DIABETES & STRESS

KEY POINTS

• 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. 

• Exercise

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.