Dr. Hans Selye, an Austrian-Canadian endocrinologist invented with word “stress” in 1936. He defined stress as, “the non-specific response of the body to any demand for change”.
The diagnosis of diabetes, topped with the daily demands of self-management and fear of both acute and chronic complications are all stressors that impact the individual with diabetes as well as their loved ones. Response to stress varies greatly among individuals.
In 1997 the American Academy of Diabetes Educators (AADE) developed the AADE7 Self-Care Behaviors. Number seven on the list is Healthy Coping. Healthy coping is essential to managing stress and for successful diabetes self-management.
What are common types of diabetes-related stressors?
Stressors can be categorized as personal, interpersonal and environmental. Stress can further be categorized as temporary or chronic.
- ex. fear of low blood glucose or concern over potential long term complications
- ex. arguing with spouse about food choices or family not being supportive of necessary diet changes
- ex. frequent travel for work that makes choosing healthy options difficult or an inconsistent work schedule that makes planning meals or taking medication more difficult
How does stress impact metabolic control?
Stress can result in poor metabolic control (i.e. blood glucose and A1c outside of target range)
The two ways in which stress may result in poor metabolic control:
- It is common for blood sugar to rise during or after a stressful event.
- Chronic stress may also result in persistently elevated blood sugars leading to an above target A1c.
- Stress induces a “fight-flight” response. This response results in the release of counter regulatory hormones that resist the action of insulin and tell the liver to make more sugar thus resulting in elevated blood sugar levels.
- Stress takes focus away from necessary day-to-day self-management tasks and may also result in non-compliance with self-management tasks such as monitoring blood sugar and taking medication as prescribed.
- Stress may result in unhealthy behaviors such as overeating, inactivity, smoking, or consuming excessive alcohol. All of which can work against glycemic control.
How is stress assessed?
Stress often presents in one of the following ways:
- Physical symptoms such as headaches, gastrointestinal discomfort, muscle tension, elevated blood sugar, etc.
- Emotional symptoms such as sadness, fear, increased anxiety, etc.
- Interpersonal symptoms such as more arguments with family/friends, distancing from usual contacts, avoiding appointments with health care providers, etc.
How can stress be managed?
First: try to identify what the stressor is
- ex. fear of low blood sugar at night time
Can something be done to deal with or eliminate the stressor?
- ex. check blood sugar before bed and in the middle of the night (if bedtime blood sugar is low)
If something cannot be done to directly eliminate the stressor; can you change your mind about the stressful situation?
- ex. concern that spouse will be annoyed when you wake up to check blood sugar at night. Instead of thinking your spouse will be annoyed consider how else your spouse might feel: relieved that you are doing your best to prevent/treat a potential low blood sugar.
Coping/treatment/interventions for managing stress:
- Improve organization and time management
- Deep breathing
- Meditation and/or yoga
- Hot baths
- Cognitive Behavioral Therapy (CBT) – a counseling technique to help patient recognize that their thinking/beliefs are at the center of their stress. This form of treatment would take place between the patient and a trained professional.
- Attending a support group
If you are having trouble coping with stressors in your life please make sure to discuss your concerns with your health care provider. There are many effective intervention options to help cope with stress and improve glycemic control as well as quality of life.1-3