Last weekend I decided to stay up late and watch a scary movie. It had something to do with super-gross vampires who get their jollies by eating the flesh of unsuspecting hotel guests.
Anyway, after the final gut-wrenching, heart-pumping scene, I decided to check my blood sugar. I’ll be darned – it had risen about 200 mg/dL (11 mmol) during the movie. With blood that sweet, I felt like the grand prize for any vampires that might happen to be lurking in my neighborhood.
As you may be aware, the liver serves as a storehouse for glucose, keeping it in a concentrated form called glycogen. The liver breaks down small amounts of glycogen all the time, releasing glucose into the bloodstream to nourish the brain, nerves, heart and other “always active” organs.
The liver’s release of glucose depends largely on the presence of certain hormones. Of all the hormones in the body, only insulin causes the liver to take sugar out of the bloodstream and store it in the form of glycogen. All the other hormones—including stress hormones, sex hormones, growth hormones and glucagon—cause the liver to secrete glucose back into the bloodstream.
Growth hormone is produced in a 24-hour cycle and is responsible for the blood sugar rise that we sometimes see during the night or in the early morning. The other “stress” hormones, particularly epinephrine (adrenaline) and cortisol, are produced when our body needs a rapid influx of sugar for energy purposes. The glucose rise I experienced during the scary movie was no doubt the work of stress hormones.
Emotional stress (fear, anxiety, anger, excitement, tension) and physiological stress (illness, pain, infection, injury) cause the body to secrete stress hormones into the bloodstream. For those without diabetes, the stress-induced blood sugar rise is followed by an increase in insulin secretion, so the blood sugar rise is modest and temporary. For those of us with diabetes, however, stress can cause a significant and prolonged increase in the blood sugar level.
Anxious moments and nerve-racking situations happen to all of us. From speaking in public to test-taking to a simple visit to the doctor or dentist, many events elicit a stress hormone response that causes, among other things, a sharp blood sugar rise.
I once experienced another dramatic blood sugar rise when I was late for an important meeting, hit a pothole and got a flat tire, then discovered that the spare tire was also flat. Without the slightest bit of food, my blood sugar rose almost 300 mg/dL (17 mmol)!
Of course, different events cause different responses in different people. What causes a great deal of anxiety for you might have no effect on someone else.
The key is to look for patterns. Is there something that causes a consistent blood sugar response in a given situation? It can be helpful to record the causes of your high blood sugars in your written records, and then tally the causes to determine whether specific situations account for a large number of high readings.
One of my clients did this and found that high blood sugars were occurring every time he watched a horror movie on TV or saw one at the movies. Apparently, the stress hormone response to the sudden appearances of the knife-wielding maniac was driving his blood sugar up.
Many anxious moments occur spontaneously. However, some can be predicted. And if you can predict it, you can prevent it. If you notice a consistent pattern of high blood sugars during certain events, consider giving yourself a small dose of rapid-acting insulin an hour or two prior to the event. This will help to offset the stress hormones produced in anticipation of the event as well as during the event itself. If you wear an insulin pump, consider raising your basal rate using the temp basal feature. A 60 percent to 80 percent increase for three hours, starting an hour or two prior to the event, can work nicely.
(excerpted from Think Like A Pancreas: A Practical Guide to Managing Diabetes With Insulin by Gary Scheiner MS, CDE, DaCapo Press, 2011)
Gary Scheiner and his team of clinicians at Integrated Diabetes Services are available for individual consultations via phone and the internet. Visit integrateddiabetes.com call 1-610-642-6055 for more information.
If you would like to purchase a signed copy of Think Like a Pancreas, call Integrated Diabetes Services directly at (877) 735-3648; (outside the US 1-610-642-6055), or order it through the IDS store here.
- Is Stress the Source of Your Blood Sugar Swing?
- How are diabetes and stress linked?
- 5 Ways Your Stress Can Worsen Your Diabetes
- It’s a Catch-22: Diabetes gets you stressed out and the stress worsens your diabetes.
- High stress can worsen your diabetes in 5 different ways:
- DIABETES & STRESS
- KEY POINTS
- HANDLING YOUR RESPONSE TO STRESS
- SOME WAYS TO RELAX
- IF YOU DEVELOP A COMPLICATION OF DIABETES
- The Adrenal Glands
- Effect of long stress on blood glucose levels
- Book an Appointment
Is Stress the Source of Your Blood Sugar Swing?
