Diabetes affects our whole life,  physically, emotionally, socially & psychologically. It requires self management by us on a daily basis – we need to be in the driver’s seat. It can be frustrating & feel “pointless” as diabetes can be difficult to control no matter what sometimes and it can complicate life in general!

Health targets can raise stress

Targets in diabetes are important, such as blood glucose levels (BGL), HbA1c (the average BGL over the past 6 - 8 weeks), blood pressure and so on – but some people feel like they are “sitting an exam” every day. The results of BGL checks, trying to lose weight, eating the “right” foods and so on can lead to guilt, anger & fear if you feel you are “not doing the right thing” or “not getting the right results” - this can in turn lead to more stress about diabetes and your long term health and blaming yourself. It is important to remember that these targets are guides to our health and diabetes management. The results on your home blood glucose monitor are a tool to helping you and your health care team to make adjustments and work towards a healthy you. These numbers are not ends in themselves. Talking about "high and low" BGL instead of "good and bad" can be a good place to start.

Living with the threat of diabetes complications can lead to increased stress, therefore doing all you can to minimise these complications can minimise your stress. Our daily lives and general stress levels also affect our diabetes control &  how well our diabetes is going can affect our general stress levels – it is a bit of a chicken and egg situation at times. It is thus very important to get the general stress in your life under control, as this will assist with your diabetes managment.

Diabetes may cause of specific problems as it can be hard to manage and/or diabetes may become the “victim” of other problems/ stress in our life – this means that if we are struggling with stress at work, or in our personal lives, it can be harder to manage diabetes and it suffers. We all experience stress & life would be boring without some stress! People say they would rather not have stress in their lives, but in fact we need a balance between just enough stress and not too much, to keep us alive and active. Not all stress is bad believe it or not.

Diabetes blocks & barriers

Problems that are specific to managing diabetes can lead to diabetes related stress and make it harder to manage diabetes.

They include the following:

• Worry about food changes & weight loss
• Going onto insulin/medication
• Hypos (low BGL)
• Depression & mood swings – have been shown to be higher in people with diabetes
• Relationship & sexual problems
• Work stress, discrimination
• Disclosure – who to tell and when
• Guilt, fear, worry, panic & anxiety about diabetes
• Diabetes burn out

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It is not all doom and gloom! 

That is not to say you will have all or any of these problems. You may or may not, experience some ups and downs with your diabetes and this might lead to increased stress. We are all different. What is important is to understand that diabetes is in itself a full time job and managing it can bring increased stress. This can make it easier to be gentle on yourself when things get tough and to seek support in managing.

What is stress?

“Stress is a condition or feeling experienced when a person perceives that demands exceed the personal & social resources the individual is able to mobilize”

In other words, if what you are being asked to do at this point in time is too much for you, you will experience stress. What you can handle will vary from day to day and even within a day and will vary from person to person. Stress is made up of many things: the experiences we have, pathways within our body and brain, the responses we have to stressful situations and events & the outcomes of this stress. Stress is caused by a range of different events or circumstances. Different people experience different aspects & identify with different definitions. So it is not a simple thing to define!

Your body has a broad definition of stress. To your body any change to your equilibrium equates to stress. This can be a positive or negative change and depending on the cause of the stress, it may have a positive or negative outcome on your body. This may include things like illness, exercise, excitement and travel.

Stress and worrying

Even imagined change can be a stress. This is what we tend to call "worrying".  If you worry that you will not have enough money to pay your rent, or that you might suffer the complications of diabetes, that can lead to increased negative stress. This kind of stress is in your control to manage - you can tune into the way you are thinking about things and stop this worry in its tracks, thus minimising the impact on your body and your life.

Regular relaxation and time out can help you to minimise worry. Talking to other people about your worries, rather than keeping them to yourself, can also help. "Catastrophising" when something goes wrong also increases your stress - you know the "it's the end of the world"; "everything happens to me" kind of thinking? If one small thing goes wrong it is easy to start linking it to all the other things that have happened and then see this as "the end of the world". Learning how to keep this thinking in check can really help minimise stress.

