Updated July 18, 2006

Stress: Finding Peace Amid the Storm

by Laura Hieronymus, M.S.Ed., A.P.R.N., B.C.-A.D.M., C.D.E., and Patti Geil, M.S., R.D., C.D.E.

"Serenity is not freedom from the storm, but peace amid the storm."—Unknown

Everyone experiences stress in life, and people with diabetes are no exception. In fact, diabetes itself can be a source of much stress. While stress is often perceived as a negative thing, at times it can also have positive aspects, such as when it motivates a person to take positive action. The challenge, therefore, is not to seek a life with no stress but to learn to deal with the stresses life hands us.

Dealing with stress effectively is particularly important for people with diabetes because stress can have an effect on blood glucose control. Learning stress-reduction techniques can be a useful part of your diabetes management plan.

Effects of stress
Stress can be defined as a demand on physical or mental energy. Injury, illness, infection, and surgery are some examples of physical stresses. Mental stresses may include difficulties with relationships, job pressures, financial strain, and even concerns about self-worth.

Your body naturally responds to stress, whether mental or physical, by “defending” itself with what is often called the fight-or-flight response. In essence, your body prepares itself to either run away from danger or fight off an attack. As part of the fight-or-flight response, so-called stress hormones, including epinephrine, cortisol, and glucagon, are secreted, which increases heart rate, blood pressure, and blood glucose levels and dilates the small passageways of the lungs. In the short term, this gives the body the extra oxygen and energy it needs to cope with stress. But if a person with diabetes doesn’t have enough insulin circulating in his bloodstream to enable his cells to use the extra glucose, the result will be high blood glucose.

Some stresses are short term. For example, you may feel stressed before and while you are taking an exam but quickly relax once it’s over. Short-term stresses may or may not affect your blood glucose control, and they’re less likely to if stress relief is prompt.

But some stresses can last over a long period of time. Things like dealing with financial problems or job insecurity or recovering from an illness that requires several months of rehabilitation can cause prolonged stress. When stress becomes long term or chronic, the stress hormones are secreted over a long period of time, and the result can be chronic high blood glucose. If long-term (or short-term) stress is affecting your blood glucose control, speak to your diabetes care team about how to manage your blood glucose during times of stress.

In addition to its direct effect on blood glucose levels, stress can affect diabetes control in indirect ways as well. Some people experience poor sleep habits when they feel stressed, and disruptions in usual sleep patterns can decrease energy levels and interfere with your normal routine. People often do not take good care of themselves when under stress. For example, you may drink more alcohol or exercise less frequently when feeling stressed, both of which can affect blood glucose levels. You may also not be as attentive to daily diabetes self-management tasks, such as checking your blood glucose levels or making healthy food choices. The end result can be either high blood glucose, particularly if you tend to eat more or exercise less when stressed, or hypoglycemia, if you tend to skip meals or pay less attention to matching insulin doses to meals or activity.

Dealing with stress
One way to deal with stress is to identify what is causing it and to look for a way to change the situation. Family problems, a boss or coworker who is difficult to work with, or financial commitments that are out of control can all create stress. Changing situations like these might involve letting others know how their behavior is affecting you, seeking family or financial counseling, or looking for a new job. If a physical stress, such as an infection or illness, is affecting your blood glucose control or your health generally, getting prompt medical attention to treat the problem is in order.

Also in this article:
Symptoms of Depression

Laura Hieronymus and Patti Geil are certified diabetes educators and diabetes health consultants in Lexington, Kentucky. They are part of the education team at an American Diabetes Association–recognized education service at Drs. Borders & Associations, PSC.

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