If you have type 2 diabetes, you know that certain foods — particularly foods that are high in carbohydrates — can send your blood glucose (sugar) level through the roof. But did you know that there’s a long list of other factors — such as too little sleep, illness, even monthly menstrual cycles — that can sabotage your best efforts to control your blood sugar?
High on that list, though you may not be aware of it, is stress.
Whether it’s related to work, to relationships, or to some other aspect of your life, research, according to the American Diabetes Association (ADA), has continually shown that emotional stress can cause blood sugar to surge. And since strict blood sugar control is the key to the successful management of type 2 diabetes, it’s important to understand how stress affects you and to find healthy ways to cope when mental distress mounts.
The Effect of Stress on Blood Sugar
According to the ADA, stress triggers an increase in the body’s fight-or-flight hormone levels, as if the body were under attack. In response, the body releases extra energy in the form of glucose and fat. People with diabetes are unable to properly process that glucose because of insulin resistance, and consequently glucose builds up in the blood.
“For someone who doesn’t have diabetes, stress causes a temporary rise in blood sugar, but their body can adjust,” says Amy Campbell, RD, LDN, a certified diabetes educator and a contributor to DiabetesSelfManagement.com. “For someone with diabetes, the blood sugar level stays high.”
Everyone gets stressed out at times, but it’s important to understand that there’s a difference between short-term and long-term stress, says the ADA. While life’s inevitable short-term stressors — getting stuck in traffic, bickering with a family member — cause a temporary rise in blood sugar, it’s the long-term stressors, such as an unhappy marriage or a cruel boss, that can cause serious damage.
What’s more, stress can start to undo the routines you put in place to manage type 2 diabetes. “You may start to eat more, change your behavior, or exercise less,” says Renata Belfort De Aguiar, MD, PhD, an assistant professor of medicine, in endocrinology, at the Yale School of Medicine in New Haven, Connecticut. Campbell agrees: “Not only does long-term stress cause chronic high blood sugar but it can affect how you take care of yourself.”
Is It Only “Negative Stress” That Affects Blood Sugar?
Even positive life changes can cause blood sugar to swing, Campbell says. Planning a wedding, moving to a new city, getting a job promotion — such “happy stressors” can also send your fight-or-flight hormones into overdrive.
A large review of studies on stress and blood sugar published in Diabetes Spectrum cited the definition of stress as the “physiological or psychological response to an external stimulus,” regardless of whether that stimulus is good or bad. That means that if you experience a significant change in your life — whether it’s positive or negative — it’s a good idea to keep an extra-close watch on your blood sugar.
10 Ways to Maintain a Healthy Balance
It’s not possible, of course, to eliminate all of life’s headaches. But you can take steps to gain better control over both your blood sugar levels and your stress levels. Start here.
When stress strikes, closely monitor your blood sugar. “When you’re stressed, you should be monitoring and checking your sugars to see if the stress is having an effect or not,” Dr. Belfort De Aguiar says. Simply being aware that stressful situations can affect blood sugar can prepare you to make adjustments. “When you’re under a lot of stress, that’s when you want to be really on top of your blood sugar,” Campbell says. “It’s the time to hone your self-care behaviors.”
Fill your doctor in on big life changes. If a stressful situation is causing your blood sugar to swing, your diabetes doctor needs to know. Says Campbell, “Your doctor may temporarily change your diabetes medication or put you on a higher dose. If necessary, he or she can even make a referral to a mental health professional.”
If possible, eliminate long-term stressors — for your health’s sake. According to the ADA, too much stress can be a warning that something needs to change. Since long-term stressors affect your long-term blood sugar levels and can cause damage to your overall health, they’re even more worthy of a reevaluation. Is it your job that’s tipping you over the edge? If so, the ADA suggests that you have a conversation with your boss on how to improve your work environment, apply for a transfer, or even start the hunt for a new job.
Cut back on short-term stressors, too. Minor annoyances have only a minor effect on your blood glucose level, but when the annoyances are strung together day after day, that effect can mount, says the ADA. Be mindful of little things that consistently get under your skin and try to avoid them. For example, if your highly trafficked commute to work drives you crazy, search for a route with less gridlock, or try getting an earlier start to beat the rush.