Of course a major source of stress is overdoing things. If you push yourself too much you have less rest time. Eventually the energy drain can cause your body to fall behind in its repair work and changes can occur in your body's internal environment - you will "hit the wall. If ongoing, permanent damage may be done. The body's fight to stay healthy in the face of the increased energy that you are expending is major stress in itself.

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What happens to our body when under stress? 

Fight or flight response

When faced with a threat an automatic response is set off in our body – the fight or flight response.

To our cave-dwelling ancestors, this was an essential tool for survival, developed over many thousands of years living in wild & dangerous places. To us, living in today's world, it is often an ineffective response, which can actively prevent us from responding usefully to a problem situation – just think about road rage!! Fight or flight is a response to anything which is perceived as a threat, or a potential threat by our body – it is not something we necessarily think about – it just happens. This begins when certain primitive parts of the brain send a message to the adrenal glands which release adrenaline. This begins a process involving a number of hormones including adrenaline, whose purpose is to prepare the body for vigorous emergency action.

The main changes that follow are below:

• Non-essential processes are immediately switched off. Things we don’t need right now are “turned off” by our body.In particular, if the body is digesting food, that is stopped immediately, & people notice a feeling of churning of 'butterflies' in the stomach, or feeling nauseous or sick

• A number of other changes follow, to make the muscles as strong as possible
  • The liver releases glucose into the bloodstream
  • Fats are released into the bloodstream from the fat stores in the bod. These are fuel for the muscles, so oxygen is needed to burn them - so the breathing increases, & those under stress may notice feeling breathless
  • The body needs to get fuel to the muscles - (remember, the body thinks this is a life or death emergency) - so the heart begins beating far faster - & some people notice palpitations
  • Blood pressure rises, some people notice feeling hot or cold - breaking into a sweat, as the body seeks to dissipate heat that will be generated by vigorous muscular activity for which body is preparing
  • Becoming ready for instant action, muscle tension increases, & a person may notice shaking, or becoming restless - fidgeting

Some people feel like this often and if this pattern is continued for long enough, chronic headaches, backache & other physical complaints may result i.e. chronic stress.

At the same time as all this muscle action is happening, blood supply to the frontal parts of the brain, responsible for higher levels of reasoning is reduced, while the blood supply to the more primitive parts, near the brain stem, is increased. These parts are responsible for automatic, or instinctive, or impulsive decision making & behaviour. A person undergoing a stress response may be prone to impulsive thinking & behaviour - which they may thoroughly regret later – we can say and do things without thinking clearly.

There are a number of ways in which chronic stress can impact on your body and general health:

• Brain -fatigue, aches & pains, crying spells, depression, anxiety/panic attacks, sleep disturbance
• Gastrointestinal Tract - Ulcer, cramps & diarrhoea, colitis, irritable bowel
• Glandular System - Thyroid gland malfunction
• Cardiovascular (important for diabetes) - High blood pressure, heart attack, abnormal heart beat, stroke
• Skin - Itchy skin rashes
• Immune System - Decreased resistance to infections

How does stress affect diabetes?

Stress can cause BGL's to rise. Feelings of distress, especially when intense & long lasting, can show marked increase in HbA1c & HbA1c is typically higher in those struggling with difficult conditions at work, home or problems such as depression. Laboratory studies have not shown that stress consistently raises BGL – some studies show that it does & some show that it does not! While many people report that stress does raise BGL, there is a lack of research yet to confirm that this happens to all people, all the time.  What we know for sure is that when life becomes busy, stressful and overwhelming, diabetes can take a back seat. In this case the stress raises BGL as the situation causing the stress interferes with diabetes management, rather than a direct effect on blood glucose levels.

