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Many people living with type 2 diabetes do everything they are advised to do. They take multiple medications, adjust their diet, and follow medical guidance, yet their blood sugar levels remain persistently high. For years, this situation has often been explained as the natural progression of diabetes or the challenge of maintaining long-term lifestyle changes. However, new research suggests that in some patients, an underlying hormone imbalance may be contributing to the problem.

That hormone is cortisol.

What Is Cortisol and Why Does It Matter?

Cortisol is often called the body’s “stress hormone.” It is produced by the adrenal glands and helps regulate blood sugar, blood pressure, metabolism, and the body’s response to stress. In normal amounts, cortisol is essential for health.

Problems arise when the body produces too much cortisol over a long period of time, a condition known as hypercortisolism. Excess cortisol raises blood sugar levels, makes the body less sensitive to insulin, and encourages fat accumulation around the abdomen—all factors that make diabetes much harder to control.

A Closer Look at People With Hard-to-Control Diabetes

A large recent study focused specifically on adults with difficult-to-treat type 2 diabetes, people whose blood sugar levels stayed high despite taking several diabetes medications. More than 1,000 participants were tested using a simple overnight hormone test that measures whether cortisol levels drop as expected.

The findings were surprising.

Nearly one in four people in this group had cortisol levels that remained abnormally high. In certain subgroups such as those with heart disease or people taking several blood pressure medications, the numbers were even higher.

These results suggest that excess cortisol is not rare among people whose diabetes does not respond well to standard treatment.

Why This Problem Often Goes Undetected

Most people associate high cortisol with a rare condition called Cushing’s syndrome, which causes noticeable physical changes like a rounded face or wide stretch marks. However, many individuals with cortisol excess do not show these classic signs.

Instead, they may experience:

• Persistent high blood sugar

• High blood pressure that is hard to control
• Abdominal fat accumulation

• Fatigue or muscle weakness

Because these symptoms are common in type 2 diabetes itself, cortisol imbalance can easily be missed.

Why Identifying Cortisol Excess Matters

Finding and treating excess cortisol can make a meaningful difference. In some cases, correcting the hormone imbalance may:

• Improve blood sugar control

• Reduce the need for multiple diabetes medications

• Help manage blood pressure more effectively

• Lower the risk of long-term complications

Importantly, the test used to screen for this problem is relatively simple and widely available.

What This Means for Patients

These findings do not mean that everyone with diabetes has a cortisol problem. But they do suggest that for people whose diabetes remains poorly controlled despite proper treatment, cortisol excess should be considered as a possible contributing factor.

If blood sugar levels remain high despite multiple medications, or if diabetes is accompanied by hard-to-control blood pressure or heart disease, discussing hormone testing with a healthcare provider may be worthwhile.