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Book 7: Handling Stress
Introduction
Stress is not always bad. We need some positive stress in our lives to function. We do not need negative stress. Unfortunately, we can't always
control the negative stress in our lives. What we can control is how we deal with stress.
Stressful situations may affect our ability to manage diabetes effectively. The purpose of this book is to help you learn how to deal with those
situations in order to maintain a healthy lifestyle.
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Book 7: Handling Stress
What is stress?
Stress occurs when your body believes it is under attack. Stress comes from physical or mental sources (for example, traffic, public speaking,
being in hot or cold weather). When stress occurs, our bodies prepare to take action with a "fight-or-flight" response. This response increases
hormone levels. Higher hormone levels cause stored energy (glucose and fat) to be made available to the cells. This energy helps us sprint away
from danger. It helped many cavemen escape from hungry saber-toothed tigers!
For persons with diabetes, the "fight-or-flight" response is not as effective because insulin is not always able to let the extra energy into the cells.
This causes glucose to increase in the blood.
This problem is made worse when sources of stress are not short-term threats but long-term threats (the saber-toothed tiger built a den next
door). Stress hormones, designed to deal with short-term, immediate threats, continue to circulate in the blood. As a result, long-term stress can
cause high blood glucose levels.
Many long-term sources of stress are mental. Our minds can react to events as if they are a life-or-death threat even if they are not dangerous
(for example, an audit by the Internal Revenue Service). Like physical stress, mental stress can be short-term or long-term. Our body continuously
pumps out hormones, even though the stress is only in our minds. Fighting or fleeing will not provide relief. More examples of situations that may
cause stress are in the box below.
What is Stress?
Stress is the way your body reacts to demands that are placed on it. These demands can be good or bad. Below are examples of situations that
may cause stress.
{
{
{
{
{
Traffic
Retirement
Feeling rushed
Having a baby
Being out in hot
or cold weather
{
{
{
{
{
Job Promotion
Divorce
Arguing
Public speaking
Changes at work
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Book 7: Handling Stress
The harmful side effects of stress
It is good to have some stress in our lives. Stress can be motivating. It can help us stay alert for a test or give us a "competitive edge" in sports.
Too much stress, however, can be unhealthy.
How Does Your Body Respond to Stress?
Your body responds to stressful situations, good or bad, in the same way:
{
{
{
{
{
{
{
The heart beats faster
Breathing becomes more rapid
Food stored in the body is turned into energy
Muscles become tense
Digestive juices are released in to the stomach
Sweating may increase
Senses like taste and smell are heightened
These changes occur to help prepare us to deal with stressful situations. If we experience these changes for extended periods of time, however,
they can be harmful to our health.
Some of the Harmful Side Effects of Stress
{
{
{
{
{
Stomach aches
Backaches
Extreme tiredness
Diarrhea
Indigestion
{
{
{
{
Headaches
Rashes
Trouble sleeping
Stiff neck
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Book 7: Handling Stress
How stress affects blood glucose levels
The table below summarizes how stress may affect individuals with diabetes.
For individuals with type 2 diabetes, controlling stress with relaxation activities seems to have a very positive impact. Stress blocks the body from
releasing insulin. Reducing stress, therefore, releases insulin. This keeps blood glucose levels lower. In addition, some people with type 2 diabetes
may also be more sensitive to some of the stress hormones. Relaxation can help decrease this sensitivity. Individuals with type 1 diabetes do not
produce insulin, so stress reduction does not have the same effect.
Type of Stress
Type 1 Diabetes Type 2 Diabetes
Physical Stress
(For example, illness, injury or trauma) Blood Glucose
Mental Stress
Blood Glucose
or
Blood Glucose
Blood Glucose
Blood Glucose
Try the exercise:
Find out how mental stress affects your blood glucose level. When testing your blood glucose level, write down a number rating your mental
stress level on a scale from 1 to 10. Then write down your blood glucose level. If you see a pattern between high mental stress and high blood
glucose levels, you may benefit from relaxation activities.
