By Laura Hieronymus, MSEd, APRN, BC-ADM, CDE, and Patti Geil, MS, RD, CDE
“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.
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.
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.
However, some chronic stressors, even if they can be identified, can’t be removed or quickly remedied. Diabetes and many other chronic illnesses, for example, never go away. If you are mourning a loss, there’s really no way to speed up the grief process. In cases like these, it’s important to both accept that the situation may not be changeable, at least not immediately, and to look for positive ways to manage the stress so that life can go on in spite of it. Many strategies and techniques can help people deal with chronic stressors, including the following:
Support groups. Support groups can offer both emotional and practical support to people dealing with a common issue or problem. Many communities, for example, have diabetes support groups. Support groups also exist for those coping with grief, debt, overweight, and many other health and social problems. In addition to in-person support groups, there are many online support groups, which can have many of the same benefits.
Before you join any support group, find out how it operates and what the ground rules are. Make sure that what is said in the group remains confidential and that members do not attempt to dispense medical advice or sell products. Seek out support groups that are affiliated with a reputable institution or association. If you want to participate in an online group, keep your personal safety in mind, and don’t give out identifying information or join groups that pressure you for money.
Education. Lacking the basic information and skills you need to manage your diabetes can cause you to feel stressed, and getting the information and training you need can reduce those feelings. There are many ways to learn more about diabetes and its management, including asking questions during appointments with your health-care providers, reading publications such as this one, and attending diabetes education sessions. One way to find out about diabetes education opportunities in your area is to call the American Diabetes Association (ADA) at (800) 342-2383 or to look on the ADA’s Web site, www.diabetes.org. Click on “In My Community” to find a list of ADA-recognized education programs. Medicare and some health insurance plans cover a certain number of hours of diabetes self-management education and training per year. It may be worth it to find out if your insurance plan has such a benefit.
Relaxation techniques. Certain relaxation techniques can help with both mental and physical stress by slowing your respiration rate, lowering blood pressure, relieving muscle tension, and “quieting” the mind. Examples of such techniques include massage, deep breathing exercises, some kinds of yoga, and meditation. When performed regularly, these practices can help you react less strongly to acute stresses, such as getting cut off in traffic, as well as improve your ability to deal with long-term stresses, such as having diabetes.
Spiritual support. Many people find that their spiritual commitment can be a positive influence in helping to weather the storm of stress. Prayer may offer a coping strategy that is emotionally healing. Trained clergy can also provide support during times of stress and offer guidance for dealing with chronic sources of stress.
Humor. Seeking out books, movies, or activities that make you smile or laugh may be helpful to decrease tension and improve your outlook. In addition to laughter’s psychological benefits, some research suggests that it has physiological effects on the body, including decreasing the level of cortisol (a stress hormone) and increasing endorphins (natural substances that alter perception and reaction to pain), that may help with stress.
Exercise. Regular physical activity and exercise can be helpful in reducing stress over the long term, and for people with diabetes, the benefits of regular exercise can include improvements in blood glucose control. However, if you don’t currently exercise, it is important to check with your health-care team before you start to discuss which activities are safe for you and whether you should have a stress test or any other form of medical evaluation before you start. Once you begin, it’s important to increase your level of physical activity gradually.
Many people use more than one of these strategies to cope with stress. However, if you currently use none of the strategies listed here, it’s best to try one or two at a time and to give yourself some time to incorporate them into your usual routine. Taking on too much at once, even positive behaviors, can increase stress rather than reduce it.
When considering which strategies might help you cope with stress, it’s also worth considering what will not help. Avoid coping with stress by overeating, using tobacco products or recreational drugs, or abusing alcohol. Overeating can lead to feelings of guilt and low self-esteem and can affect blood glucose control. Abuse of tobacco, alcohol, and drugs can lead to chronic dependence on these substances and create additional physical as well as mental stressors.
Although many of the coping strategies described here could be called self-help strategies, there’s no need to feel you have to locate these sources of help all by yourself or make use of them alone. Members of your diabetes team, for example, may be able to connect you to resources such as diabetes education opportunities or support groups in your community. They may also have suggestions for where to find classes in relaxation techniques or exercise programs for people at your level of physical fitness. Engaging in relaxation exercises and physical activity as part of a group often makes it easier to stick with these types of activities.
There may be times when self-help strategies aren’t enough. If you continue to feel stressed in spite of using positive coping strategies, talk with your diabetes care team about the possibility of seeing a mental health professional, such as a psychologist or psychiatrist. You may actually be depressed, and if that is the case, you may not be able to feel significantly better without professional help. (See “Symptoms of Depression.”) Depression is common among people with diabetes and among people living with other chronic health conditions. Although there’s no sure-fire remedy for depression, both psychotherapy and antidepressant drugs have been found to be effective treatments.
Feeling extremely stressed or anxious in spite of self-help measures can also be a sign of an anxiety disorder. If your life is being disrupted by an irrational dread of everyday situations, obsessive thoughts, or panic attacks, it’s worth seeking out professional help. Treatment for anxiety disorders is similar to treatment for depression.
In life, stress is inevitable. However, recognizing stressors, keeping a close check on your blood glucose control during stressful situations, and finding positive ways to cope will likely help you to find some peace amid the storm.
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