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Stress and Diabetes
“Stress is the trash of modern life-we all generate it but if you don't dispose of it properly, it will pile up and overtake your life.” Danzae Pace
Stress comes in many forms physical, mental and even financial. Unfortunately, stress in all these forms has become a regular part of modern life. Recent studies conducted by Carnegie Mellon University have concluded that stress can cause ill health when it is chronic. The signs of stress will not only show up in your body as physical symptoms such as more frequent colds, injuries, relationship problems, depression, insomnia and more. Earlier studies from other sources indicated that as much as 75% of doctors’ visits are related to stress. This can be especially problematic for people with diabetes.
When stress occurs, the body prepares to take action and behaves as it were under attack. This preparation is called the fight-or-flight response. In the fight-or-flight response, hormones such as epinephrine and cortisol kick in since one of their major functions is to raise blood sugar to help boost energy when it's needed most. Their net effect is to make stored energy (glucose and fat) available to cells. These cells are then primed to help the body get away from danger.
These physiological responses are designed to work for short periods of time so when stress is ongoing it can be dangerous.
Complicating matters for people with diabetes, those mechanisms are either lacking or blunted, so they can't keep blood glucose at a normal level, says David Sledge, Director of Diabetes
Management at The Ochsner Clinic Foundation.
"In diabetes, because of either an absolute lack of insulin, such as type 1 diabetes, or a relative lack of insulin, such as type 2, there isn't enough insulin to cope with these hormones, so blood sugar levels rise," says Richard Surwit, PhD, Duke University Medical Center and author of The Mind Body Diabetes Revolution.
"Stress plays a more direct role in the control of blood sugar than it does in any other disease," continues Surwit. People with diabetes should be sure to eat well and exercise regularly. It's also a good idea to check blood glucose levels more frequently when you're under stress and drink plenty of fluids to avoid dehydration.
"A lot of patients can easily tell if their sugar is up by the way they feel or how much pressure they're currently under," says Paula Butler, chief of endocrinology at Mt. Sinai Hospital.
Diabetes is one of those health stresses that are never going to go away. Still, there are ways to reduce the stresses of living with diabetes. Peer support and self-empowerment are good techniques to help get a handle on diabetes stress. Knowing other people in the same situation helps you feel less alone. You can also learn other people's hints for coping with diabetes related problems. Find a peer support group in your area here.
Dealing directly with diabetes care issues can also help. Review the aspects of life with diabetes that are the most stressful for you. It might be taking your medication, checking your blood glucose levels regularly, exercising, or eating as you should. If you need help with any of these issues, ask a member of your diabetes team for a referral.
Another way to reduce stress is to reduce the disorganization in your life. As a person or parent of someone with diabetes, you’ve probably already figured out it takes a lot of work to “organize diabetes”. Not only do you have to organize all the “Tools of the Trade”, (meters, test strips, lancets, syringes, pump supplies, medications, etc.), you also have to keep track of diagnosis and the medications to go with them, daily glucose readings, blood pressure, A1c’s, weight, carbs, exercise durations and a host of other stuff.
Add in daily life and it takes an acrobat to keep all of the elements in place.
Developing and keeping your diabetes self-management “systems” organized, can really help you get, and keep, your diabetes and stress levels under control.
Stress can also be compounded because under these pressures, you may lose your appetite and skimp on eating or "stress-eat" usually on unhealthy fat, sugar and carb laden foods. Others may skip their daily workout because they're too frazzled or exhausted, which can create a vicious cycle since exercise is an excellent way to lower blood sugar.
Since stress has become an almost daily part of modern life it can be difficult to know if what you are feeling is related to stress. Listed below are some of the physical, mental and emotional symptoms of stress.
• Do you find yourself feeling fatigued or exhausted?
• Do you have trouble falling asleep or staying asleep because your body is tense or your mind is racing with thoughts?
• Do you find that your libido has decreased, or that you're just too tired for sex?
