The Practical Aspects

Stress and Diabetes

It’s true that stress is part of everyday life for everyone. However, if you have diabetes, too much stress can make your blood sugar go too high or too low and make you feel sick. The information given below may help you learn how to better handle the ups and downs in your life so you can control your stress.

What is Stress, Anyway?

When something happens that makes your body or your mind feel strained or threatened — that’s stress! “Stressors” are things that could make you feel sad, afraid or worried, such as:

• Death of someone close to you
• Getting fired from your job
• Problem with your husband, wife or friend
• Taking a difficult test

Stressors are not always bad.

Sometimes good things can also make you feel stressed and nervous, such as:

• First day on your new job
• Buying a house
• Going on vacation

Doesn’t Everyone Have Stress?

What Happens To My Body When I Feel Stressed?

Stressors tend to make your body speed up and get tense to help get you through a stressful situation. This is called the “fight-or-flight” response. Your body is protecting you by preparing you to run from a threat or fight it off so you can stay safe. In ancient times, the threat might have been from a dangerous animal. Today, the threat could be anything from money troubles to a problem at work. Your:

• Heart beats faster
• Blood pressure goes up
• Muscles get tense
• Breathing gets shallow
• Stress hormones are released that act to raise blood sugar

A little stress can be a good thing, helping you to stay alert in school or at work, and pushing you to do better. However, some problems — like money troubles — can’t be solved quickly and you may feel stress for a long time. Your “fight-or-flight” changes get switched on and stay on. It is not good for your body to feel tense for too long. When this happens, these changes can make your body work too hard and lead to problems with your diabetes. Such constant stress can also add to a variety of other health concerns from ulcers to high blood pressure. It can also result in changes to your emotions and to the ways in which you behave that might not be good for your diabetes.

Exactly What Can Stress Do To My Diabetes?

Too much stress in your life can have an effect on:

1. Your body.
2. Your mind.

Stress has a direct effect on your diabetes by causing the following changes in your body:

• Your blood sugar could get too high
• Your blood sugar could get too low
• You could start producing ketones
• You could get symptoms like muscle aches, diarrhea, tiredness, shortness of breath, and headaches.

Stress can also have an indirect effect on your diabetes by causing changes inbehavior from healthy actions, habits, routines and outlooks to unhealthy ones, such as:

You could become irritable, anxious, angry, depressed or have low self esteem You could over-eat, not eat on time or not eat enough food, smoke, turn to alcohol or drugs, or spend too much money. Some of these changes in behavior might be a way to distract yourself from your stressful problems. However, all of these changes are bad for your diabetes control and could bring about even more stress. Any change in your approach to self-care (the careful balance of your meal plan, medicine and exercise) could cause your blood sugar to go out of control. Taking alcohol or drugs can change your body’s chemical balance. Also, emotions like depression or anxiety may result in the release of more hormones and make blood sugar go up.

What Can I Do to Get Rid of Stress?

First, you must know how your body and mind are affected when you are feeling stressed. You are most likely already testing your blood sugar several times a day and recording your numbers in your Blood Sugar Logbook. When you are feeling stressed, mark

What is Stress Management?

Two kinds of techniques have been designed to help you cope with the effects stress can have on your body and your mind. Any plan you develop to deal with stress must include both kinds of methods.

1. Body — these methods target the physical changes that occur during stress and help bring them back to normal, such as relaxing tense muscles.

2. Mind — these methods target the emotional side of stress, or your feelings, they help to change sad or unhappy thoughts and actions to more upbeat outlooks.

What Strategies Can Ease Stress on My Body?

• Deep breathing exercises
• Relaxation training
• Yoga
• Meditation
• Biofeedback training
• Massage

These methods teach skills that will help you breathe slower and more deeply. All of these methods encourage you to relax and loosen tense muscles. If you do them on a regular basis, they can help you to bring your heart rate, pulse rate, blood pressure and blood levels (the tests that your doctor orders on blood taken from your arm) to healthy levels.

What About Physical Exercise?

In the long-term, exercise such as walking, jogging, playing sports and working in the garden, is a great way to reduce stress and helps you “work off steam.” In the short term, however, physical exercise does not lower heart and breathing rates. Instead, it increases most of the physical symptoms of stress. So it is also important to learn some of the relaxation methods listed above. Once you have these skills they should be practiced regularly, along with physical exercise, for the best results.

Where Should I Begin?

Many local Y Groups, health clubs and adult schools offer relaxation training. Check with your doctor or diabetes educator for a recommendation. In the meantime, here is an exercise to get you started. Deep relaxation breathing — This approach is very useful in fighting stress because it can be done almost anywhere and is available whenever you might need it.

• While sitting or lying down, place one hand on your stomach and the other hand on your chest.
• Close your eyes.
• Breathe in through your nose to a count of three.
• Breathe out through your mouth to a count of five.
• Continue for one to five minutes.

You should feel the hand on your stomach move out and in, while the hand on your chest stays mostly still. You should practice deep relaxation breathing any time you feel stressed. It will allow you to cope with the problem on the spot.

What Can Help With Emotions or The Feelings That Come With Stress?