Arm yourself with (healthy) quick fixes. The toll stress takes on your health largely depends on how you react to it, Campbell says — “We can’t always avoid being stuck in traffic.” We can, however, learn how to take small stressors in stride. Campbell suggests that you rely on a few quick fixes to help you cool off: “Maybe you go for a walk to clear your head. Maybe you treat yourself to a massage or a manicure. Or maybe you just talk to someone about it.” Focusing on your breath is another simple way to calm your mind and body, wherever you are.
Practice relaxation. Whether you choose deep-breathing exercises, meditation, or aromatherapy, relaxation techniques are designed to help you reduce stress. In fact, a study presented at the 2015 annual meeting of the Endocrine Society showed that mindfulness-based stress reduction (which involves breathing exercises and the practice of nonjudgmental awareness of one’s thoughts) was beneficial in managing blood sugar. The researchers followed 86 overweight women, half of whom were assigned to 16 weeks of training in mindfulness-based stress reduction. Compared with the control group (who did not receive the training), these women exhibited significant reductions in both stress and fasting blood glucose levels. Explore a variety of relaxation techniques, Belfort De Aguiar suggests, to find one that works for you.
De-stress with exercise. Physical activity is crucial for people with type 2 diabetes for many reasons. In particular, exercise lowers blood sugar by increasing insulin sensitivity (meaning that the insulin does a better job of processing glucose), explains the ADA. But a good workout is also a great way to blow off steam and rein in stress levels. Even a quick walk can help — says Campbell, “Not only will getting out and walking remove you from a stressful situation but it can help improve your mood.”
Talk it out. Sometimes you just need to unleash your emotions. A family member, friend, or other source of support who will listen to you can make a big difference in the way you manage stress, Campbell says, adding, “You can also talk to a counselor or join an online support community.”
Beware of “diabetes burnout.” Living with type 2 diabetes can be stressful enough without allowing the management of the disease to become a major source of tension. Staying organized about all the aspects of your care — doctors’ appointments, at-home blood-glucose monitoring, medication schedules — can help. The ADA also recommends diabetes support groups — they allow you to talk to people who understand what you’re going through and to share management and coping advice.
Recharge your batteries. Plenty of research shows that lack of adequate sleep can lead to emotional strain — for example, a study published in the Journal of Neuroscience in 2013 found that sleep deprivation was a contributing factor to anxiety disorders. What’s more, poor sleep may cause blood sugar levels to swing: A large study published in 2014 in Diabetes Care found that people with type 2 diabetes who slept less than 4.5 hours a night had higher blood sugar levels than those who slept 6.5 to 7.4 hours a night. Sleeping too much (more than 8.5 hours) was also associated with higher blood sugar. “Getting enough sleep can help your diabetes management,” Campbell says. If you’re not sleeping well at night, discuss the matter with your doctor.
How Not to Deal With Stress
Food, alcohol, self-pity: These unhealthy “coping” mechanisms do more harm than good. “When we’re stressed out, we turn to unhealthy food — comfort food — and we may start eating a lot of sweets,” Belfort De Aguiar says. “We don’t leave the house.” These are the wrong ways to cope with stress.
Campbell also warns against keeping your emotions bottled up inside. “Be sure to share your stress,” she says, “even it just means having someone listen to you vent.”
Share on PinterestResearch suggests that a person has a higher risk of developing type 2 diabetes if they experience depression or anxiety.
Researchers have been discussing the potential link between diabetes and stress since the 17th century.
More recent research suggests that people with depression and anxiety have a higher risk of developing type 2 diabetes.
A review article from 2010 reports that people who experience depression, anxiety, stress, or a combination of these conditions are at higher risk of developing diabetes.
The scientists found that various stressors can increase a person’s risk of developing diabetes, including:
- stressful life events or traumatic experiences
- general emotional stress
- anger and hostility
- work stress
- distressed sleep
Researchers from the University of Amsterdam in the Netherlands have suggested possible explanations for how different types of stress can give rise to diabetes. These include lifestyle factors, effects on hormone levels, and effects on the immune system.
These explanations for how stress affects diabetes are only theories. Some researchers have even found conflicting evidence that diabetes and stress are related. For these reasons, researchers must continue to study these two conditions to determine if and how they are related.
