Type 2 Diabetes and Trauma
The science of adversity changes the current paradigm that bigger bodies are the cause of type 2 diabetes (T2D). Instead it explains how weight and other factors linked to T2D are indicators of past adversity. Having a bigger body, in other words, is an INDICATOR of changes in the nervous system, not the cause of T2D.
The science explains why T2D is not your fault, even if there are things you can do to help with reversibility.
Risk factors for T2D also affect many other chronic illnesses and this post may be relevant if you have ME/CFS, fibromyalgia, Alzheimer’s (type 3 diabetes), Parkinson’s, osteoporosis, heart disease, high cholesterol and more.
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Table of Contents
A New Model
The first ACE study in 1998 found that people who experienced 4 or more of the 10 adverse childhood experiences (ACEs) have almost double the risk of developing diabetes compared with those who have an ACE score of 0.
Of note, an ACE score of 4 also carries more than twice the risk of developing heart disease.
The New Model: Weight is Not the Cause
There is a profound and deeply shaming stigma assigned to larger bodies or having type 2 diabetes (T2D) in our culture.
T2D is “largely the result of excess weight and physical inactivity “The World Health Organization, June 2020
Such a view points a finger and says T2D is entirely due to poor lifestyle choices, overeating and being sedentary. This judgment persists in society and medicine even though T2D is known to be due to insulin resistance and a body with an altered metabolism that has trouble regulating sugar.
I have often wondered if this view was actually true.
I asked if trauma had played a significant role for people with T2D and hear a resourcing yes. I dug into the research and asked, “Is there evidence of links between trauma and type 2 diabetes?”
In other words, do events such as emotional neglect, abuse, accidents, discrimination, parental divorce, work stress, the loss of a loved one, or a mother’s experience of stress during her pregnancy increase risk for type 2 diabetes?
The answer is an overwhelming yes. For most, this is unexpected. For most, it runs counter to convention.
But it turns out there are extensive bodies of research describing at least 8 categories of trauma that increase risk for T2D. This post presents that science. I also summarize it in the 2 page Trauma and Type 2 Diabetes Fact Sheet (with 2 pages of references that you can download at the top and bottom of this post).
Note: 1) The term “obesity” is loaded. It is associated with stigma, blame, and judgment. I use it sparingly, and in quotation marks to acknowledge this state of affairs, so that others googling and searching online can find this post. It is also in a few quotes I cite. 2) Research has shown that effects of trauma are not psychological. In other words, if adversity has played a role in your life and you have T2D it does not mean it is in your head. It’s not because you are “weak” or “lazy” or have no will power (some people with T2D have more will power than most people I will ever know). The effects of trauma actually influence gene function through epigenetics, and alters the nervous system, immune system, tissues and cells, physiology and biology, and much more.
What you’ll learn here is how adversity can increase risk for:
- weight gain and bigger bodies
- food cravings
- the use of food, smoking, alcohol, and overwork as coping strategies when no other tools are available
- challenging relationships with other people and with food
- difficulty finding motivation to take action
- high cholesterol
- high blood pressure
- heart disease
- kidney disease
- and more (Felitti, 1998, 2010; Harris, 2017; Wickrama, 2017).
An understanding of trauma offers an unexpected and empowering new perspective of T2D because it explains why it’s not your fault and offers new tools.
Here are my theories and the research.
Dr. Vincent Felitti, co-investigator of the original and most well known ACEs (adverse childhood experiences) study spent over 25 years running a weight loss clinic. His team found that trauma is a risk factor for type 2 diabetes (1998) and also for bigger bodies (2010). “Obesity,” it turns out, is a “biomarker.” Bigger bodies are an indication of stressful events in the past and a physiology that is no longer regulating in an optimal way for current circumstances (Wickrama, 2017; Felitti, 2010).
High weight is not the cause of T2D but the effect of a similar underlying cause:
The reference to “the disease of obesity” is grossly in error, diagnostically destitute, and apparently made by those with little understanding of the antecedent [trauma in] lives of their patients.
Obesity [is not] the problem. Obesity is the consequence, the marker for the problem, much in the way that smoke is the marker for a house fire.
Obesity, like tachycardia [fast heart rate] or jaundice, is a physical sign, not a disease.Felitti et al, 2010, p. 28
Having type 2 diabetes, or dealing with weight or a body that is extra sensitive to sugar is not a person’s fault. Rather, as research indicates, having this chronic illness stems from what happened in our past and to our ancestors.
Type 2 Diabetes and Trauma
To have us all on the same page, here are brief descriptions of type 2 diabetes and trauma.
Type 2 Diabetes Results from Insulin Resistance
Almost 50% of the population in the US either has diabetes (13%) or prediabetes (35%) (CDC, 2020). These numbers reflect an epidemic. Rates have been rising since WWII and are expected to continue to increase.
T2D used to be known as adult onset diabetes, but age of onset has decreased and T2D now occurs in children as well.
Research in trauma identifies that the more adversity a person has experienced the higher the risk for T2D and the greater the potential for a younger age of onset (Felitti, 1998; Luby, 2017; Sonu, 2019; Yehuda, 2015).
Type 2 diabetes is the vastly more common form of the disease and can often be managed by dietary changes, exercise and medications.
Insulin is the hormone that enables cells to use and store sugar.
Type 2 diabetes occurs in a body that cannot use or absorb sugar well because its cells and tissues are RESISTANT to insulin. In other words, the main physiological problem in T2D is not a lack of insulin but instead one in which cells have trouble using sugar and taking it in for fuel. It is a problem of “insulin resistance.”
A lack of insulin may eventually become part of the problem in T2D but is not the original cause. Recognizing insulin resistance is one way we begin to recognize the effects of trauma on other characteristics thought to increase risk factor for T2D. This is because adversity is a risk factor for insulin resistance and the symptoms related to it such as:
- bigger bodies
- high cholesterol
- high blood pressure
- sensitivity to carbs
Insulin is not usually necessary for T2D in the way it is necessary for survival for the less common autoimmune type 1 diabetes, in which the body has high blood sugar levels because there is little or no insulin.
What is Trauma?
Trauma is any experience that is too overwhelming for us to be cope with or manage. It’s something we cannot overcome by fighting or fleeing and that can result in a form of collapse, shut down, or hopelessness called “freeze.”