Ten Steps Toward Reducing Emotional Stress

1. Find the cause of your stress. Seems clear, doesn’t it? Don’t be so sure. Often, people who feel overcome by stress think that everything is going wrong at once, yet this hardly ever happens.
2. List the parts of your stress that are beyond your control. There is always a part of any situation that you cannot do anything about (such as when bad weather keeps you from leaving your house).
3. Learn to accept what you cannot change. Do not waste time and energy spinning your wheels. This is an important step toward feeling content. Work on the things that you know that you can change if you try.
4. Recognize the parts of the stress that you can control. One thing you can always control is your outlook — the way you look at things. However, it can still be helpful to get an outside opinion. Ask a friend or family member if they see things the same way as you do.
5. Plan changes by setting short-term and long-term goals. Plan goals or changes that you want to reach. Then break that goal down into something that you can reach in the next week or two. Do not set goals so high that you will not be able to reach them.
6. List the steps you need to take to reach your goals. Then take one step at a time. As you complete one step, cross it off and go to the next step.
7. Expect some setbacks in achieving your goals. There will always be some bumps on the road to change.
8. Be ready with possible solutions for any setbacks you may face.
9. Learn from your mistakes — reward yourself for your achievements.
10. NEVER GIVE UP!

Making the 10 Steps Work For You

Let’s see how these steps might be used in real life, taking a new diagnosis of diabetes as an example of a stressful situation:

Identify the stress: Being diagnosed with diabetes is a stressful event in your life.

Describe what is beyond your control: At present, diabetes has no cure. You cannot undo the diagnosis, or control what will happen.

Accept what you cannot change: Accept the diagnosis and feelings that you have about living with a chronic disease. Make peace with the fact that you have a chronic illness, an illness that you may be able to manage, but will have forever. You may benefit from seeing a social worker, counselor or attending a diabetes support group to help you accept your diabetes and learn to live a healthy life.

Recognize what you can control: Following a healthy meal plan, exercising, taking your diabetes pills as your doctor ordered, and taking charge of how you will live with diabetes are all things you can control. It is also important to view living with a chronic condition as a challenge rather than a threat.

Set goals: Since your stress is from diabetes, your goals are likely to be in the following areas:

Meal Plan: Work with a dietitian to develop a meal plan. The meal plan should fit into your daily schedule and the way you live. For example, if you need to lose weight, your long-term goal would be to lose 10 pounds. Your short-term goal is to follow your meal plan and lose about 1 pound a week for the next 10 weeks.

Medicine: Work with your doctor or diabetes educator to develop a schedule to take your medicine. Your short-term goal is to take your medicine at the right time during the day, to keep your blood sugars in their target ranges, learn the side effects of the medicine and report any problems to your doctor. If your doctor orders insulin to help you manage your blood sugar, your short-term goal would be to learn about how to give the insulin in the correct way. Your long-term goal in both cases would be to bring your blood sugars within the target range.

Self-Monitoring of Blood Glucose (SMBG): You and your doctor will decide on:

• The best blood glucose meter for you
• How often you need to check your blood sugar
• The “target range” your blood sugar should be

Your short-term goals are to decide on a schedule for checking your blood sugar that will fit into your life. Your long-term goal is to be able to see the effect of food, exercise and stress on your blood sugar.

Exercise: You and your doctor will decide on an exercise plan that will fit in to your life and is safe for you to do. Your doctor may send you to an exercise specialist who will help you develop a plan that you will enjoy doing. Your short-term goal is to begin an exercise program, the long-term goal is to see an effect on your blood sugar levels and overall blood sugar control.

Meet goals: To meet your goals you will have to plan how you will reach them. You may have to plan your meals to include the correct amount of carbohydrates that you and your dietitian have agreed upon. You will have to plan the type of exercise you will do and when you will do it. You may also look at your blood sugar records to learn the effect that food and activity have on your blood sugar and how you can change your activities based on that information.

Setbacks to meeting goals: This could include forgetting to test your blood sugar, forgetting to eat a meal on time, your weakness for ice cream, or your lack of time for exercise.

Solutions for setbacks: You might set alarm timers to remind you to test your blood sugar at the right times; add an extra walk to your schedule so you can have ice cream sometimes; or ask a friend to join you for daily walks to make exercise more fun. It is important to decide on someone that you could talk to when you have concerns and issues related to diabetes.

Learn from mistakes, reward successes: If your blood sugar drops during exercise and you forgot to take a fast-acting snack with you, remember to keep glucose tablets or gels with you in a pocket. If you set a goal of having no high or low blood sugar levels for two weeks and you achieve it, reward yourself by seeing a movie with a friend — you’ve earned it!

Never give up!: You may need to try several solutions until you find the right one. If you are having trouble managing your stress or blood sugar levels, ask for help when you need it from your doctors. No one can do it all alone.

Be patient — coping with stress involves learning new skills that take time. Try to balance work and play by giving yourself a break now and then. It is important to distract yourself from stress through reading, watching TV, listening to music, or doing whatever is fun for you. Although you must deal directly with stress in order to reduce its effects on your blood sugar control, the stress management skills in this booklet can really help. You can live better with your diabetes.