Stress and blood sugar

How stress affects blood glucose levels

Stress can increase your blood glucose levels. Stress can also cause you to turn to unhealthful behaviors such as overeating, eating unhealthful foods or smoking.

Managing your stress and relaxing more will help you and your baby stay as healthy as possible.

Identify sources of stress

Being pregnant, preparing for a new baby and learning to manage gestational diabetes are stressful things on their own. But you also lead a life in the real world, with all it stresses and tensions.

Stress has many sources. Name some of your main sources of stress and see if you can identify an action to reduce or eliminate complications of gestational diabetes for you and your baby.

You might find that simply learning as much as you can about gestational diabetes will relieve much of your worry.

How to reduce your stress level

  • Find opportunities to rest: sit, lie down, put your feet up.
  • Talk to friends, family and your partner about your concerns and stresses.
  • Lower your expectations of yourself. The house can be messy, the laundry can fall behind and you can be less than perfect. You’re helping your baby grow and be healthy, and that’s your first priority.
  • Get enough sleep.
  • Ask for help in getting tasks done. Ask a friend to drive, a sister to help set up the nursery, your partner to grocery shop. If possible, hire out tasks like yard work and house cleaning during your pregnancy.
  • Know and accept your limits. Let friends and family know that for now, you have to take special care of yourself and your baby. When you need rest. excuse yourself and go rest. When you feel overwhelmed, take on less.
  • Be physically active every day. It’s a great stress reliever.
  • Add relaxation to each day. Listen to your favorite music at work. Take a bubble bath. Close your eyes and do nothing except breathe deeply.
  • Schedule time for what you want to do. Book time on your own calendar for whatever gives you joy. Visit a museum. Do needlework. Talk long distance with a friend. Read a long novel. Sit in the garden.
  • Watch funny movies, read silly books, laugh with friends.
  • Cry if you want. It’s a great stress reliever.
  • Remind yourself that gestational diabetes isn’t forever.

If you’re struggling with the emotions and stress caused by gestational diabetes and pregnancy, tell your health care provider and your diabetes educator. They can help you find ways to cope.

Stress, whether physical stress or mental stress, has been proven to instigate changes in blood sugar levels, which for people with diabetes can be problematic.

While stress can affect diabetes control, both directly and indirectly, it can also be caused by various diabetic factors such as being diagnosed with diabetes, adjusting to a diabetes treatment regimen, or dealing with psychosocial pressures of the disease.

What is stress?

Simply out, stress is a state of emotional strain or tension that occurs when we feel that we can’t cope with pressure.

When we become stressed, the body quickly responds by releasing hormones that give cells access to stored energy – fat and glucose – to help the body get away from danger. This instinctive physiological response to perceived threats is known as the “fight-freeze, or flight” response.

Over time, both physical and mental stress can wear us down mentally and lead to depression and other mental health issues.

What can cause stress?

We live in a very stressful society which is constantly putting us under pressure. This pressure can sometimes be too much to handle, leading us to feel “stressed out”.

This everyday feeling can be caused by simple things such as:

  • Work pressure
  • Marriage and relationships
  • Parenting/children
  • Health problems such as diabetes (see below)
  • Financial insecurity
  • Traffic

Diabetes causing stress?

Being told you have diabetes, or any serious chronic condition for that matter, can also cause a lot of stress and pressure.

This can make it harder to control blood sugar levels which, in most cases, only adds to the frustration and stress.

How does stress affect my diabetes?

It is widely recognised that people with diabetes are who regularly stressed are more likely to have poor blood glucose control.

One of the reasons for this is that stress hormones such as cortisol increase the amount of sugar in our blood. High levels of cortisol can lead to conditions such as Cushing’s syndrome, which is one of the lesser known causes of diabetes.

Constant stress and frustration caused by long term problems with blood glucose regulation can also wear people down and cause them to neglect their diabetes care.

For example, they may start to ignore their blood sugar levels or simply forget to check them, or they may adopt poor lifestyle habits, such as exercising less, eating more ‘junk’ and processed foods, drinking more alcohol, and smoking. This is known as diabetes burnout.

