Diabetes Counselling - Chill Out

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Diabetes affects our whole life

Diabetes affects us 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.
It can complicate life in general!

Health targets can raise stress

Targets in diabetes are important, such as blood glucose levels (BGL), HbA1c, 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.
Living with the threat of diabetes complications can lead to increased stress.
Our daily lives and general stress levels affect our diabetes control & our how well our diabetes is going can affect our stress levels – it is a bit of a chicken and egg situation at times.
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!

Diabetes blocks & barriers

Problems that are specific to managing diabetes and can lead to diabetes related stress, can make it harder to manage diabetes & can thus actually block your self care.
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

It is not all doom and gloom!

That is not to say you will have 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, stress = change.
Anything that causes a change in your life is stress to your body -“good" change or "bad" change.
Even IMAGINED CHANGE is stress.
Imagining changes is what we call "worrying".
If you fear that you will not have enough money to pay your rent, or that you might suffer the complications of diabetes, that can lead to stress
Major source of stress is overdoing things.
Push yourself too much = less rest time.
Eventually the energy drain can cause your body to fall behind in its repair work.
Changes can occur in your body’s internal environment – You will "hit the wall," "run out of gas".
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.

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 body
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
stress
There are also two important changes in the neurology – that is, in our brain
Reflexes are speeded up
At the same time, so is the thinking, & some notice racing thoughts
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 impulsivedecision 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

Some common stress symptoms

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 about the effects on diabetes?

Stress can cause BGL to rise
Feelings of distress, especially when intense & long lasting can show marked increase in HbA1c ( the average BGL over about a 6 – 8 week period) & HbA1c 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 back this up
What we know for sure is that when life becomes busy, stressful, overwhelming- diabetes can take a back seat. 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 (taken from William Polonsky – “Diabetes Burnout” book) is this :
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 rise under conditions of stress
BGL drops when stressed

Some people might experience elements of all at different times
So stress definitely effects BGL
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 and overall health

Getting balance back

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”
We head to our next activity, our next responsibility, 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 affect your general stress levels and ability to manage your diabetes.

Rest and 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" –Parasympathetic activity results in a response of 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. –
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.

Strategies for stress management – Number 1 – Exercise!

Begin a regular exercise programme

Critical to overall health
30 minutes moderate every day if you can and at least 4 – 5 times week (60 minutes a day for children)
It encourages parasympathetic (rest and relaxation) response
Calms body and mind
Uses excess energy and muscular tension

Number 2 – Make a friend!

Realise that you are not alone & reach out to others who are experiencing similar things for support
Happiness and wellbeing have been shown to be linked with having connections to other people
Seek information at group sessions for people with diabetes
Join groups at places like Diabetes Australia and other diabetes support groups
Surf the Internet for support/discussion forums/chat

Number 3 – Take a break every day

Have time out to do quiet things
Just “be” – we have to much ”doing” and not enough “being” in our lives
Relaxation, structured “no thinking, no action” times
Even just sit and breathe quietly for 10 minutes in your lunch break

Number 4 – Practice regular relaxation

Deep relaxation/ meditation are wonderful, help overall wellbeing – the parasympathetic nervous system is activated – it takes time to learn deep relaxation and it is a skill, so stick at it and the benefits you reap will build a lot
Try to build into every day whatever R & R works for you – it might be walking, music, dancing or gardening for example
Some people find a warm bath; some gentle music and a candle can really relax them
You can use tapes and CD’s to guide you in deep relaxation practices, there are many to choose from
You might attend classes such as yoga and mediation
Some Diabetes Australia branches and diabetes centres offer these sorts of classes. You can also find plenty of books and videos about relaxation practices. We have a number of links to excellent relaxation resources on our Relaxation page here.

Number 5 – Think about your thinking

Challenge your ”automatic” ways of thinking about your life, who you are and the events that happen to you by looking at what goes through your head when you are experiencing stress/distress? (eg the “should’s” of life) – It’s likely to be adding to stress! Lots of people with diabetes beat themselves up about their results, this just adds to stress levels
Importantly, look at if diabetes &/or other problems in your life are overwhelming you – try to get perspective & balance
Learn how to challenge” your “stories”/ideas about your life and the problems you face (through counselling) – we all have some problems or suffering in our lives, it’s how we deal with this 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 – are the emotional reactions you are experiencing out of proportion to what is happening? If so you might need to look at what you are thinking about in those situations – 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, “why me” – can lead to stress, unhappiness and lowered mental health. It is important to recognise these feelings and then try to move away from them, towards acceptance and dealing with the situation you are facing – such as diabetes or whatever else it is – you will feel much better for it
This is done through tuning into your thoughts and feelings and taking time out to “meditate” on this and seeking support and counselling to do so where needed

Number 6– avoid the dangerous approaches to stress management

Avoid the dangerous approaches to stress management -such as alcohol, drugs & over eating etc – they don’t help!
These activities give short term relief and long term pain and further stress!
Seek help if you feel such behaviours are problematic

Number 7 – Involve your loved ones

Reach out to someone in your network who can offer support
Involve your loved ones where you can and seek their help & support in managing diabetes as well as other problems/stress in your life
Realise you are not meant to be a “hero”
Talk about it, write about it, and get it out there!
Asking for HELP is ok.

Number 8 – develop true compassion

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 – lead to high stress
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 ultimately 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 – What do you want?
Working out how stress comes into your life and how much you can personally handle
Relaxation and rest/peaceful times
Make time to just “be”
Talk to other people–get support and make connections
Practising compassion towards other people.
Seek medical treatment for any depression/anxiety/underlying mental health issues
See a counsellor, psychologist, psychiatrist
Seek information & education
Revisit dietician; educator; doctor

Finally – RELAX!

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