Trauma can happen from the big stuff such as abuse or war.
Trauma can also happen from the seemingly little stuff, such as an accident, surgery, or emotional neglect. Trauma is also sometimes described as adversity, which is easier for some of us to grasp when thinking about events in our lives that didn’t seem “big enough” to refer to as traumatic. I use the two words interchangeably.
Most of us don’t think we’ve experienced any kind of trauma or adversity. But the more we learn about the science of trauma, the more we start to recognize it in our own lives. It took me a while to see it in my past too, including in my prediabetes story.
The one major theme I’ve seen from investigating and exploring the research for the past 20 years is that trauma is an important risk factor for chronic illnesses of all kinds.
Next are 8 categories of adversity that may have affected your risk of developing prediabetes or type 2 diabetes. I include some of the research showing links between trauma and type 2 diabetes.
8 Categories of Adversity Increase Risk for T2D
Adverse Childhood Experiences (ACEs)
The first ACE study in 1998 found that people who experienced 4 or more of the 10 adverse childhood experiences (ACEs) have almost double the risk of developing type 2 diabetes compared with those who have an ACE score of 0.
Of note, an ACE score of 4 also carries more than twice the risk of developing heart disease.
1. ACEs: Adverse Childhood Experiences Increase Risk for Type 2 Diabetes
Adverse childhood experiences (ACEs) refer to 10 types of trauma before our 18th birthdays that increase risk for type 2 diabetes, heart disease, strokes (Felitti, 1998), autoimmune diseases such as type 1 diabetes (Dube, 2009), and more.
ACEs were first described in a 1998 Kaiser-CDC study with 17,000 participants (Felitti, 1998). Results have been reproduced in hundreds of studies in different populations (Hughes, 2017) and in a continuation of the original study with over 440,000 patients.
The 10 ACEs are:
- Physical abuse
- Sexual abuse
- Emotional abuse
- Physical neglect
- Parental divorce
- Parental domestic violence
- Member of household with mental illness
- Member of household incarcerated
- Member of household with substance abuse and
- Emotional neglect, which may be the most important risk factor for T2D according to a recent study (Huang, 2015)
Effects of Adversity Add up – Also Known as “Dose”
Risk for T2D and other effects of ACEs rise as the number of ACEs you’ve experienced increase.
The effects of trauma, in other words, are cumulative. It doesn’t matter which ACEs you have experienced.
This additive effect of adversity is like your “dose” of trauma. The more ACEs you’ve experienced, the higher your ACE score and the larger your “dose” of adversity. Risk for T2D increases as dose of adversity increases (Felitti, 1998; Harris, 2017)
The higher the dose, the greater the risk for developing any of the other effects of trauma:
- emotional dysregulation, such as depression or anxiety (or both)
- behavioral challenges such as addictive behaviors (to food, work, substances…)
- difficulty in relationships (learned from parents who weren’t good role models)
- feeling the need to be always on the go (body states caught in fight or flight)
- difficulty accessing motivation to “do” or be active (freeze states of immobility)
- weight excess (and sometimes under weight)
- chronic illness, including autoimmune diseases, asthma, ME/CFS and more
Adverse Childhood Experiences Plus (ACEs+)
Risk for type 2 diabetes from adversity in childhood is not limited to the 10 ACEs.
Here are more examples.
2. ACEs+: There are More Than 10 ACEs that Increase Risk for Type 2 Diabetes
The types of childhood adversity that affect risk for T2D are not limited to the 10 ACEs. Other types of trauma in childhood also affect risk for T1D such as growing up or living with the stress of poverty, losing a family member other than a parent, and more ….(Harris, 2017; Li, 2012).
Adversity also includes serious life events such as having a family member who was seriously ill or hospitalized, having been hospitalized yourself, being in an accident, witnessing a natural disaster or violent crime and more.
Learn more about ACEs in this blog post and download the freely available original study that showed that ACEs increase risk for type 2 diabetes.
Adverse Babyhood Experiences (ABEs)
Prenatal stress and being born small are among of the most well studied risk factors for type 2 diabetes.
They remain among the least recognized risk factors in medical care.
3. ABEs: Adverse Babyhood Experiences Increase Risk for Type 2 Diabetes
A mother’s experiences of stress during pregnancy is one of the early risk factors for T2D because it has an impact on her baby’s long term health. Prenatal stress includes nutritional stress, physical illness, emotional stress, loss of a loved one and other events. This includes physical stress such as being sick during pregnancy or after the birth of her baby; psychological stress such as being a single mom or struggling financially; and nutritional stress – or a combination of these.
Babies who were in the womb when their mothers experienced stress are at increased risk of developing symptoms of insulin resistance, type 2 diabetes, or being overweight later in life, and more.
The role of prenatal stress was identified in the Developmental Origins of Adult Health and Disease (DOHaD) studies, some of which followed survivors of a siege and starvation in WWII known as the Dutch Hunger Winter. DOHaD studies have assessed over 20,000 subjects, and have been replicated.
Here are some especially good references:
- pediatrician Calkins’ free journal article review (2011)
- obstetrician Nathanielz’ book “Life in the Womb” for medical and nonmedical people alike (1999)
- The Fetal Matrix for a deeper look (2005)
Examples of prenatal and perinatal risk factors for T2D also include maternal grief and bereavement, such as from the loss of a parent, spouse or child before the birth of her child’s (Li, 2012). Bereavement is a marker for prenatal stress and can influence a parent’s ability to connect with their new baby, including after birth (Mead, 2020).
Cesarean sections have also been recently found to affect risk for T2D, and are associated with increased risk even after adjusting for a high body mass index (BMI) or overweight (Chavarro, 2020). This may be in part because cesareans can be traumatic for mothers and babies (see my ABEs Guide).
Low Birth Weight
Low birth weight is a well acknowledged indicator of stress (Calkins, 2011; Gluckman; Nathanielz, 1999). The smaller size reflects changes in development of the nervous system and can lead to fewer cells in tissues and organs. This includes fewer insulin producing cells in the pancreas, which would add yet another layer of risk for dysregulation in glucose metabolism.
Babies whose mothers experience stress are at higher risk of being born small. One does not, however, have to be born small to be at risk (prenatal stress ie enough to affect risk and does not always affect birth weight) (Calkins, 2011).