We provide more details of these three factors in the sections below:
Stress affects lifestyle factors
High levels of stress may cause a person to engage in unhealthful lifestyle habits. These lifestyle habits can increase a person’s risk of developing diabetes. They include:
- eating a poor quality diet
- low exercise levels
- excessive alcohol consumption
Stress affects hormones
Another explanation is that emotional stress can affect a person’s hormone levels, potentially disrupting how well insulin works.
Stress can activate the hypothalamic pituitary adrenal axis and the sympathetic nervous system. This can cause hormonal changes, such as higher cortisol levels and lower levels of sex hormones. The levels of these hormones affect insulin levels.
Cortisol is commonly known as the stress hormone. It can also stimulate the production of glucose in the body and raise a person’s blood sugar.
People with abnormal hormone levels may notice their waist-to-hip ratio increasing. An increased waist-to-hip ratio means that the size of the waist is becoming larger than the hips. This is an important risk factor for diabetes and cardiovascular disease.
Stress affects the immune system
Chronic stress may also affect the immune system.
In one study, researchers noticed that a particular immune system response to chronic stress is a similar response to one that is involved in the development of type 2 diabetes.
5 Ways Your Stress Can Worsen Your Diabetes
It’s a Catch-22: Diabetes gets you stressed out and the stress worsens your diabetes.
Do you sometimes feel like your entire life is centered on your diabetes? When you’re snacking, you’re thinking about your blood sugar level. When you’re exercising, you’re nervous to work your body too hard. When you’re at work, you make sure you have a snack on you at all time or extra insulin shots. When you’re at home, your spouse and children try to not eat their favorite sweets around you.The stress of constantly thinking about diabetes can take a toll on your body. We know that stress is not just bad for our mental health, but also bad for our physical health. This includes your diabetes and its often undiagnosed companion, hypertension. It’s not bad to be a little more conscious or concerned about your health—but high stress levels can negatively impact your body and potentially worsen your condition.
High stress can worsen your diabetes in 5 different ways:
1. Stress raises blood sugar levels
Why does extra tension in your body cause your blood sugar to go up even if you haven’t eaten anything? There are a number of factors that go into this, but a primary reason is that stress triggers the body to release cortisol, which is a hormone that helps the body get through tough situations (the fight-or-flight situations).When cortisol comes out to play, your heart rate and breathing speed up. This also sends glucose and protein stores from your liver into the blood to make energy immediately available to your muscles. In other words, your body releases sugar into the blood so that the energy can get throughout your system. The result: higher blood sugar levels.
2. Stress activates our fat cells
That isn’t the end of the story for cortisol. Cortisol also triggers an enzyme in our fat cells that helps relocate fat from storage deposits around the body to fat cell deposits deep in the abdomen, also known as visceral fat cells. Stress can actually cause many people to accumulate more belly fat. The more stress you have, the more cortisol is in your body and the more abdominal fat you’ll find.In studies, these central fat cells have been linked to not only a greater risk for heart disease, but also a higher risk for diabetes. If you already have diabetes, your condition can grow worse because of an overall elevated level of stress and cortisol in your system.Not only that, but cortisol also increases food cravings, which are already hard to manage with diabetes.
Stress-induced cortisol increases food cravings, making it even harder to manage your dietBut it’s ok to snack! If you haven’t had a chance to see it, we’ve posted a blog on 5 “Swap” Food that Decrease Stress. Just remember, everything in moderation.
3. Stress contributes to insulin resistance
Cortisol also makes it more difficult for the pancreas to secrete insulin, which is needed to move sugar out of the blood and into the cells for energy, stabilizing the concentration of sugar within your blood. Over time, the pancreas struggles to keep up with the high demand for insulin. Glucose levels in the blood remain high. Cells cannot get the sugar they need and the cycle continues.This all contributes to insulin resistance—which you’re already fighting against—and may worsen your condition
4. Stress impacts sleep, which impairs glucose tolerance
Often times, stress leaves us tense and anxious and can cause sleep problem. Many studies have shown the negative health impacts of not getting enough sleep. The impact on diabetes is no exception.
Although everyone has their own standards of what good sleep is, keep in mind that sleeping less than six hours a night has also been found to contribute to impaired glucose (or sugar) tolerance, a condition that often precedes or can worsen the progress of type 2 diabetes.Add to this, the fact people who are tired tend to eat more because they want to get energy from somewhere. This is usually by consuming sugar or other foods that can spike blood sugar levels, further aggravating their diabetes.
