What is stress, and how does it affect blood glucose levels in someone with type 2 diabetes?
What is stress? Stress is a physiological response to a perceived attack or an event that produces strain. It can be triggered by a physical cause, such as injury, illness, or surgery. Or it can stem from an emotional reaction to problems with health, finances, or relationships. Stress can be "good" (an active vacation or a much-anticipated family visit) or "bad" (sickness, money woes, a family visit that turns contentious). It can be short term (getting stuck in traffic or catching a cold) or long term (dealing with diabetes or coping with an ailing partner).
- Stress takes a toll on the body. When the body feels stressed, it responds by triggering the fight-or-flight response, in which levels of certain hormones, such as adrenaline, cortisol, and epinephrine, kick in and shoot up. These stress hormones make a lot of stored energy -- specifically glucose and fat -- available to the cells to help the body escape from danger or get ready to do battle.
Everyone experiences stress from time to time. But having many stressors or a long, intense, physical response to stress can lead to health problems such as headaches, migraines, digestive troubles, insomnia, anxiety, and depression, as well as changes in appetite and cravings for caffeine, alcohol, and sugar.
How does stress affect people with type 2 diabetes? In people who have diabetes, the fight-or-flight response doesn't work so well. Insulin isn't always available to unlock cells and let that extra energy in, so glucose starts to back up in the blood. In addition, if someone with diabetes is dealing with an emotional stressor, his body may continue to pump out hormones with no end in sight, as neither fighting nor fleeing helps in a situation where the enemy is actually the mind.
- Stress elevates glucose levels. If someone you're caring for is experiencing stress, his blood glucose levels are likely to be elevated for a couple of reasons. First, stress hormones can make blood sugar levels soar, sometimes to harmful heights. Second, people under stress often don't take good care of themselves. He may forget to eat or exercise, skip medications, become dehydrated, or feel too under siege to check blood sugar regularly or keep routine medical appointments.
Chronic, long-term stress can be particularly taxing on the body and can increase his risk of routine stress-related health ailments as well as complications linked to diabetes.
How can I help someone minimize the impact of stress on his diabetes and learn to relax?
Reducing the impact of stress
Someone with diabetes usually has some control over how he reacts to stress. If he's aware he's feeling tense, he may be able to learn to relax and reverse the body's hormonal response to distress. Help him recognize when he's stressed and what's upsetting him by asking him to keep a stress journal. By jotting down a few notes when the going gets tense and rating his level of stress before testing his blood sugar, he should be able to figure out what's likely to cause a rise in his numbers.
- Encourage the person you're caring for to alleviate stress whenever possible. Once he has identified the cause of his distress, ask him to write down his feelings about this stressor, and help him identify potential solutions or options. Then help him come up with an action plan about how he can eliminate this stressor from his life so he feels less frazzled. If, for instance, he knows that his numbers go up whenever the neighbor's son cranks up his stereo after 10 p.m., maybe he can convince the neighbors to keep it down at night. If he bickers constantly with someone in his life and realizes that this makes his blood sugar go wild, perhaps the two of them can consciously work to reduce the squabbling or see a counselor.
- Consider his personality. Different personality types have different ways of coping with stress. If, for example, the person you're caring for has a problem-solving mindset, he may be able to reduce stress by asking himself: "How can I handle this predicament?" and taking action. If he finds it easier to let things go, he might try telling himself, "This problem really isn't so important after all," meditate, or play cards for an hour or so. Neither approach is right or wrong: The goal is to encourage him to handle stress in constructive ways without making his blood sugar levels swing out of control.
- Set small, healthy goals. During stressful times, help your friend or relative set small, achievable goals for keeping his blood sugar on track so he won't feel overwhelmed -- and tempted to blow his treatment plan altogether. Maybe he's willing to take a short walk around the neighborhood with you. Or perhaps he'll agree to eat three veggies today or have two cookies instead of five. Maybe he'll agree to check his blood glucose at least once -- or let you do it for him. Little steps like these can help keep him motivated and prevent him from throwing in the towel under pressure.