While stress alters blood sugar levels, the extent of its impact varies from person to person. Studies into the effects of stress on glucose levels in humans have shown that mental or psychological stress causes a rise in glucose levels in people with type 2 diabetes and in most type 1 diabetics, although levels can drop in some individuals with type 1.

Physical stress, such as illness or injury, almost always causes blood sugar levels to elevate in people with either type of diabetes.

How do I know whether stress is affecting my glycemic control?

A simple way to do this is to rate your stress level on a scale of 1 to 10 every time you test your blood sugar levels. Make a note of this number and next to it write down your glucose reading.

By doing this consistently for a few weeks, a pattern should emerge that allows you to see whether high levels of stress coincide with high glucose levels, or vice versa.

What is the fight-freeze or flight response?

The fight-freeze or flight response is an evolutionary coping mechanism enabling us to deal with threats and stressful situations.

When confronted by a threat, hormones are released that help us get ready to either fight the threat or fuel a quick escape. There is an increase in glucose for energy, increased blood pressure to take fresh oxygen to working muscles, and the release of adrenalin for heightened vigilance and alertness.

The “freeze” factor has been introduced in recent years as theories have been put forward as to why people sometimes “freeze” in a hopeless, shocking situation. It is possible that this ‘rabbit in headlights’ reaction is similar to playing dead, which could have helped our ancestors avoid attacks in the wild.

Modern humans have fewer physical threats, but when faced with psychological pressures such as getting stuck in traffic, the brain and body still behaves in the same manner as when faced with a physical threat (i.e. the fight-freeze or flight response).

However, in people with diabetes this instinctive response does not work as well. Insulin is needed to get stored energy (glucose) into the body’s cells. But in people who have diabetes, this process is hampered as insulin is either not produced (as with type 1 diabetes ) or not used effectively (type 2 diabetes), resulting in the build-up of excess glucose in the bloodstream.

How can I combat stress?

There are a number of ways you can alleviate the feelings of stress. These include:

  • Taking regular exercise or joining a sports team
  • Going on holiday
  • Listening to music
  • Practicing yoga and breathing exercises
  • Mindfulness meditation

The ultimate aim of these exercises/activities is relaxatio, which is key to controlling stress.

How does exercise help with stress?

Research studies, including one from Maastricht University in 2000, show that physical activity can increase insulin sensitivity and help to lower blood glucose levels, as well as burn calories.

In the UK, the NHS advise to build up to 150 minutes of aerobic activity, such as jogging or brisk walking, each week.

Moving your body through a wide range of motions can also give the mind a rest from the pressures of everyday life. Some people find this relaxing as the mind is preoccupied with exercising rather than worrying about any problems in life.

How does mindfulness meditation alleviate stress?

Mindfulness meditation is the art of becoming aware of our present moment experiences, including thoughts, emotions and sensations in a non-judgemental and accepting manner.

Mindfulness meditation courses have been shown to significantly reduce stress, anxiety and panic attacks in people who are diagnosed with chronic stress and anxiety disorders such as Seasonal Anxiety Disorder (SAD)

Specifically, research studies have also shown that mindfulness can help people who have diabetes improve their blood glucose control, reduce their blood pressure and enhance their overall quality of life.

The research suggests that by simply accepting or acknowledging destructive emotions in a non-judgemental way, as opposed to suppressing them or trying to change them, people with diabetes are able to better regulate their blood glucose levels and cope with the mental strain of constantly treating themselves.

Stress prevention

Simply alleviating the consequences of stress will not stop it altogether, but it may be possible in your situation to stop or prevent the things that stress you out in the first place.
If you frequently get stressed out by one or more of the following, there are certain changes you can make to your life that may help stop your stress at the source:

  • Traffic – Avoid traffic by commuting on a different route or by leaving home/work at an earlier time, if possible.
  • Work – Speak to your employer about making improvements to your work load if you are struggling to cope, or apply for a transfer. In some cases, it may be best to seek a new, more enjoyable role elsewhere.
  • Relationships – Not getting on with relatives or loved ones can cause a persistent overbearing feeling of stress Try taking the first steps to resolving any long lasting conflicts and mending your relationships.
  • Try something new – Taking up a new hobby or learning a new craft may introduce a positive factor into your life, which could be just what you need.
  • Managing diabetes – If aspects of your day-to-day management of diabetes make you feel stressed, talk to your GP or a member of your diabetes team about these issues You could also try joining a support group where you will be able to make friends with other people in the same situation and pick up tips on how to reduce the burden of diabetes-related stress.