Low birth weight is associated with greater risk of
- metabolic syndrome (high blood pressure, high cholesterol, high weight, insulin resistance)
- type 2 diabetes
- kidney disease (unrelated to complications from T2D)
- depression, anxiety or ADD
- PCOS (polycystic ovarian syndrome)
- high blood pressure
- Alzheimer’s and other forms of dementia
Risk for T2D exists for those of us born in the 7 pound range but RISK FOR T2D INCREASES as birth weight DECREASES.
The highest risk of developing T2D is with a birth weight under 5 1/2 pounds. This was identified in Harvard’s Nurses Health Study of more than 69,000 adult women. The women were followed starting in 1976 (Rich-Edwards, 1999).
Risk decreased as birth weight increased:
- < 5 pounds carries 1.83 times the risk or almost two times the risk for T2D
- 5 to 5.5 pounds carries 1.76 times the risk for T2D
- 5.6 to 7 pounds carries 1.23 times the risk for T2D
- 7.1 to 8.5 pounds is the reference weight for comparison
- 8.6 TO 10 pounds carries .95 times the risk, meaning slight decrease in risk
- > 10 pounds carries .83 times the risk, meaning slight decrease in risk
Low birth weight is a risk factor for T2D even after adjusting for other factors we commonly think of as important risk factors. These other risk factors include
- childhood socioeconomic status
- adult lifestyle factors
- being born prematurely
- being a twin or other multiple birth
- mother’s age at the participant’s birth
- history of having been breast fed or not
- paternal history of diabetes
- or the participant’s adult height, number of pregnancies, cigarette smoking, or physical activity
Risk was highest for women who were born small and were overweight as adults, but the size of the risk was similar whether women were lean, of moderate weight or overweight. This suggested that prenatal experiences were independent risk factors for type 2 diabetes.
Learn more about adverse babyhood experiences, including how ABEs increase risk for ACEs in my detailed Guide or in this shorter resources post. Posts include free downloadable fact sheets, PDFs of the post themselves, and my 2020 published journal article on ABEs.
Adverse Multigenerational Experiences (AMEs)
The effects of prenatal stress and low birth weight are examples of risk factors for type 2 diabetes that have an impact on two or more generations.
This is another well-studied finding that is not yet well known by doctors or in medical care.
4. AMEs: Adverse Multigenerational Experiences (AMEs) Increase Risk for Type 2 Diabetes
Experiences of loss or of physical, emotional or nutritional stress during pregnancy increase risk for type 2 diabetes and other symptoms of insulin resistance. Risk increases for a woman’s child and for her grandchildren. This knowledge comes from research known as the Developmental Origins of Adult Health and Disease (DOHaD) Studies studies, which has looked at over 20,000 individuals. DOHaD has now followed some participants, such as from the siege at the end of WWII known as the Dutch Hunger Winter, for at least 2 generations. Other studies have replicated these findings.
If you have type 2 diabetes, you probably have parents and grandparents, brothers and sisters, as well as cousins, aunts and uncles who also have T2D. They likely also have other symptoms related to insulin resistance, including high cholesterol, high triglycerides, the apple shape of “truncal obesity” (carrying weight around the waist), high blood pressure, heart disease, and more. Depression is also likely to be common in the family since it is also increased in children whose mothers experienced stressful events during pregnancy.
Having a family history of T2D has long seemed to imply that T2D must be entirely due to genes. And if it’s genetic, it means there’s not much we can do about it.
The research, however, is pointing in a different direction. Genes only contribute about 10% to 30% of risk for T2D (Mambiya, 2019, p 5, ) or even less (Schnurr, 2020).
This means that environmental factors such as trauma, adversity, diet and lifestyle contribute 70% to 90% of risk for T2D. The fact that environmental risk factors play such a big role in autoimmune diseases and other chronic illness too (Rappaport, 2010) has surprised the medical community and is not yet well known for those of us living with a chronic illness.
Despite advancement of genetic research tools, they have only been able to explain and identify genetic variants that increase the risk of Type 2 diabetes by 10.0–30.0%Mambiya, 2019, p. 5
Prenatal stress, adversity, trauma and stressors in the first years of life are environmental factors.
What’s helpful to know is that environmental risk factors are ones we may be able to change as a way of improving, preventing or healing our chronic diseases.
This includes healing, resolving and potentially reversing effects of trauma and adversity.
It does not, as we are seeing from all of these studies showing links between trauma and type 2 diabetes, mean that being sick is your fault.
Effects of Trauma Carry Across Generations
Risk for T2D can happen across three generations or more in humans. It appears to happen in at least 6 ways. These include
- grandmother’s experiences
- mom’s physiology when she’s pregnant
- mom’s experiences of stress and more during pregnancy
- mom and dad’s experiences of adversity before pregnancy
- how you were parented
I. Dose: Prenatal Stress in Your Mom’s Womb
My sensitivity to carbs and sugar crashes suggest I might have or have had prediabetes. As such, I can wonder whether my mom experienced any particularly significant stressors when she was pregnant with me because this is known to be a risk factor for altered glucose regulation in her kids.
I forgot to look consider this when looking into my prediabetes last week and this is common when we try to explore our past for possible adverse events. It’s a kind of “blind spot” that happens as a result of adversity.
When a reader and colleague reminded me about this risk factor, I remembered that my mother had moved to another country when she was pregnant with me. She had chosen this, but she was also shocked by the ugliness of her new industrial city and had cried when she first saw it. My mom had also left her entire support system behind except for my Dad.
II. Dose: If Your Mom Has Diabetes or Insulin Resistance
If my mother had had subtle problems with sugar regulation, insulin resistance, gestational diabetes or type 2 diabetes then I would have been exposed to altered forms of sugar regulation.
Being exposed to high blood sugar levels in the womb is a 2nd factor influencing how one’s body capacity to regulate sugar. This can could have increased my risk for developing insulin resistance myself or for prediabetes or T2D.
I do not know of any problems with blood sugars during my mother’s pregnancy with me, however this is common for people with T2D and metabolic syndrome.
III. Dose: Exposure as an Egg in Grandma’s Womb
If my mother had T2D or insulin resistance or if her body had problems regulating her blood sugars, the research explains that we would want to look back to HER experiences in the womb as potential sources of risk.
