Just having lived through Irma, a category 4 hurricane in Florida, I decided this would be an excellent time to review stress and how it relates to your diabetes. According to Diabetes Care, “Stress is a potential contributor to chronic hyperglycemia in diabetes. This evidence is more consistent with type 2 diabetes.” It is well documented that stress can cause an increase in blood pressure and a rise in adrenaline and cortisol levels, which in turn raise blood sugars and systemic inflammation. Systemic inflammation is the basis for most chronic diseases including diabetes.

First, we all worried about when and where the storm would hit. This is the short-term intense stress in which the body uses the “fight or flight” reaction. Although the storm did major damage to the Caribbean islands and parts of Florida, in time we will rebuild. The problem then became the lack of power, water, cable and making note of all the structural damage. This is the chronic long-term stress, “eating away at you” the minute you wake up until the minute you sleep. This is more damaging to the body. According to a Harvard study, “almost 50% of all people (diabetes or not) report a major stressful event yearly.” We can’t always avoid stress but we can learn to tame how we deal with it. Let’s examine the aspects of stress, whether it be the immediate kind or the chronic long-term variety.

What is Stress?

“Stress is a state of emotional strain or tension that occurs when we feel that we can’t cope with the pressure.” Whether you feel threatened physically or mentally, the body reacts in the same way to the situation. This reaction is called “fight or flight” which causes an increase in heart rate, blood pressure, respirations, muscle tightening and catecholamines rushing into your blood stream. The entire body is now involved including your emotional state, how you behave and your ability to think. This is where it becomes important since the way you deal with stress mentally will affect the way your body reacts physically.

How Do Different People Deal with Their Stress?

Those who “go with the flow” and understand what they can and can’t change are the ones with the least mental and physical problems. Even in the most stressful situations, they ride out the storm. For others, a slight variation to their normal day plays havoc with them, setting off panic, anxiety, depression, frustration and possible cursing. This reaction causes all the physical symptoms to evolve.

What Are The Possible Symptoms of Stress?

Stress EatingMany people react to stress with negative habits. Over-eating is one of the biggest reactions to stress. It usually involves eating more junk foods and comfort foods which are normally high in carbohydrates and packaged, processed foods. This leads to rises in blood sugar and weight gain and more weight will continue to keep the blood sugars high. People tend to rely on tobacco or nicotine, alcohol and tranquilizers for a quick fix which further destroys your overall health. Insomnia is common as is sleeping too much, which is a sign of depression. People are unable to quiet their mind, get easily agitated, become moody, depressed, have tension headaches, tense and achy muscles and little to no energy. They may suffer from poor judgement, dry mouth, sweaty palms and feet, eye twitches, clenched jaws with possible jaw pain, becoming forgetful, disorganized and unmotivated. Stress affects the immune system which can cause more powerful colds and infections and raise blood sugars.

What Are The Biggest Chronic Stressors?

As discussed above, hurricanes, earthquakes and floods cause immediate short-term stress. Traffic jams cause short-term stress. The aftermath, like huge, home damage or car accidents cause the long-term, chronic stress. Other chronic stressors include work stress, deadlines and relationships with fellow employees or your boss. Any relationship may cause stress including spouses, children, parents, friends, neighbors and associates. Health issues like diabetes, cardiovascular disease and cancer are chronic stressors. Finances play a major part in stress as do many general daily responsibilities.

Stress Patterns and Blood Sugars?

It is wise to track your daily reactions to stress and how they coincide with your blood sugars. Rate your stress reaction using a scale of 1-10, with 10 being the highest amount of stress. Document the number, then test your blood sugars. Try to find a pattern, when the highest number of stress shows the highest blood sugar response. This will increase your awareness and show you what changes need to be made.

What Can You Do to Change Your Reaction to Stress?

Stress can “wear you down” and make you less likely to care for yourself and your diabetes. Suggestions vary from the smallest changes to major ones. Only you can decide what works best for you.

Start the day with a 15-20-minute self-meditation. This often helps people organize their day. Sit comfortably and quietly and push away all your thoughts. The concept of a “mantra” is to empty your mind of all thoughts for that specific time. It is more about “being in the present moment”, feeling the breath, deep rhythmic breathing, and ridding yourself of all other thoughts. You could focus on “I will be positive today”, “I will be patient today”, or chant a number like “one” or the word “om”. There are several APPs which are free and others cost a minimal fee per month to help you get mentally focused. Check out Calm, Headspace and Insight timer which are free or Buddhify which has a fee.

Try to keep a routine. During our storm, the people who had power did the best since they could keep their daily routine. Do not self-criticize or be your own worst enemy. Most people are usually harder on themselves. Stop comparing yourself to others. Stay positive and stay in the present. Worrying about what already happened or what will happen is not productive and uses up valuable energy. Accept what you can’t change and do not dwell on it.

Move ahead and focus on the things you can change. Learn to delegate and to say “No.” Many people create their own stress simply by taking on too many things. Find safe, meaningful and worthwhile escapes. Make time to read a good book. Start a book club or join one. Take a warm, bubble bath and add lavender essential oil drops, light candles with a fragrance, work in your garden, try self-hypnosis, pray or volunteer. Take your mind off yourself and focus on others. Join a support group especially for those with diabetes, listen to music or cook a delicious, creative meal. Take music or language lessons, attend a college course, learn to play bridge or cards. Take acting lessons and act in a community play. Find an outlet for your frustration. Learn to laugh and try to keep a positive attitude. Join a movie matinee club.

The best way to help “burn off” stress is with physical activity. Go for a walk, join a kick-boxing class, mow the lawn or ride your bike. Learn to swim and join a water aerobics class. Take dance lessons or karate. Find a Tai-Chi, Pilates or yoga class. Glucose provides us with the energy to move. When you have excess glucose from stress, Move!

Sleep is extremely important especially during stressful times. Do what you need to get sleep. Make your bedroom cool and dark. Avoid electronics and blue light for at least 2 hours prior to sleep. Have a small protein and carbohydrate snack like cheese and crackers 30 minutes prior to bed. Try OTC sleeping remedies for the short term if you can’t sleep. If you still can’t get quality sleep, talk to your health care provider for a solution. Some professionals recommend melatonin although according to multiple sleep experts, “melatonin is not harmless, vastly overused and should not be used to treat insomnia.” Melatonin is naturally produced in your body by the pineal gland but when taken in the synthetic form it is “considered a dietary supplement” and not FDA regulated. You may not get the amount it states on the bottle. Melatonin should be used more for jet lag and “Circadian rhythm” problems more than daily sleep issues. Talk to your health care provider if you have questions. You may temporarily need a prescription sleeping aid.

Professional Help?

If none of these measures seem to help with your reaction to stress, you may need to seek help from a psychologist, mental health counselor or social worker. Talk therapy often works along with biofeedback techniques. Your health care provider may suggest medications such as anti-anxiety pills or pills for depression until you can learn improved coping skills. Remember, it is a process. If you have viewed life one way for years, it will take longer to incorporate these changes. Try to be patient with change.

Stress will always be there since it really is a part of our life. The magic is learning how to deal with it in a reasonable and positive manner. This will help control your diabetes, blood pressure and your general well-being!

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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

Roberta Kleinman

Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia.

She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.

She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.
Roberta Kleinman

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