5. Stress affects your blood pressure
Let’s go back to the hormone cortisol for a moment. Another one of cortisol’s functions is to narrow the arteries throughout the body in order to allow blood to pump harder and faster through the rest of the body. In fight-or-flight situations, this is advantageous because delivery of oxygenated blood throughout the body.However, constant stress over time keeps the blood vessels constricted and keeps your blood pressure high. Over time this high blood pressure (or hypertension) can worsen many of the complications of diabetes, including diabetic eye disease and kidney disease. In fact, many people with diabetes eventually develop high blood pressure.It is no wonder that diabetes and hypertension often go hand-in-hand. Looking out for one can help prevent or alleviate the other.
A quick and simple step to help better your health
One simple way to ensure yourself that you’re not causing more harm to yourself by being concerned about your health as diabetic is to check your blood pressure regularly.When you keep track of your blood pressure (iOS, Android), you’re empowered with the knowledge to know what works best for your body.For example, if you’re a bit more stressed than usual, you’ll be able to see that trend. If a particular meal and diet plan is not working for you, you’ll be able to observe that in the numbers that your measurements present. If an exercise routine is a bit more intense than your body can handle, your blood pressure measurements can show you that.Getting a simple home blood pressure monitor and then tracking your blood pressure on an app, like Hello Heart (iOS, Android), is a way to good way to start. The Hello Heart app is free in the iTunes store and Google Play. It included built-in reminders and colorful visuals that help you easier see the trends that matter the most.
The Hello Heart App keeps track of your blood pressure and heart health trends. Available for iPhone and Apple Watch.But of course, don’t feel guilty for being stressed. Stress is a completely normal reaction to dealing with tough things in your life. But even just a little bit more awareness about how stress affects your health can help you manage your diabetes beyond what the doctors have recommended you and help you regain your control of your own life. Just remember that your life is not dictated by your diabetes.You control your diabetes, and ultimately you are the one in charge of your life.
DIABETES & STRESS
- Stress is a part of our daily lives
- Stress becomes unhealthy when it begins to make us less able to manage our physical or psychological health, or other factors in our lives such as our work and relationships
- Stress can be caused by physical factors (like an injury or illness) or psychological / social factors (unresolved work issues, bereavements, moving house, unresolved relationship problems)
- In many people with diabetes, stress can cause their blood glucose levels to rise. Learning strategies to deal with stress may lessen this effect
- Having diabetes is in itself a major source of stress. People with diabetes have higher rates of anxiety and depression. Learning how to manage stress and treating these skills as a priority, can help you cope with stress more effectively
- There are practical things you can do to reduce stress, such as learning relaxation techniques, learning different ways to respond to stress, identifying situations that cause stress and choosing to avoid them, and making changes to your life that increase your enjoyment level
- Developing a positive coping style may help you deal more effectively with stress
You will inevitably experience ups and downs in your journey with diabetes. Learning what skills and resources you have to help you manage stress (and your response to stress) can help you effectively deal with the difficult times.
What happens in my body when I get stressed?
Each person will have a somewhat different response to stress. When we experience stress our body tends to respond as if it were under attack. This can be regardless of whether the stress is physical (like an injury or infection) or psychological (like an argument, a marriage break up, a bereavement, or financial problems).
The body responds to stress by preparing itself to take action. This is called the “fight-or-flight” response. In the fight-or-flight response, the levels of many hormones rise. These hormones (which are sometimes called ‘stress hormones’) include adrenaline, growth hormone and gluco-corticosteroids.
One of the things raised levels of these hormones do is to stimulate the body to release stored glucose into the bloodstream. If you don’t have diabetes you will respond to the higher blood glucose levels by increasing your insulin levels. The end effect of this is that more energy (in the form of glucose) will be available to your body’s cells. This means that they have more energy to either fight the stress or run away from the stress.
When you have diabetes, the fight-or-flight response can cause you problems. As your blood glucose increases, you may not have enough insulin to move this glucose into your cells. This can result in your blood glucose levels becoming high.
What if the stress is happening over a long period of time?
Some sources of stress are immediate and short term. Other sources of stress can go for much longer. For example, it can take many months to recover from major surgery. You may have higher levels of stress hormones during this time. As a result your blood glucose levels can be increased over a long period.
A long period of psychological stress may have the same effect.