What I know is that my grandmother had 2 miscarriages before getting pregnant with my mom and there was an eight year gap between my mom and her older sister. Loss of a baby or a pregnancy can be a devastating event and the sense of loss can influence future pregnancies, including fear of losing the next baby (there may be biological problems associated with miscarriages that influence risk but a woman’s experiences of adversity and ACEs are risk factors for miscarriage as well).
My mother has gained weight in her later years and she and I look similar in shape these days. This suggests there may be at least 3 generations of us affected by my grandmother’s experiences of stress: my grandmother, my mother, and me.
My sensitivity to carbs and sugar crashes, which suggest I might have or have had prediabetes, suggest I may have been affected by my grandmother experiences during her pregnancy with my mother, when I was an EGG growing in my mother’s womb (Calkins, 2011; Dias, 2014).
Eggs are not static “things” – research is finding that we are influenced by our grandmother’s experiences because we were inside her, growing in our mom’s developing little womb, when she was growing as a baby in HER mother’s womb (Chan, 2018).
IV. Dose: Dad’s Trauma Gets Passed Down Too
Effects of trauma also pass down through sperm for multiple generations (Dias, 2014; summarized in Curry, 2019).
As with Moms, Dads’ experiences can also influence gene function through epigenetics, in which experiences lead to the attaching or removing of molecules to the surfaces of genes, which changes how they function.
What’s encouraging is that epigenetic changes linked to adversity can reverse in adult mice who were exposed to trauma in early life but then given enriched environments allowing them to play and explore (reading studies of animals exposed to trauma has gotten very difficult to read, with all I now know). Resourcing environments can also prevent mice from passing epigenetic changes linked to trauma on to the next generation. It may even help reverse epigenetic changes from past generations.
You can learn about how healing multigenerational trauma, on both sides of our families, can improve or even reverse chronic illnesses in adults. Learn more about Family Constellation work in this deeply inspiring book composed mostly of case examples, Even if It Costs Me My Life by Stephen Hausner.
How’s that for extraordinary new information?
V. Dose: Low Birth Weight
Prenatal stress increases chances that a baby will be born small, especially if the stressors happen later in pregnancy (Calkins, 2011). Lower birth weight is an INDICATOR of prenatal stress and is associated with increased risk for diseases of insulin resistance later in life, including T2D.
Not all babies who experience stress in the womb are born small. Prenatal stress is a risk factor for T2D even if you were not small as a baby. Such multigenerational effects and mechanisms are thought to be epigenetic (Weaver, 2004; Wright, 2018; see talk by Tracy Bale on youtube).
I was born in what is thought to be a healthy range for birth weight at 7.2 pounds. This could be from all kinds of protective factors. Even though my Dad was a student and my parents didn’t have a lot of money at the time, they had enough. They also had some good friends nearby and family even if far away, who they were able to visit from time to time. The fact that no one in my family has T2D was likely also an indication I was less at risk for it than others even as these were likely risk factors for my asthma and the chronic illness I would eventually develop as an adult.
VI. Dose: Parenting
The effects of prenatal stress, birth complications and other adverse events in early life have at least one more side effect. Such events also influence the ability of parents to bond with their children as they are naturally designed to do. This means that it can be more difficult to parent in nurturing, supportive ways. This has an impact on parent-child relationships and influences a baby’s developing nervous system, immune system, ability to regulate stress and more. Learn more in my ABEs posts and journal article and in the next section on ACREs.
The Good News About Understanding Types of Trauma
These multigenerational effects of prenatal stressors may be important reasons for the increasing global rates of type 2 diabetes. It’s not just diet and lifestyle, it may be due to additive effects of adversity during pregnancy over the generations.
These data are not meant to be stressful or discouraging. While it can be hard to note that we may have been exposed to many risk factors in the distant past, knowing about the science offers more tools for healing T2D and other effects of trauma in the present. It also gives us better tools for prevention and early treatment going forward.
Learn more about the role of adverse multigenerational experiences in my story.
Here are tools that support healing chronic illness.
Adverse Childhood Relationship Experiences (ACREs)
One of the subtle and poorly recognized effects of prenatal stress is that it can interfere with a parents’ ability to bond with their kids.
A parent’s history of adversity also affects their ability to nurture, protect and care for their kids. This affects risk for chronic illness.
5. ACREs: Adverse Childhood Relationship Experiences Increase Risk for Type 2 Diabetes
A recent study has found that physical and emotional neglect may be the biggest risk factors for type 2 diabetes among all of the different types of childhood trauma (Huang, 2015).
Emotional neglect is an adverse childhood experience. It is also one of the characteristics of what I call adverse childhood relationship experiences (ACREs), which are a large and important group of risk factors for chronic illness.
ACREs is a term I’ve coined for the kinds of experiences that are often the most invisible and difficult to recognize. This is because ACREs are about the absence of nurturing support, attuning connection, and helpful emotional regulation rather than about the presence of something like physical or emotional abuse.
Children are sensitive to emotional neglect because they are born with immature nervous systems. This means their bodies are not emotionally, physiologically or biologically able to cope with intense or overwhelming emotions such as grief, rage, loss, or fear by themselves. Children need the presence of parents to help understand, work through and integrate these kinds of difficult emotions. They also need adults to help their young nervous systems develop pathways of safety and resilience through repeated experiences of successfully moving through difficult feelings in a context of safety. ACREs aren’t about parental perfection. They are about the need for parents to recognize their mistakes, work to improve and heal them in themselves, and make repairs with their children on a regular basis.
ACREs are present in any situation of abuse because it means the adult caregiver is not reliably safe or protective. ACREs can also happen with kind, loving parents whose own past traumas and early adversities such as prenatal stress make it difficult for them to feel, tolerate or regulate their own emotions and who therefore can have a hard time helping their children learn to regulate theirs.
Learn more about adverse childhood relationship experiences (ACREs) in this blog post.
Chapter 6 & 7
Adverse Adulthood Experiences (AAEs)
Adverse Pre-Onset Experiences (APOEs)
Stress, adversity and trauma in adulthood are risk factors for type 2 diabetes.
Based on research in other chronic illnesses, however, I suspect they are not the cause.
