Diabetes mellitus, or just “diabetes,” is a disease that is increasing in prevalence.
The incidence of diabetes is increasing and becoming more well-known.
According to the World Health Organization (WHO), the number of people with diabetes has risen from 108 million people in 1980 to 422 million in 2014.
Types of Diabetes
Diabetes presents in two different ways; type 1 diabetes and type 2 diabetes. Type 1 diabetes is an autoimmune disease where the pancreas loses its ability to produce the hormone insulin, which helps lower blood sugar to keep it in a healthy range.
People with type 1 diabetes are known as “insulin-dependent” because they must inject insulin in order to live a healthy life. Type 1 diabetes is much rarer than type 2 diabetes.
Type 2 diabetes is linked to insulin resistance and is more likely to be passed along genetically, and can also occur due to lifestyle factors. People with type 2 diabetes don’t necessarily need to be on insulin in order to survive, unlike people with type 1 diabetes. Risk factors for type 2 diabetes include age, ethnicity, family history, and lifestyle habits such as activity level.
Complications of uncontolled diabetes
The goal of managing both types of diabetes is to keep blood sugars within a healthy range, usually between 70-140 mg/dL.
Having blood sugar levels consistently higher than that range can cause health complications. Some of the complications of chronic high blood sugars include:
- Heart (cardiovascular) disease: people with diabetes are two to four times more likely to die from cardiovascular disease than those without diabetes. People with diabetes are also more likely to have high blood pressure, which is another risk factor for heart disease.
- Stroke: Diabetes increases the risk of stroke, as well as increases mortality when a stroke occurs.
- Kidney disease and failure: High blood sugar damages the kidneys and can lead to kidney disease. About one in four people with diabetes have kidney disease.
- Poor wound healing leading to amputations: High blood sugar inhibits proper wound healing. Diabetes is thought to be the leading cause of leg amputations worldwide.
- Neuropathy: Damage to the nerves, which can cause painful symptoms like numb and tingling legs and feet, as well as delayed stomach emptying from damage to the nerves of the stomach.
- Retinopathy and blindness: Damage to the nerves in the eyes is called retinopathy, which can lead to blindness if not treated.
On the other hand, frequent hypoglycemia (low blood sugar) can also be dangerous. Some of the potential side effects of low blood sugar include:
- Clumsiness or jerky movements
- Muscle weakness
- Slurred speech or difficulty speaking
- Blurry or double vision
- Convulsions or seizures
Many factors affect blood sugar levels, which can make managing diabetes more challenging.
Stress is one of these factors and is prevalent in everyone’s lives in one form or another. Understanding how stress can impact blood sugar levels can help those wanting to manage their diabetes and improve their health and well-being.
What is stress?
According to the National Institutes of Health, stress is “a feeling of emotional or physical tension [which] can come from any event or thought that makes you feel frustrated, angry, or nervous.”
Stress is also defined as “the body’s reaction to any change that requires an adjustment or response.” Our bodies react to changes with both physical, mental, and emotional responses, all resulting in stress.
Stress can be short-term, such as the feeling when an animal runs in front of your car while driving. Your heart rate may increase, and you feel worried and very alert as you slam on your brakes. Stress can also be long-term or chronic, meaning it lasts over the course of days, weeks, or even longer.
Stress that continues without relief and is negative is referred to as distress, which is usually what people associate with the word stress. Things like losing a job, getting a divorce, and having a long-term health problem can cause distress. Distress tends to cause health issues if it’s chronic. Having diabetes in itself can be a stressor as well.
Stress is often thought of as negative, but it can exist in happy and positive situations as well. Positive stress is called eustress. Having a baby, moving to a new house, or starting a new job are usually positive experiences, but can cause stress because they are new situations for you to adapt to. Eustress is normal and usually doesn’t negatively impact our health as distress does.
Symptoms of stress
Per The American Institute of Stress, 50 signs of stress include:
- Frequent headaches, jaw clenching or pain
- Neck ache, back pain, muscle spasms
- Lightheadedness, faintness, dizziness
- Cold or sweaty hands, feet
- Dry mouth, problems swallowing
- Frequent colds, infections, herpes sores
- Rashes, itching, hives, “goose bumps”
- Heartburn, stomach pain, nausea
- Difficulty breathing, frequent sighing
- Sudden attacks of life-threatening panic
- Chest pain, palpitations, rapid pulse
- Frequent urination
- Diminished sexual desire or performance
- Excess anxiety, worry, guilt, nervousness
- Increased anger, frustration, hostility
- Depression, frequent or wild mood swings
- Increased or decreased appetite
- Insomnia, nightmares, disturbing dreams
- Difficulty concentrating, racing thoughts
- Feeling overloaded or overwhelmed
- Frequent crying spells or suicidal thoughts
- Feelings of loneliness or worthlessness
- Obsessive or compulsive behavior
- Reduced work efficiency or productivity
- Social withdrawal and isolation
- Constant tiredness, weakness, fatigue
- Frequent use of over-the-counter drugs
- Weight gain or loss without diet
- Increased smoking, alcohol, or drug use
How can stress affect your diabetes?
When someone is stressed, the body’s adrenal glands release a hormone called cortisol. Cortisol triggers the fight-or-flight response, which results in physical changes such as pupils dilating and heart rate increasing.
It also increases blood pressure and blood sugar, as well as insulin levels. This response helps someone truly in danger and needs to run from a bear, but most of us aren’t in true life-or-death situations when we’re stressed.