The best answer to how stress affects diabetes is taken from William Polonsky – “Diabetes Burnout” book :

• Stress can have a negative effect on diabetes self management, but only for certain people at certain times
• Stress can have a direct & immediate effect on BGL but only for certain people at certain times

If you are significantly distressed over a long period of time it is likely that you will begin to have problems managing your diabetes. Stress might affect your ability to exercise or follow a meal plan for example. In this case it is how you understand & respond to stressful events that is the key to managing diabetes when under stress. Interestingly not all types of stress appear to make BGL rise. Situations where you feel trapped or where you feel things are out of your personal control appear to be most likely to influence BGL directly.

Also some of us are more sensitive to stress than others. Some scientists believe that there are 3 types of people:

• Stress insensitive – BGL not directly affected by stress
• BGL rises under conditions of stress
• BGL drops when stressed

Some people might experience elements of all of these at different times. You can experiment to see what happens to your BGL when under stress. You can do this by either tracking your BGL when under a particular stress to see what happens and/or checking BGL prior to and following, a relxation session over a week or so, to see if your BGL decreases.

What we do know is that stress definitely effects our diabetes and that the more distressed you are (that being too much stress over a period of time) the more likely it is to effect your diabetes. We still do not truly understand the relationship between stress & diabetes BUT the bottom line is that stress has the potential to interfere with diabetes care which can raise BGL & to influence BGL directly

Managing stress

Our ancestor’s lives were far simpler. As a result, they were able to regroup, relax, & recover from the sabre-toothed tiger attacks & other real dangers they experienced! We tend to "just move on," "get over it," or "deal with it later” as we head to our next activity, our next responsibility and, our next stress, without taking time to let our bodies & minds recover. The more stress accumulates the more at-risk we are for illness & disease and the more it will impact on your general stress levels and ability to manage your diabetes.

Steps to stress management  - it's all about balance

Relaxation

The human nervous system has a component that works automatically - the autonomic nervous system. This has two parts:  the 'sympathetic' & 'parasympathetic'. When the sympathetic part is active we experience the fight/flight response. When the parasympathetic part is active we experience something quite opposite from "fight/flight" - rest & relaxation. These two systems work to help us maintain our physical balance. Too much "fight/flight" activity without corresponding rest & relaxation is what distress is all about and we actually need both to maintain balance. You can “bank” your rest and relaxation. By practicing regular relaxation and rest times, you allow your body to heal itself and stay strong in the face of the inevitable stresses of our lives.

This may be listening to quiet music, getting out in the garden, walking in the sunshine, or using guided relaxation practices. We have a number of relaxation practices here on our relaxation pages. We use and recommend Dr Gillian Ross's relaxation CDs. You can listen to some of these on our relaxation pages.

Exercise

Exercise is critical to overall health. The current recommendation for adults is 30 minutes moderate every day if you can and at least 4 - 5 times week (60 minutes a day for children). We now have so many convenience machines and often sedentary lifestyles, that structured exercise is even more important. This does not need to be at the gym. Walking is one of the best forms of exercise and it is free! Swimming and water based exercise are great for people with mobility problems. If you need help to work out the best exercise for you, an exercise physiologist can be great. You can access one via a diabetes care plan - just ask your GP to refer you to someone as part of your 5 allied health care visits. They can then set this up and work out an exercise plan that will work for you and your abilities. If you have type 1 diabetes this is a great resource Allan Boloton.

Apart from the obvious physical health benefits exercise is also vital to stress management as it encourages that parasympathetic (rest and relaxation) response, calms body and mind and uses excess energy and muscular tension.

Support, happiness and wellbeing

We all want to be happy and happiness and wellbeing have been shown to be linked with having connections to other people.  In mananging stress it is important to realise that you are not alone & reach out to others who are experiencing similar things for support. You can do this via friends and family; diabetes groups at your diabetes centre or Diabetes Australia; counselling; the Internet and sites like Diabetes Counselling Online, and if you have type 1 diabetes, Reality Check. If there are other problems in your life outside of diabetes, likewise seek support from people who understand where you are coming from.