6. AAEs: Adverse Adulthood Experiences Increase Risk for Type 2 Diabetes
Stressors and adversity include with family, at work, and in personal life are associated with increased risk for T2D (Mommersteeg, 2012; Rutters, 2015; Renzaho, 2014). I refer to stressful events after our 18th birthdays as adverse adulthood experiences (AAEs).
Trauma perspectives suggest that stressors in adulthood are probably not isolated causes of T2D. Instead they are events that build on or strengthen cellular and nervous system defense pathways that began with earlier traumas, such as in babyhood, childhood or in our ancestors’ lives. This adds a new layer of understanding to the complex roles of stress in T2D and traditional tools for working with blood sugar levels, T2D and stress.
Trauma science suggests that our efforts for self-care, self-compassion and healing the effects of old traumas may be able to prevent onset of T2D for some people or delay onset and reduce severity and complications for others.
7. Adverse Pre-Onset Experiences Increase Risk for Type 2 Diabetes
Stressors of all kinds in adult life increase risk of developing T2D within 3 years in one 12-year longitudinal study. I refer to these as adverse pre-onset experiences or triggers. As with other studies in trauma, risk increased with greater number of stressful events or “dose” (Harris, 2017). Rather than being the cause, they may be experiences that act like the “last straw” that unmasks a long developing, intelligent albeit no longer needed, survival pathway of fight, flight and freeze.
Adverse Institutional Experiences (AIEs)
Adverse institutional experiences (AIEs) is a term I’ve coined to include any kind of discrimination in the present or in the past.
AIEs differ from our personal histories of multigenerational trauma in that they involve adverse events that have affected groups of our people through historical and ancestral trauma, such as from slavery and genocide.
8. Adverse Institutional Experiences (AIEs) Increase Risk for Type 2 Diabetes
The prevalence of racism in the US has become more overt for whites to see in the past few years. For Blacks, it has always been present. For this and other reasons, social justice educator and somatic experiencing trauma therapist Resmaa Menakem now uses the term “people of culture” or “bodies of culture.” Because it helps him feel more HUMAN.
People of culture have higher rates of low birth weight (National Center for Health Statistics, 2018), which as explained earlier is an indicator of prenatal stress and important risk factor for T2D.
Low birth weight in Blacks and Native Americans is not genetic. Neither are the 3 or more times higher rates of maternal mortality in Black women, which is not prevented even when Black women are highly educated and in the maternal health care field. Birth weight is affected by lower health care, racism, and less access, as evidenced by normalization of birth weight and prematurity (also higher in Blacks) when women receive more emotional and physical support during pregnancy (Joseph, 2017).
Discrimination is 2 to 3 times higher for those who develop T2D (Whitaker, 2017) and is associated with lower preventive screening for complications of T2D (Williams. 2009, p5).
Below are two examples that highlight the prevalence and poorly acknowledged role of discrimination and AIEs in T2D. Both demonstrate the layers of complexity that persist to influence risk and complications today.
Native Americans and Type 2 Diabetes
Conventional thinking suggests that all Native Americans have higher rates of T2D and that risk seems due solely to the western diet. This is not accurate.
Here in the US, we live on red soil. Lands that all once belonged to Native Americans.
Most, but not all, Native Americans have much higher rates of T2D than whites. In a narrative that pulls together many of the categories of trauma presented earlier, University of Nevada Professor of Anthropology Dr. Daniel Benyshek presents the role of historical trauma as an important way to rethink our understanding of T2D (2001). This includes recognizing the role of prenatal stress, starvation, colonialization and other trauma.
Benyshek describes how the highest rates of T2D in the world in 2001 were in the Pima Indians in the Gila National Reserve in Arizona. Although their rates of T2D didn’t begin until they started eating westernized foods, the Pima have a prior history of 70 years of starvation from drought and floods followed by colonization and development as whites moved into their areas. The Pima adopted the new foods that were brought out of necessity. Prior to starvation, the Pima experienced the historical traumas of forced migration from their home lands, and were exposed to violence of all kinds.
In contrast to the high rates identified in the Pima, the Eskimo and Inuit in Alaska have lower rates of T2D. Benyshek describes how this may be due to the fact that Alaska and Eskimo Natives experienced neither the migrations nor the famines that the Pima and other groups did. They had well established hunting practices which kept them alive through the turbulent times of colonization, supported them during periods of poverty and meant they could supplement their diets with foods brought in by whites rather than converting fully to these different ways of eating. Their rates of T2D are the lowest among the Native American populations in the US, the rest of whom experienced the effects of the relocations and the trails of tears (Benyshek, 2011).
African Americans and Type 2 Diabetes
African Americans have 2.5 to 3 times higher rates of maternal mortality (and more), premature births, low birth weight (see above and the ABEs guide). Blacks and Native Americans also have 2.6 to 4 times higher rates of hospitalizations and deaths from COVID compared with whites. As suggested in the above segment and in the next, this is not due to genetics. As these examples present, it is due to past and present discrimination.
One example of discrimination and its effects in T2D is seen with amputations in Black Americans in the American South. Amputations arise from changes to blood vessels and blood flow related to the potentially severe and life-threatening complications of type 2 diabetes. Amputations are three times higher in blacks than in whites in Mississippi.
Dr. Foluso Fakorede, a cardiologist, decided to work in Bolivar County, Mississippi after discovering the epidemic of amputations being performed there.
Mississippi has among the highest rates of type 2 diabetes in the country. Poverty can double the risk for T2D, increases rates of amputations, and there are few doctors, even fewer specialists, and few grocery stores.
The Black American Amputation Epidemic, ProPublica, May 2020
When Fakorede started to research the reasons, he was shocked to discover a striking overlap between maps documenting who was enslaved in the 1800s and who had the highest rates of amputations today. The highest rates of amputations in the US overlap areas that had enslaved populations before the Civil War.
Fakorede found that amputations were a form of racial oppression, dating back to slavery. This lead him to create a clinic to help identify risk early and to begin preventing these often unnecessary amputations that lead to so many other difficulties including job loss, pain and shortened life spans.
Discrimination and Type 2 Diabetes
Below are some of the most important statements I found in journalist Lizzie Presser’s article in ProPublica in May 2020, The Black American Amputation Epidemic.
