High Stress and High Blood Glucose: by Kevin J. Eames, Ph D
Most of us take the daily stresses and hassles of life in a stride, but when they build up they can become bad for your health. The human stress response is best suited to reacting to an immediate threat. Imagine yourself confronted with a skunk in your back yard or being in the path of a runaway golf cart. In both cases, your nervous system reacts as it should, by releasing chemicals into your blood stream that increase your heart rate and respirations so you can run or fight. . . But I’d recommend against both of these examples.
Your body has released chemicals like adrenaline to help you cope with the stressor, which quickly dissipates once the stressor is past. Your body also releases stress hormones called glucocorticoids that are involved in a variety of functions that help in fighting acute stress. Part of what they do involves putting some of your bodily mechanisms on the back burner, like the immune system and digestion. The assumption is that, when you are fleeing from a hungry tiger or golf cart, your body sets aside functions like fighting infection or digesting food, while it attends to the more immediate need of coping with the present threat. Robert Sapolsky, in his excellent work on stress entitled Why Zebras Don’t Get Ulcers, noted that there is no point in digesting breakfast when you are trying to avoid becoming someone’s lunch.
The negative aspects of stress occur when stressors becomes chronic. While our bodies are efficient at coping with acute stress, they are not as efficient with chronic stress. The increased heart rate and respirations associated with an acute stress response can become the chronic condition of high blood pressure. Similarly, we get sick more easily when we are under stress because the immune system is compromised. Inhibition of digestion during chronic stress may also contribute to the development of ulcers.
People with diabetes are particularly vulnerable to the hazards of stress. Glucocorticoids that remain in the blood stream during periods of chronic stress contribute to high blood glucose levels. Combine that with the glucose we are already struggling to metabolize from nutrients and you can see why our blood glucose levels continue to rise. If we already have damaged arteries, the sticky glucocorticoid cells can attach themselves to the plaques forming on arterial walls. They also contribute to problems with kidneys, eyes, nerves, and circulation. While glucocorticoids give us what we need to survive an acute stressor, they have the potential to harm us when stress becomes chronic. Some of the more serious complications that can arise from chronic stress are described below:
Coronary artery disease (CAD) is one of the more devastating complications that can afflict people with diabetes. Unfortunately, stress can contribute to the seriousness of CAD, when coronary arteries that are affected by diabetes develop plaque, which narrows the arteries and reduces blood flow. These affected arteries are over-responsive to stress, and more likely to constrict than healthy arteries. Chronic stress, and particularly mental stress, can cause ischemia or significant constriction of blood flow in the coronary arteries, which can lead to a heart attack. In a research study published in the journal Circulation, researchers reported that blood vessel blockages related to stress were just as serious as those related to smoking or high cholesterol were.
Clinical depression is also a potential problem for people with diabetes. Research suggests that depression is three times more likely to occur amongst people with diabetes than in the general population. However, only one-third of the people with diabetes are diagnosed and treated. The research also suggests that 40% of people with diabetes have depressive symptoms that are not serious enough to be diagnosed at the clinical level, but are still distressing for the sufferer. This is often referred to as sub-clinical depression. While it may seem that stress and depression aren’t related, being depressed can be stressful. Clinical symptoms of depression include:
Depressed mood for two or more weeks
Loss of interest in daily activities or pleasures
Significant changes in weight or appetite
Significant changes in sleep habits
Feelings of worthlessness, excessive guilt
In the most extreme cases, thoughts of suicide
Depression can also cause significant challenges in family relations. Depressed people tend to become self-absorbed and withdrawn. Family members of a depressed person may become angry or resentful, wanting their loved one would “snap out of it,” even when they realize it is part of the illness,
Sources of Chronic Stress
What kind of things might create chronic stress for people with diabetes?
Ongoing problems in relationships, marriage, or with children
Difficulties at work
Recent life changes, such as a job change or the last child leaving home
Positive changes, like a promotion or a big vacation
What kind of stressors might be unique to people with diabetes?
Routine frustrations with medical insurance, doctors’ offices, or government agencies
Worry about less-than-perfect adherence to a diabetes management regimen
Worry over possible complications
Restrictions resulting from complications or the disease itself
Strategies for Managing Stress
In addition to being an essential part of blood glucose management, exercise is also vital for successful stress management. Some research suggests that exercise increases a chemical in the brain that reduces stress and anxiety, and can even make the brain’s response to stress more efficient. The type of exercise is important however. Exercise that is “forced,” or un-enjoyable, is not as effective as exercise that is enjoyable. In other words, it is important to find an exercise you like. If you think walking on the treadmill is drudgery, then see if walking around a track outside is more enjoyable. If walking itself is unappealing, perhaps a recumbent bicycle would be appealing. Exercise that involves others has double benefits. For example, if you choose to play badminton, you get exercise and social contact.
Like physical fitness, mental fitness is vital for stress management. One aspect of mental fitness is to recognize problematic personality traits. The “Type A” personality has been linked to coronary artery disease, and most specifically to anger, hostility, and cynicism. If these traits are a prominent part of your personality, then it is important to find alternative ways to cope with things that upset you. You may want to consider talking with a counselor about ways to cope with these traits.
A second aspect of mental fitness is learning to recognize stressful thinking patterns. Stressful thinking patterns are patterns that are inaccurate and increase your mental stress. Some psychologists call these cognitive distortions. Some examples of cognitive distortions include:
All-or-nothing thinking – This is the kind of thinking that creates perfectionism. It says, “If I can’t manage my blood sugar perfectly, than why bother?” All-or-nothing thinking must be countered with good-enough thinking. While a blood sugar of 110 is optimal, a blood sugar of 150 may be good enough for one test, with the determination to decrease it for next time. What it shouldn’t do is encourage you to eat a whole package of cookies.