Thinking, feeling and self esteem

We all have ”automatic” ways of thinking about our lives, who we are and the events that happen to us. Often we have a history of things in our lives, stories about things that have happened to us, which can lead us to thinking this is the way things will "always be" for us. However by challenging these thoughts and looking at what goes through your head when you are experiencing stress/distress - eg the “should’s” of life – we can reduce our stress. Most of us respond to events in our life with "should's and should not have's". By this we mean the "I should have worked harder", "should not have eaten that", "should have acted sooner", "should not have taken on that job" etc etc etc. This way of thinking is unhelpful as it greatly increases our stress. What can help is to turn this around into things like " it would have been nice if I had thought about that earlier, but I made the best decision I could at the time and now I am moving forwards". In this way you are being much gentler on yourself and your stress will be lower and your self esteem higher, as a result.

Lots of people with diabetes beat themselves up about their BGL results, but this just adds to stress levels.  What can help is to look at if diabetes &/or other problems in your life are overwhelming you - try to get perspective & balance.  Learn how to challenge your thoughts about your life and the problems you face (through counselling) – we all have some problems in our lives, it’s how we deal with these that matters. See all the things that are happening in your life – try not to focus on just the problems – there are always alternative things happening in our lives.

During times of stress tune into whether the emotional reactions you are experiencing are out of proportion to what is happening (again think of road rage as a good example of this). If so, you might need to look at what you are thinking about in those situations.

Remember it is not events that cause us distress, it is our beliefs, thoughts, ideas and reactions to those events.

Emotions such as anger, resentment, jealousy, and the old “why me”, can lead to stress and unhappiness. It is important to recognise these feelings and then try to move on - you will feel much better for it.  This is done through tuning into your thoughts and feelings and taking time out to “meditate” on these, seeking support and counselling to do so where needed.

Avoid the dangerous approaches to stress management

It is important to avoid the use of alcohol, drugs & over eating as a way of managing stress. They don’t help! These activities give short term relief and long term pain and further stress as they can become entrenched problems in themselves. Seek help if you feel such behaviours are problematic- many people do find these things problematic at some point. Reach out to someone in your network who can offer support and involve your loved ones where you can, seeking their help & support in managing diabetes as well as other problems/stress in your life.

Rememember you are not alone and build compassion

Realise you are not meant to be a “hero! Talk about your problems and worries, write about them, blog or start a journal and get it out there! Asking for HELP is ok. It is also important to tune into your reactions and thoughts about other people. Our emotions in regards to others can lead to high stress – “it’s not fair”, feelings of hate etc – all lead to high stress and unhappiness. Trying to let go of jealousy, anger and resentment and put yourself in other’s shoes – showing true compassion – can help to reduce stress in our lives.

Managing stress is untlimately about:

• Understanding the way stress affects people
• Understanding how stress affects you personally
• Understanding what you can do about lowering the stress in your life where you can
• Understanding how to manage the stress that you can not take away
• Tuning into your needs, your thoughts, your ideas and your stories about you and your life
• Examining the thoughts and emotional reactions you experience to stressful situations and events
• Staying as healthy as you can
• Working out the goals, wishes, expectations you hold for your life
• Working out how stress comes into your life and how much you can personally handle
• Developing regular relaxation and rest/peaceful times
• Making time to just “be”
• Talking to other people – get support and make connections
• Practising compassion towards other people
• Seeking medical treatment for any depression/anxiety/underlying mental health issues
• Seeing a counsellor, psychologist, psychiatrist when needed without seeing this as a sign of failure or weakness
• Seeking information & education
• Revisiting health care team - dietician; educator; doctor

 

 

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And Finally – RELAX!

Go to our Relaxation and Meditation pages for information about these practices