Discrimination at many levels disproportionately affect people with T2D and communities of color. The following are some of the ways:
- low access to health care
- inattention to prevention in areas that are overwhelmed by need, have few doctors, and are food deserts (few grocery stories)
- lack of exams and blood flow studies in limbs (such as angiograms)
- incentive for amputations from better reimbursement than for preventive care despite the enormous increases in cost that the loss of limb incurs.
Presser cites lawyer Jennifer Smith,
Professor at Florida A&M University College of Law, wrote in the National Lawyers Guild Review what Fakorede saw firsthand: “While the roots of unequal and inequitable health care for African Americans date back to the days of slavery, the modern mechanisms of discrimination in health care has shifted from legally sanctioned segregation to inferior or non-existent medical facilities due to market forces.”“The Black American Amputation Epidemic,” ProPublica May 2020, by Lizzie Presser
Presser describes how Harvard cardiologist Marie Denise Gerhard-Herman thought that scanning limbs to assess blood flow in people with T2D was such an accepted practice that it didn’t have to be included in a guideline.
Insurance companies, however, use guidelines to determine coverage for procedures.
Marie Gerhard-Herman, an associate professor of medicine at Harvard Medical School and a cardiologist at Brigham and Women’s Hospital, chaired the committee on guidelines for the American College of Cardiology and the American Heart Association. She told me that angiography before amputation “was a view that some of us thought was so obvious that it didn’t need to be stated.”
She added: “But then I saw that there were pockets of the country where no one was getting angiograms, and it seemed to be along racial and socioeconomic lines. It made me sick to my stomach.”“The Black American Amputation Epidemic,” ProPublica May 2020, by Lizzie Presser
The role of guidelines, insurance company reimbursements (and lack of both) have had a big influence on the high rates of amputations in Mississippi. Cardiologist Dr. Foluso Fakorede has begun to change that.
Getting informed and sharing the information, such as through Presser’s article, blog posts like this one, educating doctors with the type 2 diabetes and trauma fact sheet, and more are ways we can all help make a difference.
Learn more in Presser’s article “The Black American Amputation Epidemic.”
Type 2 Diabetes Through a Trauma Lens
T2D has been on the rise since WWII.
Part of the epidemic is that it’s no longer being diagnosed only in adults but now occurs in children too.
This may reflect accumulated effects of trauma over multiple generations.
Type 2 Diabetes and Trauma Perspectives
Higher doses of adversity influences symptoms. Consequences of trauma may determine some of the following characteristics of type 2 diabetes:
- younger age of onset of T2D or other chronic illnesses
- greater dysregulation of glucose levels (therefore more difficult to manage)
- diabetes complications
- more severity of T2D complications
Lifestyle Factors Unmask T2D Rather Than Being “The Cause”
Type 2 diabetes is only diagnosed when the body is no longer able to keep blood sugar levels into the normal range but the process leading to T2D takes place over years and decades.
The science suggests that lifestyle factors stimulate or uncover patterns of metabolic function to lead to high blood sugar levels rather than being the cause.
Trauma is a risk factor for all of the symptoms involved in T2D and its complications (Calkins, 2011; Felitti, 1998):
- insulin resistance
- sensitivity to glucose / sugar / diet / caloric intake
- type 2 diabetes
- propensity for a bigger body (high BMI)
- high cholesterol, low HDL, high triglycerides
- high blood pressure
- heart disease
The research presented in this post indicates that diet, activity levels, weight etc are not themselves the cause type 2 diabetes.
Effects of Trauma are Not Psychological
The effects of trauma are not psychological. Not in your head. The effects reside in our bodies. In our epigenetics, nervous systems and our cells, and more.
Understanding trauma provides a supportive, nonblaming, and comprehensive explanation of T2D. It also explains why it’s not your fault.
This understanding highlights why you are not to blame even if there ARE things you can do to potentially decrease, prevent or reverse T2D and its complications.
T2D is not from overeating, even though eating differently may help. It’s not because you are a couch potato even though adversity can affect our motivation and ability to take action (and you very well may be someone who works hard and is very active). It’s not from depression, even though depression is more common in T2D. And while behaviors or emotions or cravings can contribute to illness, these are known effects of trauma and adversity rather than the cause of T2D.
- brain development, function and structure such as number of cells in tissues (Calkins, 2011; Shonkoff, 2012; Garner, 2012)
- autonomic nervous system regulation such as sympathetic (fight/flight) and parasympathetic (such as social nervous system activity and freeze) (ditto)
- physiology (as above; Puig, 2012; Luby, 2017; van der Kolk, 1996; Yehuda, 2016)
- emotions (as above )
- behaviors (as above )
- stress responses (as above)
- and gene function (epigenetics) (Romens, 2015; Yehuda, 2013; Moore, 2012; Wright, 2018; Huang, 2015)
Even depression, to name one example, is influenced by brain development, cell function, and epigenetics and is not “psychological.”
For those who do overeat or who have sugar cravings, these are also examples of behaviors used to cope with overwhelming emotions that are often not consciously used for those reasons. Feelings of overwhelm stem from past trauma and are typically outside of our conscious awareness.
Depression, low motivation, and low movement are common symptoms of trauma known as the freeze response.
The effects of trauma, in other words, are neither “psychological” nor “genetic.” This means that they are not in your head and, even though effects may be difficult to heal, they are not necessarily permanent as the effects of genes are.
In addition, there are tools to heal many of the effects of adversity over time and with relevant approaches, tools and practices.
See the 11 tools I have found most helpful on my own journey of healing from a chronic illness.
Bigger Bodies and Depression are Indicators of Risk Not Causes
I don’t think this new perspective on “obesity” not being the cause of T2D can be stated enough times given the fat-shaming and judgement in our society and medical culture. So this is a summary to emphasize what I’ve said earlier.
The science of trauma suggests that larger bodies are an indicator of past adversity (Felitti, 2010; Caulkins, 2011). As such, increasing weight may be the first clue that a person’s physiology is shifting towards dysregulation and diabetes. In turn, a “sedentary lifestyle” is often a clue for diagnosing depression. Depression and anxiety are the two most common effects of unresolved trauma. Depression ifs another “indicator” of past adversity rather than a cause of T2D.
12 Tips for Challenges, Healing & Reversing Type 2 Diabetes
This section pulls together the information on type 2 diabetes and trauma to offer 12 insights, tools and tips for common challenges in T2D. Many of these are also briefly included in the free downloadable fact sheet that you can use to inform your doctor and others about the science. The fact sheet includes 2 pages of references.
