Stress is a natural part of life, but when it becomes chronic, it can wear you down, both mentally and physically. If you have diabetes, stress can make it harder to control your blood glucose level. It also may increase the odds of developing certain complications, such as heart and blood vessel disease and infections made worse by a weakened immune system. In addition, it may distract you so much that you forget to take good care of yourself and to follow your self-care regimen. Yet here’s the catch: Diabetes itself can be a very stressful experience, as you’re forced to adjust to having a chronic disease and making all the lifestyle changes that go along with it. That’s why learning to manage stress is so important.
Stress and strain
To get a handle on stress, it helps to know a bit about the underlying physiology. The so-called fight-or-flight response is the body’s way of gearing up to fight or flee when it encounters danger. Heart rate, blood pressure, breathing rate, and muscle tension all increase — changes that would come in quite handy if you were being attacked or chased. Another hallmark of the stress response is the rapid mobilization of energy stores along with the inhibition of further storage. Glucose and the simplest forms of proteins and fats come pouring out of their storage sites to fuel whatever muscles might be needed immediately for fight or flight. At the same time, digestion is inhibited since there wouldn’t be time to derive benefits from this slower process.
Most situations in modern life don’t involve much wrestling or running, however. Unfortunately, the body can’t distinguish between the threat of a predator in the wild and that of an overdraft notice from the bank, so it goes into the same state of high alert.
Over time, a prolonged stress response may contribute to a range of health problems, including anxiety, depression, headaches, backaches, digestive difficulties, high blood pressure, and lower resistance to infection. As far as diabetes goes, many people say they see a link between stress and their blood glucose levels. In people with Type 2 diabetes, stress often raises blood glucose level. In people with Type 1 diabetes, the effects can vary.
“Some people who have Type 1 diabetes say stress drives their blood glucose level up, while others say it drives the level down, and still others don’t notice any impact one way or the other,” says Mark Peyrot, PhD, a sociology professor at Loyola College in Baltimore who has researched the stress–glucose connection. “Within a given individual, though, the reaction to stress tends to be consistent.” In other words, if you’ve reacted to stress in the past with a spike in blood glucose, chances are you’ll react that way in the future, too.
The means by which stress may affect diabetes is still unclear. However, part of the fight-or-flight response involves breaking down stored forms of glucose into blood glucose to ready the body for quick action. It’s easy to see how this could lead to high blood glucose in the short term. Stress also blocks the release of insulin in people whose bodies still make that hormone.
In the long term, if stress becomes a frequent problem, a person might start to confuse its symptoms with other physical cues. This is why people aiming for tight diabetes control are often advised to record life events along with their blood glucose measurements and insulin or medicine doses. The goal is to identify patterns that make it easier to distinguish the effects of stress from other feelings, such as hunger and lightheadedness before a meal. In addition, stress may affect how people with diabetes take care of themselves. Some people react to stress by eating too much, drinking large amounts of alcohol, or vegging out rather than exercising. This behavior, in turn, may lead to unwanted fluctuations in blood glucose.