Managing Stress and Burnout
When you face a physically or psychologically stressful situation, your body starts a complex process of hormone release and reaction. The adrenal glands start to pump out cortisol, the hormone primarily responsible for our physiological “fight or flight” reaction to situations we perceive as dangerous.
Cortisol signals the liver to start up glucose production to give the brain and central nervous system added energy, while signaling the fat and muscle tissues to slow their uptake. It also causes the release of fatty acids from fat tissues, which are needed for muscle fuel, and sends your blood pressure up.
Stress also prompts the adrenal glands to release epinephrine, the hormone that provides the adrenaline rush of the “fight or flight” reaction. High levels of circulating cortisol and epinephrine promote insulin resistance in addition to ratcheting up blood glucose levels.
Since it increases blood pressure and glucose levels, stress is obviously not the best medicine for diabetes control. And it's dangerous because it may distract you from controlling your diabetes as you become preoccupied with other issues.
Essential
No one, and that means no one, has perfect diabetes management skills all the time. If you have an unforeseen high or low, don't take it as a sign of personal failure. Measure your success by your commitment to care. When a high or low happens, learn from the experience to prevent it the next time.
The Physical Toll
When you're ill or suffer an injury, your body is stressed and you need to test more frequently. The same goes for times when you are mentally and emotionally under duress. Audited by the IRS? On double shifts at work? Taking final exams? Make sure you test glucose levels more often then usual.
There is some evidence that extreme, chronic stress may actually cause or predispose an individual to type 2 diabetes. However, stress has also been associated with abdominal or visceral adiposity (that “apple” shape), so it's unclear whether stress causes a spare tire and the spare tire causes type 2, or if the link is a more direct one.
Make a Change
Fact
Physical stress like injury, illness, or trauma causes blood glucose levels to rise in type 1 and type 2 diabetes. Psychological, or mental, stress causes hyperglycemia in type 2 diabetes, and in most people with type 1 diabetes. However, some type 1 patients will actually experience a drop in blood sugars in reaction to psychological stress.
Studies have shown that stress management programs can be extremely effective in improving psychological well-being and diabetes control. One Duke University study published in Diabetes Care found that just five sessions of stress management training lowered A1C levels an average of half a percentage point.
The Duke study involved a stress-training regimen of audiotapeled progressive muscle relaxation, cognitive and behavioral therapy (including guided imagery and deep-breathing exercises), and education on the mechanisms and health consequences of stress.
Other good stress management techniques include yoga, music or art therapy, and journaling. Anything that calms you and allows you to relax and release is a good stress management strategy.