1. Hibernation Looks Like Type 2 Diabetes: The Bear Science
I recently discovered that hibernating bears have bodies that look like type 2 diabetes. They have insulin resistance and high levels of fat in their blood.
Trauma science explains that this is what happens in the freeze response when we respond to threat by shutting down because the threat is too big to flee or fight. Bears hibernate to survive harsh winters where there is no food. Their fall weight gain provides fat as the fuel that feeds their brains and bodies. This is an intelligent survival response.
I suspect that T2D is an intelligent response just like a bear’s. The problem is that human bodies can get stuck in this freeze response as a result of trauma and then can’t shift when spring comes (or when the trauma is over). This is what we understand from trauma and the cell danger response. I hope to write a blog post on this in the future. In the meantime, learn more on how the freeze state works using an example with chronic fatigue syndrome. Read on to learn how to work with T2D and challenges from trauma perspectives.
2. Reversing Type 2 Diabetes and T2D Complications
The reason understanding the role of trauma can be life changing for people with T2D or prediabetes is that symptoms and complications can be improved (Hallberg, 2015, 2010; Bernstein, 2011).
A series of hallmark studies published in the 1990s known as the DCCT, UKPDS and DPP diabetes studies found that better glucose control decreased the chances of developing complications from type 1 and type 2 diabetes by up to 75% (Curry, 2019).
As presented by Dr. Bernstein in Diabetes Solution (2011), complications such as neuropathy, kidney damage and more can sometimes also be REVERSED by regulating blood sugar levels. He discovered this from his work of improving his own blood sugar levels after almost 30 years of living with type 1 diabetes, including a return to normal kidney function. I haven’t seen anything about reversing complications of type 2 diabetes so far but given the well known possibility of reversing T2D, this seems doable and possible.
Improvement and reversibility are achievable even when there are risk factors from the distant past such as childhood, birth, grandparents’ lives or historical trauma.
I don’t yet know how much healing trauma can help with type 2 diabetes or with other chronic illness since this is a new field. I have heard of some people whose diabetes is much improved and more stable as a result of working not only with diet and lifestyle but also with healing trauma. I have heard of one therapist whose client’s blood sugars returned to normal after healing trauma. I have also been testing these perspectives with my own health and finding it makes a huge difference in healing my own disabling chronic illness. It is helping me gradually improve the many different types of trauma that are relevant to my own health (learn more in my story) and has helped decrease my sugar crashes, which are symptoms of prediabetes, and sensitivity to sugar and carbs. This is also the case for many others working with different diseases from similar perspectives. I hope you will share your stories in the comments below to add more validation to this perspective.
3. T2D When Thin
Not everyone who has T2D is overweight. It is now thought that some of the approximately 20% of people in this lower weight group may in fact have type 1 diabetes or some type of autoimmune diabetes. Of importance to many is the finding that being born small is a risk factor for T2D regardless of one’s weight at the time of diagnosis of T2D (Rich-Edwards).
4. Preventing Type 2 Diabetes (1)
Support, care and safety during pregnancy are enough to reduce low birth weight, premature birth and complications (Joseph, 2017; see my detailed ABEs Guide). This is an important tool to use as we become more trauma-informed as a society and in medical and obstetrical care. Here’s also an example of curing asthma by helping mothers heal from ABEs that may support prevention of T2D and other chronic illnesses.
5. Preventing Type 2 Diabetes (2)
Supporting and educating parents, and helping parents heal from postpartum depression and other often traumatizing events around the birth of their children and from other events in their lives can help them reconnect to themselves. This, in turn, can help them better connect to and parent their children. This is another overlooked resource that may be able to prevent T2D, delay onset or reduce severity. See my post on ACREs and resources for healing ACREs and Complex PTSD.
6. Eating Low Carb Can Normalize Glucose in 2 Weeks
A study of 10 people with T2D who ate less than 20 grams of carbs a day achieved normal blood sugar levels in 2 weeks (see ref 96 in Hallberg’s article below; here’s what 20 grams of carbs looks like on this and this website, which are random examples I found and not recommendations or affiliate links).
7. Low Carb Ways of Eating Often Helps with Reversibility
Dr. Susan Hallberg is director of a supervised program for getting better control of T2D through low carb ways of eating. She ran a prospective study with people who have type 2 diabetes and ate low carb. At 1 year, 60% had achieved normal HbA1Cs (a blood test indicator of the past 3 months of average blood sugar levels). At 2 years 54% had maintained these HbA1C levels. 94% of people had gotten this normalization of glucose levels while also getting off all medications except metformin.
Hallberg’s group found the following factors make it harder to reverse T2D:
- longer diabetes duration
- increased severity of T2D
- lower BMI (not overweight)
- older age
- poor glycemic control
- low C-peptide levels (indicating decreased ability of body to produce insulin)
Most of these risk factors are influenced by adversity, including a greater accumulation of adverse experiences or greater strength of threat response pathways with older age and longer diabetes duration. Lower BMI may be linked to genes but risk for T2D is also influenced by prenatal stress and lower birthweight, regardless of weight at time of onset (Rich-Edwards).
8. There is Ample Evidence that Eating Low Carb Helps T2D
Benefits of ketogenic diet are regularly said to be unknown or not well studied.
Dr. Sarah Hallberg summarizes how a “lack of evidence” is no longer true (2015, 2019). Research studies showing the benefits of low carb ways of eating now far outnumber evidence for the current recommendations to eat from the regular food pyramid with a certain minimum amount of carbs.
You can give Dr. Hallberg’s article to your physician or diabetes educator and other professionals to support this point. Or have them listen to her video presentation at the Cleveland Clinic here on youtube or her TEDX talk hosted by Purdue University.
9. Understanding Trauma Explains Sensitivity to Sugar
It’s important to remember that T2D is not your fault. While there are things you can do to improve your health such as the ones presented here (many of which you’ve probably already heard about, tried or are already using), this does not mean that it’s your fault if you haven’t gotten better.
A person with a T2D body has insulin resistance. This means their body does not have as many options nor as much ease in metabolizing sugar.