The problem with chronic stress is that cortisol levels remain increased for much longer than is healthy. Prolonged stress can cause health problems, including an increase in blood sugar levels. Some studies have found that cortisol is associated with increased blood sugar levels in people with type 2 diabetes. This means that chronic stress can make it difficult for diabetes people to keep their blood sugar levels under control.
While stress usually doesn’t directly result in hypoglycemia, it could be a culprit if someone reacts to stress by not eating as well as they normally do. This, coupled with taking blood sugar-lowering medications, could be a recipe for low blood sugar.
How can you determine if stress is affecting your glucose levels?
The best way to identify if stress is causing blood sugar imbalances is to frequently monitor blood glucose levels. Checking blood sugar at home with a glucometer kit will yield much more insight as to blood sugar trends than waiting every 3-6 months for routine tests at a healthcare provider’s office.
It’s recommended to monitor blood sugar levels at different times of the day to get an idea of individual trends. Common times to check blood sugar includes in the morning after waking and before eating, 1-2 hours after meals, and at bedtime. Keeping notes of stress levels in relation to blood sugar levels may also be beneficial.
Some people may opt to have their cortisol levels checked by a healthcare provider to determine if stress causes their blood sugar imbalances. Cortisol levels can be checked via blood, urine, and saliva tests. Cortisol levels vary throughout the day – they are usually highest in the morning and lower later in the day and night. Because of this normal fluctuation, some tests require checking levels at different times throughout the day.
Changes in cortisol levels from morning to evening are referred to as diurnal cortisol curves; in other words, cortisol levels are charted on a graph to show a change in levels. Some studies suggest that a flatter cortisol curve results in poorer mental and health outcomes, but this hasn’t been proven despite much research on the topic.
How to cope with stress
While stress in life is unavoidable, there are ways to help cope with it. Finding a coping mechanism that works can help reduce the negative impact stress can have on health. It’s important to keep in mind that everyone copes with stress differently, so what works for one person may not work for you.
Some tips for dealing with stress include:
- Keeping a positive attitude.
- Accepting that there are events that you cannot control.
- Being assertive instead of aggressive, e.g., asserting feelings, opinions, or beliefs instead of becoming angry, defensive, or passive.
- Learning and practicing relaxation techniques such as meditation, yoga, or tai-chi for stress management.
- Exercising regularly.
- Eating healthy, well-balanced meals.
- Learning to manage your time more effectively.
- Setting limits appropriately and learning to say no to requests that would create excessive stress in your life.
- Making time for hobbies, interests, and relaxation.~
- Getting enough rest and sleep.
- Not relying on alcohol, drugs, or compulsive behaviors to reduce stress.
- Seeking out social support; spend time with people you enjoy and who don’t raise your stress level.
- Seeking treatment with a psychologist or other mental health professional trained in stress management or biofeedback techniques.
How to manage diabetes stress
Most people want to stay healthy and take care of their bodies. This is why having diabetes can be so stressful.
Despite best efforts, blood sugar levels can still swing high and low at times. While nobody can eliminate these inevitable “off” days, there are steps people with diabetes can take to minimize the stress diabetes can bring.
- Check blood sugar regularly. Ignorance isn’t bliss, no matter how much people may dread having their routine blood tests done. Waiting every 3-6 months to have blood sugar checked by a healthcare provider can increase anxiety and stress. Instead, consider monitoring blood sugar levels at home to have a better idea of what your numbers are running.
The American Diabetes Association recommends the following blood sugar targets for those checking blood sugar levels at home:
- Discuss medications with your healthcare provider. Some people may stop taking their diabetes medications because they have a hard time remembering their dosages and schedule, or because the medication is too expensive. Finding a realistic and affordable treatment plan may help offset some diabetes stress.
- Exercise. Exercising helps to reduce stress, but it helps improve blood sugar control and heart health. Exercise doesn’t have to mean running for hours or going to a gym. Finding something you enjoy, such as gardening, walking, swimming, or riding a bike, all counts as exercise!
- Discuss your health goals with trusted friends and family. If people in your support system don’t know what you’re working towards health-wise, they won’t be able to offer support and encouragement. Confiding in someone you trust can make you feel like you’re not alone. Support is a very important aspect of health, both physical and mental.
- Keep up with regular healthcare visits. Avoiding going to the doctor and not having routine blood tests such as blood sugar, cholesterol, and kidney function can increase the risk of diabetes complications. While many people understandably don’t look forward to finding out their cholesterol or blood sugars are high, avoiding these appointments and tests may only cause more problems down the road.
Stress is present in everyone’s lives in some form or another. There are two types of stress; positive (eustress) and negative (distress). Most people associate the word “stress” with distress.
While having some distress levels is to be expected, having chronic ongoing stress can be detrimental to health. Chronic stress can lead to mental health problems like anxiety and physical changes, such as increased blood sugar and blood pressure.
Stress stimulates the body’s fight-or-flight system and releases the stress hormone cortisol. Cortisol can increase blood sugar levels, so managing stress in those with diabetes is vital for health.
Finding a good coping mechanism is essential for effectively managing stress. Everyone copes with stress differently, so that these coping strategies will vary widely from person-to-person. Examples of coping mechanisms include exercise, deep breathing, and mental health counseling.
Managing diabetes can be stressful; staying on top of treatment can help reduce stress. Checking blood sugar regularly, keeping up with healthcare appointments, and establishing a support system are all strategies to manage diabetes stress.