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Helping a Partner With Gestational Diabetes

If your partner has gestational diabetes, she may have her hands full managing her nutrition, exercising regularly, and keeping track of her blood sugar and doctor visits. Add this to all the normal stresses that go along with being pregnant, and it should be obvious that she could use your help.

“During my wife’s first pregnancy she probably had mild gestational diabetes, but during the second pregnancy it was more obvious and she needed a lot more help,” recalls Bill Taylor of Danbury, Conn. “I learned to think of managing pregnancy as a team effort. I went along on all the doctor visits that I could and we learned how to manage gestational diabetes together.”

Helping With Gestational Diabetes Treatment

Keeping gestational diabetes under control requires a combination of exercise, healthy eating, frequent blood sugar testing, and in some cases, medications to control blood sugar. The goal of treatment is to maintain a relatively normal and constant blood sugar level. All this requires education about gestational diabetes and constant vigilance to make sure treatment is working. Partners can be a big help in this process. Here’s how:

  • Education. Your partner will need to work closely with her doctors and diabetes educators to learn about managing gestational diabetes. There is a lot to learn. As a partner, you should also know when glucose testing should be done and what the target readings are. Testing her blood sugar should be done at certain times of the day to see if exercise and diet are keeping the blood sugar under control. You can help by reminding your partner when to check and helping her keep track of all the numbers.
  • Nutrition. People with gestational diabetes need to be careful about what they eat and how often they eat. Your partner should be eating three small meals a day along with two to three snacks at regular intervals. She should be eating whole-grain foods high in fiber and lots of fruits and vegetables. Although her diabetes educator will help her develop a nutritious eating plan, you can also be supportive by actively helping her to eat well. “I always made sure my wife never skipped a meal, and if we went out I always reminded her to bring a snack. I would often make sure she had crackers in her pocketbook,” remembers Taylor.
  • Exercise. Physical activity is a very important part of gestational diabetes treatment. Exercise helps enhance your partner’s response to insulin, thereby lowering her blood sugar. Make sure that her exercise plan is approved by her doctor and remember that overdoing it can actually cause her blood sugar to become too low. A recent study published by the American Diabetes Association found that one of the best ways to motivate women with gestational diabetes to exercise is through encouragement from their partner. “Walking was the best exercise for my wife. We would schedule regular times to do our daily walks together,” says Taylor.
  • Physical support. One frequent symptom of both diabetes and pregnancy in general is increased fatigue. Taylor remembers that late in his wife’s pregnancy, routine chores and taking care of their first baby could be overwhelming at times. “I could see how tired she was getting. I really had to pick up the slack to give her time to rest and recuperate.” Helping your partner with responsibilities around the house can leave her with more energy to focus on her and your unborn baby’s health.
  • Emotional support. Having diabetes and being pregnant are stressful. The body’s natural reaction to stress is to try to make more energy from glucose in the body’s cells, but this process is impaired in women with gestational diabetes. As a result, stress may take even more of a toll. “I think it relieved a lot of my wife’s stress to know that we were both involved in the pregnancy together. Sometimes just being supportive and loving is the best you can do,” says Taylor.

Women who have had gestational diabetes have an increased risk of developing both type 2 diabetes and gestational diabetes during a future pregnancy. You can help your partner reduce these risks by supporting her in maintaining a healthy weight, good nutrition, and regular exercise. These healthy lifestyle habits are good for both of you and will also set a great example for your children.

Up to 10 per cent of women are not able to keep up with the extra demands of pregnancy and develop some type of metabolic problem, such as gestational diabetes.

