What To Do About Diabetes Stress
Ancient organisms likely evolved the stress response to better escape from predators. Granted many people are still challenged in this world to meet their basic needs, but many of us (certainly most reading this article) are no longer threatened by vicious animals, major infectious diseases, or shortages of food or water. Instead the “stressors” have become more contemporary: our national financial crisis, family and relationship stress, workplace stress, manufactured deadlines, traffic, and long term health conditions like diabetes. Diabetes distress is actually a separate entity, please check out my next blog on it. Right now, I am talking about everyday stress. According to the 2018 American psychological Association survey of more than 3000 respondents, the top stressors are working money economy and help. We all have and need stress. Without stress few of us would meet deadlines, perform optimally in any activity, or even wake up in the morning! This fact was recognized by Dr. Hans Selye in his 1956 book The Stress of Life, in which he coined the concept of the “General Adaptation Syndrome”. Dr. Selye recognized that “optimal stress” led to optimal performance, increased attention and focus and without any stress life would become boring and without emotion. Dr. Selye also recognized too much stress led to anxiety and unhappiness. In his book, he described phases of stress response, including the classic “fight or flight” response, or “alarm” phase, but he also recognized that chronic stress first leads to “adaptation” but ultimately leads to “resistance”. If the stress continues, Dr. Selye suggested the final stage occurs, or “exhaustion”. Although this model of stress also has some scientific support, it serves as an intuitive model of our experience with stress- first we respond, then we either adapt or resist, and then prolonged resistance typically wears us out!
Besides wearing us out, how does stress affect you and your diabetes? First, many people choose to eat their stress away, allowing the short term chemical response of feeling full with food to comfort them in times of need and obviously that can be a major problem for a person with diabetes. Second, there is a more organic problem with stress. If you have diabetes, you will notice a change in your blood sugar (and often blood pressure) during times of stress.
Although many hormones participate in stress, stress is powered by three major hormones: epinephrine (AKA adrenaline), norepinephrine, and cortisol. All three of these hormones are produced by the adrenal glands, two small glands that sit on top of our kidneys in our lower back. Upon experiencing stress, our brain sends chemical messengers into our blood to cause the release of cortisol from our adrenals into our blood. Cortisol helps maintain our blood sugar in times of starvation or deprivation. Cortisol can either maintain, or can increase, our blood sugar by reducing our sensitivity to insulin. During stress, our body needs blood sugar to give our muscles the fuel they need to run, and to give our brains the fuel and mental clarity needed to perform in times of need. Under normal circumstances, we all release a certain amount of cortisol in a daily pattern, or “circadian” rhythm. This is also apparent in the Dawn Phenomenon, in which some people with diabetes see higher blood sugars at night and in the morning.
How much does stress raise the blood sugars and iS it significant to you?
Because different stimuli serve as “stressors” for different people, and then everyone reacts differently to their stress, i.e. stress is subjective, “stress” is very challenging for researchers to study. I cannot pinpoint exact numbers on how much stress will change your personal blood sugar. Typically with Type 1 diabetes and moderate stress, there may be about a 50 point difference. It can be more or less, depending on the level of stress.
Perhaps, there can be a good example using physical illness to illustrate the point. Physical illness is a form of stress on the body. Mental stress and physical stress affect the body by the same process, "the stress response." Several years ago when working in the critical care unit, I managed IV infusion of insulin to lower blood sugars for people who were sick. The patients with diabetes would be on 10 times their normal amount if they had a major issue. Once the recovery process would start, the insulin could slowly come off and blood sugars would normalize. The blood sugar variability depends on the intensity of stress incurred to the body.
Changing back to the subject of mental stress. There are two very important notions to stress that give you power on how your body handles it:
1. Everyone perceives stress differently.
2. Your response to stress is very individualized.
Although everyone faces stress people react to it differently. "There's the situation, how are you evaluate the situation, then our skills at handling the situation. " In every person, including us with diabetes, unchecked stress is detrimental to the body and it does even more than just raise blood sugars. It impacts our immune system, blood vessels, brain activity, digestion and more. You can be thankful to your condition of diabetes, that your body tells you that it is experiencing stress in a negative way, because your blood sugars will raise. People without diabetes have no way to gauge the effect. People without diabetes will not be aware of its effect on the body, but that does not mean that nothing bad is happening to it. In a way, having diabetes means that you have a barometer of how well you are mentally perceiving and handling stress in your life.
Can anything be done about it?
As mentioned, our response to stress begins, not surprisingly, in our brain. You can change your thoughts about the stress and your action to manage it. In my next blog, I summarize clinical research on more formal stress reduction techniques that can improve blood glucose and other risk factors.
Just Breathe!
One of the most important approaches to stress reduction is free, and relatively easy: breathing! Here me out on this…Even just a few years back, I could not stand it when someone would say "Just breathe!" if I said that I was stressed. What was that supposed to mean? It sounded like a good suggestion for a crazy person. I would think "If I did not have ____ going on, then maybe I could breathe!" Looking back the mantra "Just Breathe" actually has an abundance of real science to back it up. Slow breathing helps people with diabetes restore autonomic balance and improve blood sugars. https://www.longdom.org/open-access/review-can-yoga-breathing-exercises-improve-glycemic-response-and-insulin-sensitivity-2157-7595-1000270.pdf. It prevents that harmful cycle on the body. https://www.frontiersin.org/articles/10.3389/fnhum.2018.00353/full
“Slow breathing could be a simple beneficial intervention in diabetes.”
— Nature
For the sake of experiment, focus on your breath over the next few days/weeks. What is your breathing pattern like? Do you hold your breath unconsciously? Do you breath slowly or rapidly? Do you use your diaphragm to breathe fully into your belly or is your breath more shallow?
Breathing exercise - breathing slowly, fully and regularly - can be a simple and remarkably effective means of reducing anxiety, clearing the mind for mental work, and, yes, even lowering blood pressure and blood sugar. A typical exercise is to take just fifteen minutes to focus on the breath. Inhale deeply into the belly for a full count of 3 seconds, hold the breath for a full 3 seconds, and exhale slowly and regularly also for a 3 seconds count. An old yogic mantra states, “The mind controls the body, and the breath controls the mind”. Test this mantra in your own stress responses, and feel free to let me know how it goes for you.
There are several phone apps to assist you to get started with your breathing. Many of the good apps cost money, but I have found one that is good and free called iBreathe.
I encourage you to check it out.
In the meantime, take a step back and assess your own stress and your response to stress. Which “stressors” are real and consequential? Which are perceived? Do you have responses to stress that are truly protective - or more detrimental - for your long-term health? Do you have stress reducing activities that you prioritize and do regularly? Are there patterns in your daily routine that could be changed to reduce the effects of stress on your body’s functioning? The answers to these questions have real consequences on your long-term health and happiness.
Other blogs:
Does stress cause diabetes?
