Diabetes and Subclinical Stress

I live in the city of Philadelphia, PA. It’s loud, it’s fast-paced, it’s abrasive, and it’s crowded. Not to say it’s a bad place, mind you. It’s also creative, interesting, full of great food, full of innovative artists, and never boring. Here’s the thing, though: I grew up in Colorado, in a house outside the small city of Longmont. I’m not exactly a “country mouse” (I didn’t grew up on a farm, but I did grow up around a lot of wide open space), but I’m no “city mouse,” either. And my natural speed and rhythm is not “Philly city speed,” but “Colorado open-space speed.”

I don’t typically notice this speed mismatch. In fact, I almost never do. But next week, I’m flying to Colorado to visit my family, and I know as soon as I touch down in that beautiful state, I’ll have a very familiar moment. It happens when I take in that first big, deep breath and realize just how much I’ve been ratcheting myself up to deal with the day-to-day stress of living in the City of Brotherly Love. In one instant, I realize that I haven’t REALLY taken a full, 100%, honest-to-God breath in months.


I think living with diabetes introduces something very similar to what I experience (or rather, DON’T experience but remain affected by) living in Philadelphia. I’m going to call it “subclinical stress.” Subclinical here refers to stress that is below the level of conscious naming or identifying. It’s the 24-hour-a-day, routine stress that melts into the static background of our daily lives, and is only ever identified if we have a moment AWAY from the stress and notice the change.

A lot of things can cause this kind of subclinical stress, but there is something unique about diabetes that’s worth pointing out. That is, diabetes will NEVER, ever, ever give you a break from it to actually see the effect it’s having on you. We notice the moments of acute stress — high blood sugar readings, severe episodes of hypoglycemia that require intervention, the effects of long-term complications, and so on — but that ongoing, subclinical stress is elusive. Unfortunately, just because we’re not consciously aware of it doesn’t mean it isn’t taking a toll.

Let me draw another analogy here. CTE, or chronic traumatic encephalopathy, is the degenerative brain condition that has received so much attention recently. It is associated with football, boxing, and other contact sports. In the past, the assumption has been that the more concussions someone received over his playing career, the higher the rate of CTE would be. Not so. Research is showing that it is not the number of concussions that’s most important, but the cumulative number of SUB-concussive hits. It is all those hits that are shrugged off, all those hits that don’t even register as events.

The subclinical stress of diabetes is, I believe, very similar. It builds up, and over time it can have an astounding emotional toll. And while some of that emotional toll may be unavoidable, we don’t have to just throw in the towel. We can take steps to lessen those effects, and we can take steps to raise our awareness of what we’re experiencing.

First and foremost, we can make time to slow down and check in with ourselves everyday. I’ve found that this subclinical stress manifests itself in body tension. A simple “body scan” while sitting quietly can do great things. Just take a moment, breathe deeply, center yourself, and then slowly move your awareness from the tip of your head down your face, through your neck and shoulders, your chest, stomach, through your seat, down your legs, out your arms and through your feet. As you move through your body, simply notice the pockets of tension. Then spend a few minutes in meditation to help soften that tension and let some of it go.

Secondly, and just as important, make time to express your feelings. I know, that sounds like such a “therapist-light” thing to say, but it’s good advice — really! The thing about subclinical stress is that it’s SUBCLINICAL. It’s powerful because it just hums along unidentified. If you take the time to identify it every now and then, it loses a lot of its power over you. As a former therapist, I often felt that the majority of my job was not to alter HOW people felt, but rather simply help them name what they were feeling. Just that step of NAMING the feelings sometimes changes everything for a client, particularly for issues of chronic stress!

As someone with diabetes, subclinical stress is simply an ongoing reality. But if you take a few simple steps, it can be managed, and its power over you can be cut way down.