Some people cope with stress by overeating or eating unhealthy foods, smoking, drinking and performing other activities that raise their risk for type 2 diabetes. As a reminder, we need to note that stress may be thought of as a) a physiological response to an external stimulus, a psychological response to external stimuli or stressful events themselves, which can be negative or positive or both. Essentially, stress can be considered as anything that tends to change the control that we have over our body and our emotions. For a detailed explanation on the stress mechanism, refer to the article on the introduction to the stress series. There is an established relationship between stress and diabetes and that stressful experiences have an impact on diabetes. The compacted effects of stress on diabetes are due to the emotional and psychological problems preventing diabetics from managing their illness more effectively.
Raising blood sugar is important in stressful situations, as the human body is notified to get glucose – the fuel – levels up in preparation for a lot of physical and mental activity. People who struggle with short and long term stressors often have a loss of appetite and so engage in unhealthy eating patterns or overeating to relieve stress or depression. They are also very likely to discontinue exercising. In addition to these lifestyle changes, the effects of the actual stressors help raise blood sugar levels which invariably affect a diabetic’s health. This relationship may be on the onset of diabetes, the effect it has on glycemic control and the effect it may have on the lifestyle of the diabetic patient.
In people who have diabetes, stress can alter blood sugar levels in two different ways. In the first instance, hormone release which is part of the body’s fight-or-flight response, prepares the body to take action at the first sign of trouble or run away in the other direction. Indeed, you can’t readily fight danger when your blood’s sugar is low, so it rises to help meet the challenge. Cortisol, adrenaline and other hormones release a surge of energy in the form of glucose (sugar), which the body can use to fight or flee the threat or problem. In fact, the rush of glucose is no problem if our body’s insulin response is working correctly. Normally, with diabetics, their bodies can’t move glucose as efficiently into cells as it does with people without the disease. This leads to a buildup of sugar in the bloodstream. That is, insulin is not always able to let the extra energy into the cells, so glucose piles up in the blood.
The situation captured above is worsened, especially when many sources of our stress are not short-term threats but long-term chronic stresses. Stress hormones that are designed to deal with short-term danger are forced to stay turned on for a long time. As a result, long-term stress can cause long-term high blood sugar levels. Many long-term sources of stress are mental in the form of taking a test to getting stuck in a traffic jam-a situation that is very common in our major cities today. It can also be long term. For instance, working for a demanding boss, taking care of an aging parent, living in an abusive relationship and financial worries. In such mental stress, the body pumps out hormones to no avail for almost eternity which in effect will increase the blood sugar level perpetually with no or little insulin to the rescue.
Secondly, Stress also can affect your blood sugar levels indirectly by causing you to forget about your regular diabetes care routine and you may not take good care of yourselves. When you’re stressed out, you might: exercise more or less; eat more or less; eat less healthy foods; not test your blood sugar level as often and forget or delay a dose of medication and/or insulin. People who are anxious are under pressures and may lose appetite and skimp on eating, or reach for not-so healthy food like biscuits, chocolates, sweets, pastries or chips and drinks. Such persons may even take these foods between meals.
Again, many of us are likely to use food as a source of ‘comfort’ or may turn to food as a means of ‘stress release’ or coping mechanism. This pattern of ‘comfort eating’ or ‘stress release’ will definitely increase blood glucose or sugar level. The anxiety they develop leads to less exercise, a situation that can be disastrous for diabetics. In addition, when your attention is focused on a bad job, an unprepared examination or troubled marriage, you have less energy to think about taking your insulin or eating healthy meals.
Moreover, knowing that you have been diagnosed of diabetes can be emotionally overwhelming and very stressful considering the reality that you are not only faced with a diagnosis of a chronic illness, but you are also going to deal with adjusting your lifestyle and daily habits to manage the disease. It is important to note that, as a type 2 diabetic, stress may make your blood sugar to go up and become even difficult to control. In controlling it, you may need to take higher doses of your diabetes medications or insulin.
A chronic condition like diabetes itself may propel some of us into a never-ending cycle stress. This happens because, an event that is seen by one individual as particularly threatening might be seen as totally harmless by another individual. However, when a situation is regarded as threatening, that is, seen as having the potential to cause harm to the individual, the stress or “fight/flight” response is elicited. When you get stressed and your blood sugar rises, it stresses you out even more. Often, people newly diagnosed with diabetes have trouble accepting the diagnosis, especially if they feel physically healthy and are not experiencing any symptoms of the disease. Some emotional reactions are denial, disbelief, guilt, anger, depression and anxiety and learn how to accept their condition which is the starting point for the management of diabetes.
In conclusion, the stress hormones kick in when we are stressed, since one of their major functions is to raise blood sugar to help boost energy when it’s needed most. Both physical and emotional stress can occasion an increase in these hormones, resulting in an increase in blood sugars. Stress can also have an indirect effect on your blood sugar levels by causing you to forget about your regular diabetes care routine. It is important to note that learning how to manage stress and actually, managing your stress can ultimately help you better control your blood sugar levels. Therefore, as diabetics, regulating your stress level is key to treating your diabetes.
ERIC HOWUSU-KUMI, Mphil Psyc
Member; Ghana Psychological Association
THE TRUST SPECIALIST HOSPITAL, OSU.