By Jennifer Nelson
Reviewed By Brunilda Nazario, MD
It's hard to dispute that most of us live life at breakneck speed. It's the nature of a fast-paced society, where numerous family, social, and work obligations can easily overpower your precious time and resources. But for people with diabetes, both physical and emotional stress can take a greater toll on health.
When you're stressed, your blood sugar levels rise. Stress hormones like epinephrine and cortisol kick in since one of their major functions is to raise blood sugar to help boost energy when it's needed most. Think of the fight-or-flight response. You can't fight danger when your blood sugar is low, so it rises to help meet the challenge. Both physical and emotional stress can prompt an increase in these hormones, resulting in an increase in blood sugars.
People who aren't diabetic have compensatory mechanisms to keep blood sugar from swinging out of control. But in people with diabetes, those mechanisms are either lacking or blunted, so they can't keep a lid on blood sugar, says David Sledge, MD, medical director of diabetes management at The Ochsner Clinic Foundation in Baton Rouge, La. When blood sugar levels aren't controlled well through diet and/or medication, you're at higher risk for many health complications, including blindness, kidney problems, and nerve damage leading to foot numbness, which can lead to serious injury and hard-to-heal infections. Prolonged elevated blood sugar is also a predecessor to cardiovascular disease, which increase the risk of heart attacks and strokes.
"In diabetes, because of either an absolute lack of insulin, such as type 1 diabetes, or a relative lack of insulin, such as type 2, there isn't enough insulin to cope with these hormones, so blood sugar levels rise," says Richard Surwit, PhD, vice chairman of the department of psychiatry and behavioral sciences at Duke University Medical Center and author of The Mind Body Diabetes Revolution.
Anything upsetting like going through a breakup or being laid off is certainly emotionally draining. Being down with the flu or suffering from a urinary tract infection places physical stress on the body. It's generally these longer-term stressors that tax your system and have much more effect on blood sugar levels.
The problem may be compounded because under these pressures, you may lose your appetite and skimp on eating, or reach for not-so healthy quick fixes like candy or chips. Some people actually "stress eat" (overeat during stressful periods). Others skip their daily workout because they're too strained or run down to keep it up, which can create a vicious cycle since exercise is an excellent way to lower blood sugar.
"The most important thing is to learn what it feels like when stress hormones are elevated," Sledge tells WebMD. For some diabetic people, prolonged illness or distress will keep their blood sugar levels up for lengthy periods of time. Often insulin will be needed or adjusted during this period, so recognizing periods of stress is crucial for people with diabetes.
Since stress has virtually become a way of life, you may not even notice you're frazzled. A lot of people will identify stressors such as an illness in the family (something large) but may not recognize the stress of the holidays or a hectic time at work (something smaller or shorter in duration). Being in tune to your stress level and how you feel when the going gets tense is important. One good gauge is writing down your stress level in a journal each time you check your blood sugar. Many glucose meters have the capability to enter personal notes and data when you perform checks, or jot it down in a stress journal. "Once you begin recording stress levels, most people with diabetes figure out pretty quickly what makes their blood sugar go up," says Surwit.
Learn to De-stress
"Stress plays a more direct role in the control of blood sugar than it does in any other disease," Surwit tells WebMD. People with diabetes should stay conscious of eating well and exercising regularly. It's a good idea to check blood glucose levels more frequently when you're ill or under stress and to drink plenty of fluids as so as not to get dehydrated.
"A lot of patients can easily tell if their sugar is up by the way they feel or how much pressure they're currently under," says Paula Butler, chief of endocrinology and head of the diabetes program at Mt. Sinai hospital in Chicago. Butler frequently hears patients explain why their blood sugar is high when they come in for an appointment -- everything from a fight with a spouse to missing the bus that morning is fodder for a rise in the numbers.
Once you've pinpointed your stressors and notice which ones send your blood sugar levels soaring, you'll need to devise some ways to chill out. What helps keep stress under wraps? Anything that relaxes you.
- Take up yoga, meditation, or deep breathing.
- Try progressive relaxation therapy, in which you practice tensing and relaxing major muscle groups in sequence. A study published in the journal Diabetes Care showed that just five weekly sessions of a relaxation therapy can reduce blood sugar levels significantly.
- Learn cognitive behavior therapy. In addition to learning to relax, this therapy helps you re-evaluate what is worthy of your aggravation in the first place by helping you change your behavior and teaching you to view life through more appropriately colored glasses, says Surwit.
- Talk to a therapist. Talking about your problems is a reliable way to alleviate the stress that stems from them.
- Step back from the situation. If you can, remove yourself from the stressor, says Butler.
- Keep up your healthy eating and exercise routine. Exercise can help lower blood sugar, so a stressful phase is not the time to forgo the stair stepper.
- Eliminate caffeine. Caffeine can impair your body's ability to handle sugar and increase the amount of stress hormones, which may increase blood sugars, says Surwit.
- Ask your doctor about an anti-anxiety medication. It isn't ideal, but it can help during a crisis, says Butler.
- Take up a relaxing hobby. If knitting or pottery calms you down, join a class or find a workshop. But if you stress over every imperfection in your project, save the hobby for a less stressed-out time, and take a hot bath instead.
SOURCES: Diabetes Care, January 2002; vol 25: pp 30-34. David Sledge, MD, medical director for diabetes management, Ochsner Clinic Foundation, Baton Rouge, La. Richard Surwit, PhD, vice chairman, department of psychiatry and behavioral sciences, Duke University Medical Center. Paula Butler, MD, chief of endocrinology and head of the diabetes program, Mt. Sinai Hospital, Chicago.