MandicJovan/iStockPhoto / Getty Images

The question

I’m pregnant and, to my surprise, I now have gestational diabetes. Is this a common problem for pregnant women?

The answer

In many respects, having a baby is the ultimate stress test. “During pregnancy, virtually every organ system in the body has to work harder in order to support the needs of the developing fetus,” says Baiju Shah, head of endocrinology at Sunnybrook Health Sciences Centre in Toronto.

Most of the time, everything goes smoothly. But up to 10 per cent of women are not able to keep up with these extra demands and develop some type of metabolic problem, such as gestational diabetes.

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Usually, the condition goes away immediately after the birth of the child. But it can be a harbinger of things to come. “Pregnancy is like a window into your metabolic future,” Shah explains. If there is an underlying weakness, it may reveal itself for the first time during pregnancy – and come back later in life.

In fact, about 20 per cent of women diagnosed with gestational diabetes will go on to develop Type 2 diabetes within a decade, he says.

Before delving deeper into future risks, it’s worthwhile considering what actually happens in pregnancy to trigger this condition.

The first thing you need to know is that insulin – a hormone produced in the pancreas – helps to move glucose (or sugar) from the bloodstream into the body’s cells where it is used for energy.

Midway through pregnancy, women will begin to experience insulin resistance as a result of hormones released by the placenta, the organ that supplies oxygen and nutrients to the growing fetus, says Lorraine Lipscombe, director of endocrinology at Women’s College Hospital in Toronto.

Insulin resistance essentially means that the pregnant woman’s insulin becomes less effective at moving glucose into her cells. In other words, her cells “resist” the insulin.

This likely happens to make sure the fetus is well supplied with glucose. But the mother’s cells needs a sufficient amount of glucose, too. So, her pancreas starts pumping out more insulin to compensate for its diminished effectiveness.

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However, some pregnant women are unable to produce enough extra insulin. As a result, high levels of glucose begin to build up in their bloodstream. At this point, they are now considered to have gestational diabetes, which is bad for both mother and fetus.

In particular, elevated levels of glucose in the mother’s bloodstream start flowing across the placenta into the fetus, which in turn causes the fetus to produce more insulin to process the high levels of sugar.

If left unchecked, all the calories from the extra glucose – plus the insulin, which is a growth stimulant – can lead to a bigger than normal baby. This raises the risk of complications when it comes time to give birth. In some cases, a cesarean section may be needed to deliver a supersized baby.

Canadian medical guidelines call for women to be tested for gestational diabetes between 24 and 28 weeks of pregnancy. If the amount of glucose in the blood is excessively high, efforts are made to bring it down to a healthier range.

Dietary changes and increased physical activity can often be used to successfully manage blood glucose levels, Lipscombe says.

But about 40 per cent of these women will need to take medications such as insulin injections or Metformin, a drug that’s usually prescribed to people with Type 2 diabetes.

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Gestational diabetes also raises another concern. Women who get this condition are at a heightened risk of developing high blood pressure during pregnancy. Some of them will get a more serious blood pressure-related condition called preeclampsia, which can cause organ damage.

After giving birth though, most women return to their prepregnancy metabolic condition. Blood sugar and blood pressure levels go back to normal and they are usually discharged from medical care.

But both Shah and Lipscombe think more should be done to make these women aware that they may be predisposed to developing diabetes and cardiovascular disease at an early age.

“The message gets lost that this is actually something that needs to be followed more closely,” Lipscombe says.

Research shows that lifestyle changes – such as eating a balanced diet, maintaining a healthy weight and getting regular exercise – can help keep these ailments at bay.

Yet, it can be especially challenging for new moms to focus on their health while caring for an infant.

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So, Lipscombe is heading up a study aimed at helping them adopt a healthier lifestyle. Those taking part in the study receive individual counselling and frequent follow-up telephone calls to stay on track.

“There are things that women can do to reduce their risks,” Lipscombe says. She hopes more research will lead to a personalized approach to supporting the postpartum health of this vulnerable group.

Paul Taylor is a Patient Navigation Advisor at Sunnybrook Health Sciences Centre. He is a former health editor of The Globe and Mail. Find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.

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