patches or blind spots in the visual field, distorted colour perception and difficulty seeing centrally. Sudden flashes, floaters or a curtain-like shadow across the vision also warrant urgent ophthalmological assessment. These symptoms could indicate conditions such as NAION, retinal complications or other sight-threatening emergencies.”

HbA1c, also known as hemoglobin A1c or glycated hemoglobin, is a widely used blood test to diagnose and monitor diabetes. However, ahead of World Diabetes Day, experts have warned that the test may not be accurate for everyone.

HbA1c measures how much glucose is attached to hemoglobin in red blood cells, providing an estimate of average blood sugar levels over the previous two to three months.

Certain medical conditions and blood disorders can affect its accuracy, making readings appear higher or lower than actual blood sugar levels.

Who May Get Inaccurate HbA1c Results?

Conditions such as anemia and hemoglobin disorders can affect HbA1c readings by altering the lifespan of red blood cells.

"HbA1c can be misleading when conditions alter red blood cell lifespan. Iron, B12 or folate deficiency may falsely elevate HbA1c. Conversely, hemolytic anemia, certain hemoglobinopathies, chronic blood loss, recent transfusion and some kidney conditions can lower it falsely," Dr Manisha Arora, Director of Internal Medicine at CK Birla Hospital, Delhi, told HealthandMe.

Dr Sandeep Kharb, Senior Consultant – Endocrinology at Asian Hospital, added that iron-deficiency anemia can also lead to falsely high HbA1c readings.

Experts also cautioned that HbA1c is not a direct measure of insulin resistance. A person may be insulin resistant even before their HbA1c reaches the prediabetes threshold.

What Medical Conditions And Medications Can Affect HbA1c?

Iron, vitamin B12 and folate deficiencies, chronic alcohol use, high-dose aspirin and severe hypertriglyceridemia may contribute to falsely elevated readings.

Falsely low results can occur with hemolytic anemia, hemoglobin disorders, blood loss, transfusions, pregnancy, kidney disease and erythropoietin therapy.

Certain medicines, including dapsone, ribavirin and some antiretroviral drugs, can also affect HbA1c interpretation. The direction of the error depends on the underlying condition and the testing method.

Can Fasting Blood Sugar Be Normal While HbA1c Is High?

Dr Himika Chawla, Senior Consultant, Endocrinology and Diabetology at PSRI Hospital, told HealthandMe HbA1c reflects average blood sugar over two to three months, while fasting blood sugar measures glucose at a particular point in time.

A person may have normal fasting glucose but experience repeated blood sugar spikes after meals, pushing their HbA1c higher. The reverse mismatch can also occur.

Doctors therefore consider both results and the patient's overall clinical picture before making a diagnosis.

What Test Should Be Used To Diagnose Diabetes?

When HbA1c may not be reliable, doctors can use blood glucose-based tests, including fasting plasma glucose and the oral glucose tolerance test (OGTT).

"First test it should be oral glucose tolerance test," Dr Anoop Misra told NDTV.

For the test, a person eats their usual meals for three days and then fasts for eight to 10 hours before their fasting blood glucose is measured. They then drink 75 grams of glucose mixed in water, followed by another blood test two hours later.

Misra explained that fasting glucose below 100 mg/dL and a two-hour reading below 140 mg/dL are normal. Fasting levels of 100–125 mg/dL or two-hour readings of 140–199 mg/dL indicate prediabetes. Fasting glucose of 126 mg/dL or higher, or a two-hour reading of 200 mg/dL or higher, falls in the diabetes range.

A new review of studies has found that people living with type 2 diabetes have a significantly higher risk of developing Alzheimer's disease.

Researchers from Curtin University conducted a systematic review and meta-analysis of 40 studies. They estimated that if 1,000 people with type 2 diabetes were followed for a year, an average of 4.7 would develop Alzheimer's disease.

Published in Alzheimer's Research & Therapy, a separate analysis found that type 2 diabetes was associated with a 53% higher adjusted relative risk of Alzheimer's disease compared with people without the condition.

How Does Blood Sugar Affect Memory?

Ahead of World Diabetes Day, Dr Sudhir Kumar, neurologist at Apollo Hospitals, Hyderabad, in a post on X, explained that several overlapping mechanisms may link type 2 diabetes to Alzheimer's disease. These include:

• Brain insulin resistance: Brain cells become less responsive to insulin, potentially impairing their ability to use glucose for energy and clear amyloid and tau proteins.
• Vascular damage: High blood sugar can damage large and small blood vessels in the brain, increasing the risk of strokes and vascular dementia.
• Chronic inflammation: Peripheral inflammation and lipid abnormalities can weaken the blood-brain barrier and trigger neuroinflammation.

How Does Diabetes Increase The Risk Of Dementia?

According to Alzheimer's Society UK, diabetes is an established risk factor for dementia. The risk also increases with the duration and severity of diabetes. However, having diabetes does not mean a person will necessarily develop dementia.

With diabetes and Alzheimer's disease cases rising globally, understanding the link between the two conditions is becoming increasingly important.

Insulin helps regulate blood sugar by enabling the body's cells to use glucose for energy. In people with diabetes, the body either does not produce enough insulin or cannot use it effectively, causing blood sugar levels to rise.

Studies have linked type 2 diabetes to an increased risk of dementia. In people with type 1 diabetes, severe and repeated episodes of high or low blood sugar have also been associated with a higher risk.

Diabetes and Alzheimer's disease may share certain underlying mechanisms. In both conditions, brain cells can become less responsive to insulin, potentially affecting brain function and contributing to the accumulation of amyloid and tau proteins associated with Alzheimer's disease.

How Can People With Diabetes Protect Their Brain Health?

Dr Kumar recommended the following measures for people living with type 2 diabetes:

• Maintain blood sugar levels: Aim to keep glucose within your target range.
• Avoid extreme fluctuations: Prevent prolonged high blood sugar (HbA1c of 7% or higher) and severe, repeated episodes of low blood sugar (hypoglycemia).
• Manage other health conditions: Keep blood pressure and cholesterol under control.
• Prioritise a healthy lifestyle: Eat whole foods, including vegetables, fruits and whole grains, and engage in regular physical activity to improve insulin sensitivity.

"Early detection, consistent blood sugar management, and working closely with your healthcare team can help safeguard your cognitive future," he said.