Having higher blood glucose levels because of long-term stress can often be managed by a combination of dealing with the stress (if possible) and increasing your diabetes medication during this time. Talk to your diabetes team about this.
Because higher levels of stress can cause your blood glucose to rise (if your body can’t make enough insulin), some people find out they have diabetes during a period of illness or stress. For this reason some people believe that stress can cause diabetes. Actually, what’s much more likely to have happened, is that the stress has uncovered their diabetes. The stress has challenged their body to make more insulin, but because they are beginning to produce less insulin, they are unable to meet this challenge and their blood glucose levels start to rise.
In what other ways can stress affect my diabetes?
When you are under stress (whether physical or psychological), it is often harder to find the energy to look after yourself. All your energy may be going into dealing with the stress factor, whether it is a psychological stress, or an illness or injury.
Many people stop exercising when they get stressed. Others may use alcohol or drugs to help dull their pain or distress. Some people find their eating is affected. They may eat more than usual or less than usual. Often people stop testing their blood glucose levels when they are experiencing stress.
Is stress affecting your blood glucose levels?
You can work out if psychological stress is affecting your glucose levels
Before checking your glucose levels, write down a number rating your mental stress level on a scale of 1 to 10.
Then, after checking your blood glucose, write down your glucose level next to it.
Do this for several weeks then look for a pattern.
Drawing a 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 affecting your blood glucose levels.
HANDLING YOUR RESPONSE TO STRESS
You have some control over your reaction to stress. You can learn to relax and this may reduce your body’s hormonal response to stress. There are often groups in your community, or books you can read, that teach relaxation techniques.
Some of these techniques are surprisingly simple and effective. There are a range of options to help you relax. For example:
- Breathing exercises
- Relaxation therapy
- Getting regular exercise
- Consciously replacing bad thoughts with good ones
Whatever method you choose to relax, practice it. Just as it takes weeks or months of practice to learn a new sport, it takes practice to learn relaxation.
You can also often make quite simple lifestyle changes that can help reduce some of the stress factors. For example, if you always get very stressed when you get stuck in a traffic jam that makes you late for work, think about what other options are open to you. Would it be a more healthy option for you to walk to the railway station and take the train?
Take time to look at your life – coolly and clearly. One way to do this is to imagine that you are a friend who has come to talk to you over the fact that their life is getting them down. What changes could that ‘friend’ make in their life? Changes that would either reduce their stress levels or strengthen their ability to cope?
If you feel as though your life is a treadmill with no time at all for yourself, make the effort to plan an enjoyable ‘time-out’ period for yourself every day. Adjust your thinking so that this time-out is as important as all your other commitments like eating meals, going to work, and caring for your children. Look around for the supports available to you that will enable you to take regular time-out. If you feel you don’t have those supports, think creatively about how to find them or talk to a counsellor about your situation.
If you are having conflict with someone in your life, think of creative and positive ways to resolve it. Sometimes taking the first step to sort out issues helps. If you are not confident about dealing with the issues talk to a counsellor about what options are available to you.
If you are having big problems with stress, or you need some help and support in order to learn ways to deal with it, get help from a counsellor. Your GP should be able to suggest ways to get help that are within your budget.
Many people with diabetes find good support and help from a local diabetes support group. If you think this could help, contact your local diabetes service, diabetes society or Diabetes New Zealand to find out more.
SOME WAYS TO RELAX
- Breathing exercises
Sit or lie down and uncross your legs and arms. Take in a deep, deep breath. Then push out as much air as you can. Breathe in and out again, this time relaxing your muscles on purpose while breathing out. Keep breathing and relaxing for 5 to 20 minutes at a time. Do the breathing exercises at least once a day
- Progressive relaxation therapy
In this technique, which you can learn in a group or from an audio tape, you tense all your muscles for a short period, then slowly relax them.
Another way to relax your body is by moving it through a wide range of motion. Three ways to loosen up through movement are circling, stretching, and shaking parts of your body. To make this exercise more fun, move with music.
- Banish bad thoughts
If certain thoughts make you sad, angry, or nervous, don’t think them! Of course, that may be easier said than done. One way to train yourself not to think bad thoughts is to put a rubber band on your wrist. When you catch yourself thinking thoughts that upset you, snap the rubber band.
- Replace bad thoughts with good ones
Each time you notice a bad thought, purposefully think of something that makes you happy or proud. Or memorise a poem, prayer, or quote and use it to replace a bad thought.