• Do you experience stomach aches or gastrointestinal issues like constipation or IBS that get worse with stress?
• Are you experiencing adult acne or unusual skin breakouts such as rashes or hives?
• Is your blood pressure on the high side?
• Do you experience tension headaches?
• Do you find yourself getting sick more often than usual?
• Do you find muscle tension, especially in your neck, back and jaw?
• Have you experienced an unexpected weight gain or weight loss?
• Do you find yourself eating mindlessly or craving sweet or salty food more than usual?
• Do you find yourself drinking alcohol more to relax, smoking to deal with stress, or using other "vices'?
• Do you have more difficulty with decision-making and concentration, or find that you're forgetting things more often?
• Are you are falling further behind in many of the responsibilities in your life?
• Are you are losing your sense of humor or don’t seem to have much fun anymore?
• Do you know what will make you feel better, but can’t push yourself do it?
• Do you find that you are less patient, that you're more sensitive, irritable, easily frustrated, or less sympathetic to others problems?
• Do you have a general feeling of being overwhelmed by everything you're dealing with right now?
• Do you often feel anxious about things you can't control?
• Do you find yourself getting less joy from your work and feeling a sense of burnout?
• Do you feel less social than usual?
o Do you ask more “closed-ended questions to discourage dialogue with friends and co-workers than “open-ended” ones to encourage it?
o Do you find it more and more difficult to see people socially and try to get away from people as soon as possible?
• Do you feel trapped by your circumstances?
If you answered yes to eight or more of these questions you are definitely experiencing some stress. You need to address your stress before it gets totally out of control.
Is Stress Affecting Your Glucose Levels?
"The most important thing is to learn what it feels like when stress hormones are elevated," says Sledge. For some people with diabetes, prolonged illness or stress will keep their blood glucose levels up for long periods of time. Recognizing periods of stress is crucial for people with diabetes because insulin may be need to be adjusted.
Since stress has virtually become a way of life, you may not even realize how much it’s affecting your health. Many people can identify big stressors such as an illness in the family but may not recognize holiday or work stress or the little stressors that can add up. Being in tune to your stress level and how you feel when the going gets tense is important.
Before checking your glucose levels, write down a number rating your stress level on a scale of 1 to 10 (ten being high) and note your glucose level next to it. After a week or two, look for patterns and correlations. Draw a simple graph may help you see trends better. Do high stress levels often occur with high glucose levels, and low stress levels with lower glucose levels? If so, stress may be one of the factors affecting your glucose levels. "Once you begin recording stress levels, most people with diabetes figure out pretty quickly what makes their blood sugar go up," says Surwit.
What’s Your Coping Style?
Our stress comes from two main places: external sources, such as demanding jobs, problematic relationships and financial problems; and internal sources: how we perceive and respond to these and other events is our coping style.
Coping style is how a person deals with stress. Some people are better at coping with stressful situations because they’ve learned effective ways to cope with the factors causing their stress
No one can avoid stress completely. But it can be important to recognize there are some things over which you don’t have complete control and work on managing your response to these kinds of events.
Some people have no coping mechanisms and simply throw up their hands and worry. This can cause them to do other unhealthy things like miss checking glucose levels, stress eating or ignoring their diabetes ABC’s. These folks need to find new ways to cope because ignoring the problem usually never makes it better.
Some approach stress with a problem-solving attitude and try to change their situation to remove the factors leading to stress. Others adopt an attitude the problem or stress is manageable. The second two methods of coping are usually helpful. People who use them tend to have less blood glucose elevation in response to stress.
You may not have the ability to control all your stress but you do have the ability to control your attitude, help calm your reactions to stress and make good choices. The goal is to mobilize the available resources to help you cope with stress in a healthy manner.
Catalog the areas in your life that are causing stress and seek ways to reduce the factors causing it. Some things may be easy – if, for example, heavy traffic causes stress, find a new route to work or leave home earlier, to miss the traffic jams. If you are fighting with a friend or relative, make the first move to patch things up.
