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* Stress can be physical or mental.
* It can complicate diabetes by distracting you from proper care or affecting blood glucose levels directly.
* Learning to relax and making lifestyle changes can help reduce mental stress.
Stress results when something causes your body to behave as if it were under attack. Sources of stress can be physical, like injury or illness. Or they can be mental, like problems in your marriage, job, health, or finances.
When stress occurs, the body prepares to take action. This preparation is called the fight-or-flight response. In the fight-or-flight response, levels of many hormones shoot up. Their net effect is to make a lot of stored energy — glucose and fat — available to cells. These cells are then primed to help the body get away from danger.
In people who have diabetes, the fight-or-flight response does not work well. Insulin is not always able to let the extra energy into the cells, so glucose piles up in the blood.
How Stress Affects Diabetes
Many sources of stress are long-term threats. For example, it can take many months to recover from surgery. Stress hormones that are designed to deal with short-term danger stay turned on for a long time. As a result, long-term stress can cause long-term high blood glucose levels.
Many long-term sources of stress are mental. Your mind sometimes reacts to a harmless event as if it were a real threat. Like physical stress, mental stress can be short term: from taking a test to getting stuck in a traffic jam. It can also be long term: from working for a demanding boss to taking care of an aging parent. With mental stress, the body pumps out hormones to no avail. Neither fighting nor fleeing is any help when the "enemy" is your own mind.
In people with diabetes, stress can alter blood glucose levels in two ways:
* People under stress may not take good care of themselves. They may drink more alcohol or exercise less. They may forget, or not have time, to check their glucose levels or plan good meals.
* Stress hormones may also alter blood glucose levels directly.
Scientists have studied the effects of stress on glucose levels in animals and people. Diabetic mice under physical or mental stress have elevated glucose levels. The effects in people with type 1 diabetes are more mixed. While most people's glucose levels go up with mental stress, others' glucose levels can go down. In people with type 2 diabetes, mental stress often raises blood glucose levels. Physical stress, such as illness or injury, causes higher blood glucose levels in people with either type of diabetes.
It's easy to find out whether mental stress affects your glucose control. Before checking your glucose levels, write down a number rating your mental stress level on a scale of 1 to 10. Then write down your glucose level next to it. After a week or two, look for a pattern. Drawing a graph may help you see trends better. Do high stress levels often occur with high glucose levels, and low stress levels with low glucose levels? If so, stress may affect your glucose control.
Reducing Mental Stress
Making changes
You may be able to get rid of some stresses of life. If traffic upsets you, for example, maybe you can find a new route to work or leave home early enough to miss the traffic jams. If your job drives you crazy, apply for a transfer if you can, or possibly discuss with your boss how to improve things. As a last resort, you can look for another job. If you are at odds with a friend or relative, you can make the first move to patch things up. For such problems, stress may be a sign that something needs to change.
There are other ways to fight stress as well:
* Start an exercise program or join a sports team.
* Take dance lessons or join a dancing club.
* Start a new hobby or learn a new craft.
* Volunteer at a hospital or charity.
Coping Style
Something else that affects people's responses to stress is coping style. Coping style is how a person deals with stress. For example, some people have a problem-solving attitude. They say to themselves, "What can I do about this problem?" They try to change their situation to get rid of the stress.
Other people talk themselves into accepting the problem as okay. They say to themselves, "This problem really isn't so bad after all."
These two methods of coping are usually helpful. People who use them tend to have less blood glucose elevation in response to mental stress.
Learning to Relax
For some people with diabetes, controlling stress with relaxation therapy seems to help, though it is more likely to help people with type 2 diabetes than people with type 1 diabetes. This difference makes sense. Stress blocks the body from releasing insulin in people with type 2 diabetes, so cutting stress may be more helpful for these people. People with type 1 diabetes don't make insulin, so stress reduction doesn't have this effect. Some people with type 2 diabetes may also be more sensitive to some of the stress hormones. Relaxing can help by blunting this sensitivity.
There are many ways to help yourself relax:
* Breathing exercises
Sit or lie down and uncross your legs and arms. Take in a deep breath. Then push out as much air as you can. Breathe in and out again, this time relaxing your muscles on purpose while breathing out. Keep breathing and relaxing for 5 to 20 minutes at a time. Do the breathing exercises at least once a day.
* Progressive relaxation therapy
In this technique, which you can learn in a clinic or from an audio tape, you tense muscles, then relax them.
* Exercise
Another way to relax your body is by moving it through a wide range of motion. Three ways to loosen up through movement are circling, stretching, and shaking parts of your body. To make this exercise more fun, move with music.
* Replace bad thoughts with good ones
Each time you notice a bad thought, purposefully think of something that makes you happy or proud. Or memorize a poem, prayer, or quote and use it to replace a bad thought.
Whatever method you choose to relax, practice it. Just as it takes weeks or months of practice to learn a new sport, it takes practice to learn relaxation.
Dealing with Diabetes-Related Stress
Some sources of stress are never going to go away, no matter what you do. Having diabetes is one of those. Still, there are ways to reduce the stresses of living with diabetes. Support groups can help. Knowing other people in the same situation helps you feel less alone. You can also learn other people's hints for coping with problems. Making friends in a support group can lighten the burden of diabetes-related stresses.
Dealing directly with diabetes care issues can also help. Think about the aspects of life with diabetes that are the most stressful for you. It might be taking your medication, or checking your blood glucose levels regularly, or exercising, or eating as you should.
If you need help with any of these issues, ask a member of your diabetes team for a referral. Sometimes stress can be so severe that you feel overwhelmed. Then, counseling or psychotherapy might help. Talking with a therapist may help you come to grips with your problems. You may learn new ways of coping or new ways of changing your behavior.