Whatever method you choose to relax, practice it. Just as it takes weeks or months of practice to learn a new sport, it takes practice to learn relaxation.
Certain periods in our lives with diabetes can be more difficult than others
When you are first diagnosed
- You are often feeling quite physically unwell.
- Finding out you have a chronic condition (that is not going to go away) can result in strong feelings of loss and grief. Most people grieve for the loss of expectation they feel in terms of how they anticipated their life would be.
- A diagnosis of diabetes impacts on your sense of identity or self. You are no longer the person you thought you were. You are a person with diabetes. This change in how you view yourself can take some time to adjust to.
- You may feel very anxious when first diagnosed. You may have known someone who had diabetes and had a bad experience with it. This may colour your thinking. There is also a lot of new knowledge and skills to take on when you have diabetes. This can cause a sense of pressure, fear or anxiety.
- When you are experiencing a life transition
Dealing with your diabetes when you are making changes in your life can be more difficult. Going through transitions (such as entering into a new relationship, starting a new job, leaving home, or becoming a parent) often takes up a lot of our energy as we adapt to a new role or a new environment. This can leave less energy left over to manage our diabetes.
It may also be that our usual diabetes management routines may suddenly get in the way of other life priorities. Priorities may be doing shift work in a new job, putting the needs of young children first, or being utterly spontaneous and carefree when we first fall in love.
When you feel diabetes is interfering with other life priorities it is easy to feel very angry and frustrated towards your diabetes. Sometimes underlying feelings of grief about having diabetes may be highlighted at these times.
Needing to start on insulin is a big step for many people. They may feel that diabetes is a lot more intrusive at this time as they will need to test more often and possibly pay more attention to the timing of their meals and exercise patterns.
IF YOU DEVELOP A COMPLICATION OF DIABETES
Developing a complication of diabetes may result in significant readjustments in your life. If it makes you less mobile, you may feel you have become more dependent on others, or you might need to shift house or jobs. If your vision is more limited, you may need to concentrate harder on achieving tasks that were previously easy. Depending on what impact the complication has on your life, you may feel a great deal of grief associated with the loss of full health.
Having diabetes is stressful. It can also mean that it is more of a challenge for us to manage other life stresses. As you become more experienced with diabetes it tends to assume a less intrusive place in your life. As you achieve a comfortable balance between caring for yourself and also having fun and enjoying your life, your stress management strategies can become more effective.
When the body is under stress, the adrenal glands trigger the release of glucose stored in various organs, which often leads to elevated levels of glucose in the bloodstream.
For people with diabetes, this can be particularly problematic as they find it harder than non-diabetics to regain normal blood glucose levels after a bout of stress.
The common misconception with stress is that it is an emotional problem, often disguised as anxiety, worry, or depression.
However, the reality is that stress can also be physical, nutritional, and chemical.
For example, stress can be experienced as physical pain or illness, and can also be triggered by situations such as an accident, the death of a friend or relative or confrontations with other people.
Essentially, stress can be considered as anything that tends to change the control that you have over our body and our emotions
The Adrenal Glands
The adrenal glands, which site atop the kidneys, are mainly responsible for releasing hormones in response to stress. The hypothalamus area of the brain sends a chemical signal to the adrenal glands, which become enlarged and produce two hormones – epinephrine (also called adrenaline) and norepinephrine.
These hormones are released into the blood to help prepare the body for the so-called ‘fight-or-flight response’.
They speed up the heart and widen airways and blood vessels, causing a rise in blood pressure and muscle tension.
While the main role of norepinephrine is to prevent blood pressure from falling, epinephrine is an important blood sugar regulating substance.
It is responsible for converting glycogen (the glucose stored in muscle cells and liver) into glucose when blood sugar levels drop, thus ensuring normal levels of blood glucose are maintained.
Raising blood sugar is important in stressful situations, as the body is told to get its fuel (glucose) levels up in preparation for a lot of physical and mental activity.
The release of epinephrine helps achieve this and, combined with the increase in blood pressure, ensures the supply of oxygen and glucose to all parts of the body.
Effect of long stress on blood glucose levels
It is important to be aware that repeated episodes of stress can cause serious changes in blood sugar levels, making it harder for diabetics to manage their condition and increasing the risk of hypoglycemia (low blood sugar).