Helping someone with diabetes relax
Many simple relaxation strategies can help the person you're caring for prevent or lessen the impact of stress. These include:
- Breathing exercises, yoga, meditation, massage, and other similar activities that can calm the mind.
- Progressive relaxation therapy that includes learning to tense and relax major muscles in a sequence.
- Exercise, which raises levels of endorphins and serotonin, two brain chemicals that influence mood and sense of well-being. Exercise is an invaluable stress reliever with loads of other health-related benefits as well.
- Behavior modification, a fancy term that can simply mean replacing unhelpful thoughts with helpful ones and emptying distracting thoughts from the mind. He can learn techniques for doing this from a therapist.
- Time spent outside -- don't underestimate the soothing effects of fresh air, sunlight, and nature.
- Sleep: Inadequate rest can make stress worse and lower his ability to cope with it. Conversely, healthy slumber habits can increase energy and improve attitude. If he struggles to get enough shut-eye at night, suggest a restorative short nap during the day.
Whichever strategies the person you're caring for tries, encourage him to practice for a few weeks or months before discarding them. Like learning a new sport or hobby, it takes time and practice to discover how to truly chill out.
How can I help someone if his diabetes is causing him stress?
Diabetes is a stressor that isn't going to go away, no matter what he does. That said, there are ways to lower or limit the stresses associated with living with diabetes.
- Suggest a support group. These groups can be an invaluable help. The person you're caring for is likely to feel less lonely if he has peers in the same situation he can relate to, learn from, and befriend. So find a peer support system near him or help him access one online (try searching using the key words diabetes online support group).
- Help organize his care regimen. Sometimes the sheer logistics of self-managing diabetes is a source of stress. It's understandable that dealing with this chronic condition can leave your friend or relative feeling frustrated and tired of all the effort it takes to look after himself. One way to lower or eliminate this source of tension is by helping him keep to-do lists and a notebook or journal to monitor medications, diet, exercise, and doctors' appointments. You can also help him stay organized by keeping all his diabetes drugs and devices in a convenient container and location, minimizing the stress of figuring out where these items are when he needs them.
And you can make sure he has a written plan for dealing with high or low blood sugar episodes or sick days. Check, too, that he has the supplies on hand to deal with these situations. Of course, when he's under stress he should monitor blood glucose more often so his blood sugar levels don't get out of whack.
- Help him find a new interest. Some people combat stress by adding something positive to their life. This could be a form of exercise such as hiking or a new activity such as bird-watching. Learning a hobby or craft -- say, pottery or knitting -- may have a calming effect. Doing something to help others, such as volunteering at a school, in a hospital, or for a favorite cause, is often beneficial. Playing or listening to music can also soothe an agitated mind.
- Identify the top challenges. Tackling diabetes-related stress head-on may also help. Ask your friend or relative which aspects of the disease give him the most trouble and help him address these concerns and make changes for the better. If, say, remembering to take medications is the most bothersome aspect, then help him find a way to make this task less irksome. Or if getting more active is a challenge, figure out a way to make it more fun. Maybe he'd enjoy walking with a friend more than exercising alone, for instance.
- Listen empathetically. Allowing him to share his feelings and frustrations about his disease -- without giving him advice or judging -- can go a long way toward reducing his stress. He needs your support and empathy in dealing with this progressive, long-term disorder.
- Get help when needed. Remember that you and the person you're caring for don't have to manage his stress on your own. Ask a member of his diabetes team for a referral if you think he could bene fit from therapy, or search online for a mental health practitioner . Talking with a social worker, counselor, or psychotherapist may help him come to grips with his problems or help him find new coping strategies or make behavioral changes to keep stress at bay.
- Encourage him to let his doctor know about unusual stressors. Chronic stress, such as that caused by an ongoing financial crisis or the pain of a degenerative illness, ma y warrant an adjustment in medications, since long-term stress is particularly damaging to his body. If this is the case, or if you have any concerns or questions about the level of stress he's under or how to help him handle it, discuss this situation with his doctor or other primary diabetes healthcare provider.