Stress Can Aggravate Diabetes

Stress makes diabetes worse, even if you are doing everything you can to control your condition.

That's why a person with diabetes must recognize and manage stress to control the disease, says Richard S. Surwit, Ph.D., vice chairman of the department of psychiatry and behavioral sciences and chief of the division of medical psychology at Duke University Medical Center in Durham, N.C.

Controlling diabetes is difficult. You have to worry about so many things: your blood sugar, giving yourself insulin, what you eat, when you eat, getting enough exercise, taking care of your feet. The list goes on and on. Stress complicates an already complicated disease.

Stress has a profound impact on the body, by triggering a cascade of hormonal reactions, including "fight-or-flight hormones." That means when your mind becomes anxious, stressed or fearful, hormones rev up to help your body release extra sugar into your blood stream for the energy needed to deal with the situation.

"In diabetes, your blood sugar just stays up unless you increase your medication," Surwit says. He has studied the impact of stress on diabetes for 20 years and wrote a book called "The Mind-Body Diabetes Revolution."

Stress, Good and Bad

Different kinds of stress create this fight-or-flight response. Some are good and some are bad. Good stresses can be your daughter getting married. A bad stress is where your boss is breathing down your neck. Nevertheless, any kind of stress causes this hormonal reaction.

Physical stresses such as having a heart attack or developing pneumonia, as well as mental stresses such as depression, raise the amount of stress hormones your body produces. In someone predisposed to diabetes, such as someone who has family members with the disease, physical and mental stress can trigger the onset of diabetes. However, researchers say stress does not cause diabetes.

Start With Awareness

Recognizing when you are stressed and what is upsetting you is important.

"Most of us under stress are not aware of the effects of stress. Sitting in a traffic jam can cause many of us to feel aggravated. The heart rate goes up and muscles tense," Surwit says. "We may miss these sensations from the body. We don't realize just how much stress we are under."

Surwit's research shows people with diabetes who use stress management techniques as part of their treatment can significantly reduce their average blood sugar levels. The effect in many cases can be just as effective as some diabetes-control medications.

Surwit suggests trying techniques such as progressive muscle relaxation and cognitive behavioral therapy.

"Progressive therapy involves learning to tense and relax major muscles in a sequence. It can produce a profound effect," he says. "A lot of us are walking around under a high level of arousal. What we do is get people to monitor and modulate themselves to reduce the stress hormones."

Relaxation help you turn off your body's fight or flight response. When you relax, you lower the levels of stress hormones in your blood, which lowers muscle tension, blood pressure, heart rate and blood sugar.

With progressive muscle relaxation, you systematically tense and relax the muscles in your body. Cognitive therapy lets you understand the situations and thoughts that cause stress. Such thoughts might include "Nobody likes me" and "I'm worthless."

Surwit offers techniques to help you relax:

Keep your mind open. Allow your body to relax naturally.
Empty distracting thoughts from your mind.
Practice, practice, practice. Relaxation is something you have to learn to do.
Find a quiet place to relax. Turn off the television, the radio and the phone's ringer.
Sit. Don't lie down. If you lie down, you're more likely to fall asleep.
Take it slow. Don't rush time you spend relaxing.

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