Catastrophic thinking – This is the kind of thinking that takes a specific problem and blows it into an all-pervasive crisis. This is also the kind of thinking that makes catastrophic judgments without having all the facts. There is an element of fortune-telling in this kind of thinking, where you predict a catastrophe in the future based on a few bits of evidence in the present.
Emotional reasoning – This kind of thinking equates how you feel with what is true. For example, if you feel lonely and unloved, then it must be true – even when you have evidence to the contrary.
In his book Learned Optimism, psychologist Martin Seligman provides a method you can use to counter cognitive distortions. This involves a new look at your ABC’s.
A = Adverse event, the event that causes distress
B = Belief about the event; what you tell yourself about the event.
C = Consequences, which can include stress, or distressing and painful emotions
Most of us tend to skip from A to C, forgetting about B. However, Seligman contends that it is B that produces our distressing emotions, not A. Therefore, Seligman suggests a strategy of detection and disputation. Detection involves identifying the cognitive distortions or other dysfunctional beliefs. Disputation involves using existing evidence to dispute the belief. It can also involve identifying potential alternative causes related to the belief. For example, instead of believing you have a high A1C because you’re incompetent and can’t manage your diabetes, you review the last three months and identify alternative reasons for the elevation. Perhaps it was a prolonged illness, or a death in the family, or extended travel. You can also look at previous A1C levels to compare them. If this is unusual, then the evidence suggests you are capable of managing your diabetes.
Researchers are continuing to recognize the links between social support and physical health. Networks of family and friends, a faith-based community, or other naturally occurring support networks can improve your health. Friendships based on common interests can assist people with diabetes in warding off stress-related illnesses.
This may seem surprising, but routines provide a degree of predictability that is necessary to minimize stress. Routine habits are particularly helpful in managing all the additional aspects of diabetes – such as blood sugar testing, insulin administration, medications, exercise, etc. Managing diabetes takes time, and routines help reduce stress associated with forgotten injections or medications or other consequences of disorganization.
Adequate sleep is key to successful stress management. Sleep deprivation can have all kinds of consequences, from reduced mental sharpness to an increase in cravings for simple sugars. It also reduces your tolerance for stress and increases your vulnerability to illness. At times, a sleep disorders like sleep apnea can contribute to chronic sleep deprivation. People who are overweight are particularly susceptible to obstructive sleep apnea. Sleep health is essential to good stress management, and, contrary to popular belief, you can make up for lost sleep. If you suspect you have a sleep disorder, consult a doctor who specializes in sleep medicine.
Play is not only for children. Leisure is an opportunity to pursue your interests for no other reason than enjoyment. This kind of self-care provides an opportunity to recharge while engaging in something you enjoy.
One of the things that psychiatrist and holocaust survivor Viktor Frankl noted in his book Man’s Search for Meaning is that finding meaningfulness in hardship often distinguished those who survived form those who perished. Placing your circumstances, your suffering, in a larger meaningful framework allows you to gain perspective on your sufferings. Some people find such perspective through their faith or other transcendent belief system.
Sometimes, stress and its related problems can exceed your ability to manage. When this happens, because of its impact on your diabetes, consider seeking professional help. A counselor can help you identify coping strategies to help you deal with chronically stressful situations. Occasionally, medication may be helpful in managing stress-related problems, including depression and anxiety.
If you’re human, stress is inevitable. While it is universal, its impact on a diabetes and blood pressure can have a vital impact on healthy disease management. Applying some of the behavioral and cognitive concepts described here can help you manage your diabetes more successfully and enhance your quality of life.
Kevin holds a doctorate in Counseling Psychology from Georgia State University. He presently serves as associate professor and co-chair of Psychology at Covenant College, where he teaches courses in research, statistics, cross-cultural psychology, cognitive psychology, and the psychology of religion. Prior to coming to Covenant College and the Chattanooga TN area in 2003, Kevin was assistant professor of Psychology at Dordt College in northwest Iowa, where he collaborated with diabetes educators in the region to present seminars to professionals and patients on ways to better cope with and manage stress.
Healthy Coping: AADE Video Overview
AADE7: Healthy Coping Handout
The Jokes on You: Laugh Yourself Healthier: Diabetes Health
Laughter is the Best Medicine: Help Guide.org
Share Some Happiness: Your Happiness Depends on Others: Diabetes Health
ABCs of Loving Yourself With Diabetes: by Riva Greenberg
Diabetes Stories: Riva Greenberg
Wholly Healthy: Diabetes Health
Updating Your Coping Skills: Diabetes Self-Management
8 Tips for Managing Diabetes Distress: Diabetes Self-Management
Are you Stressed? dLife Quiz
Taming Stress: Easy Does It: Accu-Chek
Stress and Staying Alive: Diabetes Health
The Emotional Side of Diabetes: Behavioral Diabetes Institute
Reluctance to Reach Out to Others Can Boost Mortality Rate: Diabetes Health
How Spouses Deal With Diabetes: Diabetes Health
Diabetes and Your Marriage: Making Things Work: Diabetes Self-Management
Depression and Diabetes:
Diabetes, Depression and Death: Diabetes Health
Diabetes and Depression are a Disabling Duo: Diabetes Health
Diabetes Burnout: When to Leave Good Enough Alone: Diabetes Health
Mind Body Connection:
Meditation Medication: Diabetes Health
Meditation and the Art of Diabetes Management: Diabetes Self-Management
YOGA: Uniting Body, Mind, and Spirit: Diabetes Self-Management
Taking a Zen Approach to Diabetes: Diabetes Self-Management
by Diana Guthrie PhD, ARNP, FAAN, CDE, BD-ADM, AHN-BS, CHTP
by Richard S. Surwit, PhD
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