A T2D body is therefore more sensitive to sugar than other people’s bodies and compared with other people who can eat what they want with few to no problems. A T2D body may gain weight more easily, or with smaller amounts of food or carbs. It may have difficulty losing weight even if you eat very little. It may have cravings for sugar, which can be the result of stress and an unconscious attempt at coping with feelings that are too difficult to manage (this is one of the effects of trauma, see Felitti, 2010).
Understanding trauma also emphasizes why it can be difficult to make changes in diet or exercise and why making changes doesn’t always work. It’s not about laziness or lack of will power. It’s about underlying survival responses that keep the body in states of fight, flight and freeze (here’s an example of why being caught in states of freeze happens after trauma and why it makes it more difficult to take action or “mobilize” towards healing).
10. Continuous glucose monitoring (CGM) Can Help
The picture above comes from a screenshot of my first full day using a continuous glucose monitoring device that stayed in place on my arm for about 10 days. You can see results from scanning it in the columns below the “57” with all the numbers.
I added notations with a graphic arts program to highlight the big spike and big dip after eating an orange and banana at breakfast time with no protein or other foods. We do not think that those of us without diabetes have such spikes and dips, but I suspect it’s more common than we realize. For example, diabetes specialist Dr. Sarah Hallberg, who does not have diabetes, had a spike to the 170s after eating watermelon one day. The big difference from diabetes is that our sugar levels come down, and do so quickly.
The big dip down to 57 suggests my body gave an extra bolus of insulin. One that seems to be larger than needed and over corrected the high. This may indicate a slightly abnormal way that my body manages sugar. I have had sensitivity to sugar with “sugar crashes” since college, and this is why it may be an indicator of prediabetes. Although my crashes and sensitivity have greatly improved, I was curious to see how my body responded to this breakfast. On some days I felt fine, on some I could feel a slight shakiness. Numbers were higher on days when I felt the slight shakiness and only reached the 130s on days I took my walk 15 minutes after eating.
Continuous glucose monitoring (CGM) is a relatively new technology. It enables a person to track their sugar levels for up to 10 to 14 days at a time with a device that is applied to the skin one time and remains in place for the duration, and to access glucose levels at any time with the use of a cell phone app or a reader.
CGMs provide feedback that help each person learn just which types of foods affect their glucose levels as well as the role of other activities such as exercise and events such as stress. Dr. Hallberg invites the use of CGMs in her clinics because they provide immediate input to therefore help improve diet and glucose levels. CGMs may also help achieve reversal more easily. Hallberg wears one herself, which inspired me to I test one too with my doctors prescription given my history of sugar crashes. It gave me insights to see what my own blood sugar levels did.
A reader with T2D recently told me that when she asked her doctor to prescribe a CGM for her, her doctor declined, saying her 3 month HbA1C levels were good and made this unnecessary. This overlooks the profound degree to which self-knowledge and understanding provide control, choice and empowerment that comes from understanding how your specific body responds to all kinds of foods, activities, emotions, stress and more.
I’ve created a type 2 diabetes fact sheet to give to your doctor. It contains 2 pages of references on the role of adversity as a risk factor for T2D. It also cites Dr. Hallberg’s research and success in which CGMs help people reverse T2D in a reliable way. You can give your doctor the T2D fact sheet as an added resource if they are reluctant to prescribe you a CGM (downloadable at the top and bottom of this post).
11. Why Tracking Blood Sugar Levels Can Be Stressful
Tracking blood sugar levels on a regular basis, such as throughout the day with a continuous glucose monitor, can help identify effects of all kinds of foods as well as stressors and exercise.
I realized during my 10 day exploration with a continuous glucose monitor, however, that checking glucose levels regularly can also be tiring, overwhelming or stressful. And I don’t even have diabetes.
Trauma perspectives offer a number of compassionate insights into this.
Checking sugar levels can be overwhelming because there is so much information to tease out in a single glucose reading – is it high or low? is it from food? stress? an event? activity? Does it mean your T2D is out of control despite what you’re doing? Is it something you can even change?
If that was stressful to read take a moment or three. Act if you need to such as if you are indeed having a high or low blood sugar. If you are okay for right now, then remind yourself where you are in this present moment. Feel your butt on the chair or bed, your feet on the floor or look at something appealing around you. Take that information in for 5 seconds. Feel what that’s like in your body just for a moment – maybe it’s a little settling in your chest, warmth in your belly or softening of your jaw. Then return to reading or your next activity. This is a mindfulness practice that can tell your nervous system that in this moment, there is safety. It’s a way to work with stress. It is also a way of healing trauma.
So back to tracking, why can it be stressful to track blood sugar levels? From a trauma perspective it’s like looking at your unhealed wound all the time. It’s like looking at the effects of unresolved trauma, which is often overwhelming, uncomfortable or distressing. Or it’s like making ourselves look at something that can feel well outside of our ability to control or change. As a result, it can be disheartening.
If checking your blood sugar levels is distressing, have heart.
The more you understand trauma, the more you can work with this and use it as a tool to support your healing in ways that work for YOU. You can pace yourself, choose when to check, take breaks, be compassionate with yourself around results, cope with the fears or frustration that might arise. You will grow your ability to interpret your results, to predict them and to work with them. You will gain more control and options. You will learn how to better prevent highs and lows. And you will gain tools to deal with whatever results you get.
This is part of the gift that comes from understanding trauma.
Doctors who ask about adversity in childhood or babyhood can help validate a person’s difficult experiences, and remove blame about T2D being “all their fault”. Understanding the role of trauma also offers a whole set of new tools for healing trauma that may also help decrease or reverse T2D. You can educate your doctors using the free downloadable fact sheet on type 2 diabetes and trauma at the top or bottom of this post.
Last Words: You are Not Alone
Remember that you are not alone. There is a whole tribe of us out here all working diligently, chipping away at the effects of adversity as our pathways to healing chronic illnesses of all kinds.
We are of all sizes, shapes and colors. We live all around the world. And we are gaining choices and tools far beyond what we ever thought was possible.
You, too, can join this tribe and approach your health journey from ways that empower and encourage. Ways that trust YOU to do what most serves you and what you want and need.
Related Posts and Resources
The image above refers to “Planting Seeds for Healing” and all resource posts
The Most Empowering and Helpful 11 Tools
Type 1 Diabetes as example of an intelligent process gone awry
Chronic Fatigue as an example of threat responses getting stuck
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