Learn to Relax
For some people with Type 2 diabetes, controlling stress with relaxation therapy can help stress and glucose levels. Why only people with Type 2? Stress blocks the body from releasing insulin in people with type 2 diabetes, so eliminating stress may be more helpful for these people. People with type 1 diabetes don't make insulin, so stress reduction doesn't have the same effect on glucose levels. Some people with type 2 diabetes may also be more sensitive to some of the stress hormones.
Regular practice of the following disciplines will immediately help you reduce your stress level, and as an added bonus, over time, bring your glucose levels down as well:
One great way to de-stress is to practice proper breathing. Breathing properly ALL of the time, not just when exercising, is a critical component to get the most out of physical activity and life. Oxygen is the most important element needed to sustain life and breathing is the only way to get it.
Tension, poor posture, smoking and poor breathing habits can cause insufficient oxygen intake. Deep and relaxed breathing delivers oxygen to all cells and facilitates efficient clearing of carbon dioxide.
Take a long deep breath in through your nose making a special effort to fill your lungs from the bottom to the top. This, when done correctly, will push out your belly. The process is similar to blowing up a balloon. Pause briefly (1 – 3 seconds). Exhale slowly through your mouth. Make sure the inward and outward breaths take the same length of time. Continue to breathe in this fashion for several minutes. Repeat several times daily.
Progressive relaxation therapy
This relaxation technique can be learned in a stress or meditation clinic or from an audio tape. These techniques teach you how to systematically relax your muscles and free them of tension. A study published in the journal Diabetes Care showed that just five weekly sessions of a relaxation therapy can reduce blood sugar levels significantly.
Meditation of any type can be beneficial to reducing stress. Mayo clinic has a great article that will give you the basics.
Regular Physical Activity
Another way to rid yourself of stress is to participate in some form of regular physical activity. Find an aerobic activity (running, walking, swimming, cycling, water exercise, tai chi, dancing, etc.) that you enjoy and participate in it regularly. Exercise is one of the best ways to release tension and keep your blood sugar in check. The choices are endless: a quick walk around the block, boxing at the local gym, flying a kite or tennis. For more options.
Seek Professional Help
Sometimes stress can be so severe that you feel totally overwhelmed. Then, counseling or therapy might help. Talking with a therapist may help you identify and come to grips with the problems causing your stress. You may learn new ways of coping or new ways of changing your behavior.
If things are really bad ask your doctor about anti-anxiety medication. Adding any other medication to your daily routine isn’t ideal, but in a crisis may be just what you need to get over an emotional hump.
Enrich Your Life
Many people never give themselves a chance to fully recharge their physical, mental and emotional reserves. As a result, we stay tightly wound and more stressed with each passing day. Instead of being a couch potato and/or stress eating do something to enrich your life in a positive way.
• Take up a hobby – maybe something you used to do, but don’t find the time for anymore, or a new hobby like pottery, glassblowing, or scrapbooking
• Visit a museum or art gallery
• Get near the water and visit a river bank, lake or seashore
• Get outdoors and visit a local, state or national park, zoo, aquarium or arboretum/botanical garden
• Take a class – art, exercise, dance, craft or academic
• Take a bubble bath
• Get a massage
• Read a good book
For people with diabetes, both physical and emotional stress can take a greater toll on health so be sure to always tackle it head on.
“Where'd the days go -- when all we did was play? And the stress that we were under wasn't stress at all just a run and a jump into a harmless fall” - Paolo Nutini
Garnero, Theresa. Your First Year with Diabetes (2008) American Diabetes Association
Peeke, Pam. Are You Caught Up in A Cycle of Emotional Eating? (Winter 2012) Prevention
Diabetes and Stress. Islets of Hope.
Stress. American Diabetes Association.
Updated December 18, 2012
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