Constant stress will also cause adrenal fatigue leading to adrenal failure, which is why it is vital to remove stress from your life, especially if you have diabetes.
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Whenever we think of the causes of diabetes, we usually think of heriditory factors (family history), overeating or lack of exercise leading to obesity as the most common causes. While this is true, we often tend to forget an important cause of diabetes – stress. Stress is defined as “a physical, chemical or emotional factor that causes physical or mental tension and may be a factor in disease causation”. Several diseases can be caused or worsened by stress and diabetes is also one of the important ones.
How does stress affect the blood sugar levels?
The blood sugar levels are controlled mainly by two groups of hormones. The first group of hormones reduces blood sugar but insulin is the only member of this group. The second group called counter-regulatory hormones, opposes the action of insulin and increases the blood sugars. There are several of these hormones and the list includes cortisol, adrenaline, noradrenaline, glucagon and growth hormone. Stress tends to increase the levels of the counter-regulatory hormones, particularly cortisol, adrenaline and noradrenaline. If the levels of these hormones are persistently elevated, this can precipitate diabetes in a predisposed individual or worsen the diabetes control in someone who already has the disorder.
Mrs. S, a 52 year old lady visited me some time ago. She had abnormally high blood sugars – over 600 mg/dl. Despite my best efforts to control her sugar with high doses of insulin and tablets, the sugar remained above 350 mg/dl. Then, suddenly one day after 3 – 4 months, the sugar levels started dropping. We had to withdraw the insulin and later, stopped all her diabetes tablets also. She told me that she was now eating sweets and chocolates every day but her sugars remained normal. She then opened out to me and said that her husband had been having an affair with another lady in his office which produced great stress in her life and that was why she had developed diabetes. After a few months, the other lady had got transferred to another city and her husband came back to her. Her diabetes disappeared! This may sound like a script from a movie but truth is stranger than fiction!
It is important to detect high stress levels in a patient, since the blood sugars will come down only if the stress is relieved or controlled. Doctors should always think of two things; when they see any patient with unexplained high sugars, or in someone whose diabetes is not under control in spite of optimum use of diet, tablets and insulin a hidden infection somewhere in the body or stress. Reduction of stress often leads to dramatic improvement or even cure of diabetes, as shown in the case above.
How can stress be dealt with?
Very often, individuals do not realize that they are under stress and even if they do, they deny it. The first step in stress management is to make the patient understand that everyone in the world is exposed to some stress or the other at some time in their lives. In fact, a mild degree of stress may actually be good for us as it raises our level of performance. Even Sachin Tendulkar recently admitted that even now he does feel mildly anxious every time he goes into bat. However, one should be alert to the signs and symptoms of excess stress, as they may be quite subtle and yet can be serious, and even dangerous.
One should try and accept stressful situations as “challenges” and not as “threats”. Many doctors tend to treat symptoms of stress with anxiolytic or anti-depressive medications without tackling the root cause of the stress. This approach could lead to harmful side-effects. Therefore, the correct approach would be the use of stress management techniques like diet, exercise, meditation, yoga and other forms of de-stressing. This approach would help to identify the underlying cause of stress and correct it. The help of a qualified clinical psychologist or counselor can be of great help in many cases as they would often have more time to spend with the patient than a busy physician.
Stress is a part and parcel of our modern, fast-paced lives. Following a healthy lifestyle with adequate exercise, correct diet and regular sleeping hours will keep one physically and mentally fit to face any stressful situation that may arise in one’s life. It is particularly important that a person with diabetes learns how to manage stress, since stress can wreak havoc with the management of diabetes. A healthy social life, taking time out to relax with friends and family is vital in reducing stress levels, thereby reducing the risk of developing diabetes and helping people with diabetes take control of their condition. We have seen many patients who were able to reduce their dose of drugs and several cases like the one described previously, who were able to completely stop all anti-diabetic medications. Find out if stress is the cause of your diabetes, and if yes, please start stress management measures today. You cannot avoid stress but you can certainly manage it!
TIPS ON COPING WITH STRESS
- Accept whatever has happened
- Practice better time management
- Improve organizational skills
- Resolve conflicts
- Yoga (eg, Pranayama) and Meditation
- Regular exercise
- Relaxation techniques
- Eat moderately and at proper times
- Proper sleeping hours
- Seek support whenever necessary either from a family members or professionally