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Book 7: Handling Stress
Mental and emotional health concerns
Like other chronic illnesses, diabetes may cause mental and emotional concerns for you and your family. These concerns come from possible
discomfort due to your diabetes, hospitalization, changes in lifestyle or job type, physical disabilities, or threatened survival. Because of these
situations, mental or emotional concerns can make it difficult to manage diabetes.
Some groups in the diabetic population appear to be at greater risk for mental and emotional concerns.
{
{
{
Teenagers and people in their 20s with type 1 diabetes may be more likely to have eating disorders such as anorexia nervosa and bulimia.
Adults with long-term diabetes and with major health problems are more likely to have signs of depression and anxiety.
Adults over age 64 with type 2 diabetes and other chronic conditions may be at a higher risk as well.
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Book 7: Handling Stress
Barriers to self-care
Barriers are like roadblocks. Sometimes the direct route to our target is blocked by unexpected objects. As a result, we have to take a different
route and seek other ways to get to our target. If we accept there will be roadblocks and plan for them, they will not be as bad when they happen.
Because psychological and social problems can impact our ability to follow a self-care plan, it is important to recognize what may be a concern.
Some concerns may be:
{
{
{
{
{
{
{
Hoping for an early cure
Believing your self-care plan is too difficult
Believing treatment is unlikely to improve or control your health problems
Stressful events in your life
Health problems other than diabetes
Lack of support from family and friends
The way your medical care is being handled
Steps to Address Barriers
{
{
{
{
{
Find your level of acceptance of your diabetes.
Create a self-care plan that is "do-able". You can always create new goals along the way.
Search for ways to gain faith in your treatment and how it will make a positive impact in your life.
Find people in your life who can support you in managing your diabetes - this could be a spouse, parent, child, friend or your doctor.
Understand what role your doctor can play in helping you manage your diabetes. Make sure you choose a doctor that supports your beliefs,
feelings, and the role you play in managing your diabetes.
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Book 7: Handling Stress
Diabetes and beating denial
For some of us, "denial" is a big river in Egypt. For our purposes, however, denial is not completely accepting a problem. Many people go
through denial when they first learn they have diabetes. This first reaction is not the real problem. The real problem comes when we keep denying
our diabetes. Long-term denial stops us from learning what we need to know to keep ourselves healthy
Why Deny
Sometimes denial serves a purpose. It is a way of dealing with bad news by pretending it does not exist. Denying that we have diabetes is
serious because it lets us avoid self-care. It shields us from the fact that diabetes is a chronic disease which, if left untreated, can result in future
problems. Denial also lets our family and friends believe nothing is wrong. It is important that we take our treatment and care seriously, no matter
how mild or severe our diabetes.
Spotting Denial
If we hear ourselves thinking or saying any of the following things, we are avoiding some part of our diabetes care.
{
{
{
{
{
One bite will not hurt.
This sore will heal by itself.
I will go to the doctor later.
I don't have time to do all the blood glucose testing, meal planning or exercise.
My diabetes is not serious. I only have to take a pill, not shots.
Avoiding Denial
Denial is human. It creeps up from time to time. When it does, we can recognize what is going on and fight back.
Try This Exercise
Refer to goal planning included in the
Taking Charge of Diabetes links on the
left. Write down your diabetes care plan
and your goals. Identify why each item in
your plan is important. Accept that it will
take time to reach your goals. If you find
you are denying part of your diabetes
care, ask for help from your doctor or
other health care professional.
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Book 7: Handling Stress
Diabetes and anger
Anger can start when diabetes is first detected, and if not dealt with can lead to further health problems. Things you can do to break the vicious
anger cycle:
{
{
{
{
Decide what is making you angry
Identify how anger is affecting your life.
Keep track of when you feel angry.
{ When were you angry? What time was it? Who were you angry with? What did you do about it?
{ After several weeks of tracking your anger, do you see any patterns?
Change the thoughts and physical actions that add to your anger. Look for warning signs. Do you feel tense? Are you talking louder and
faster? Calm yourself in the following ways:
{ Talking slowly
{ Slowing your breathing
{ Getting a drink of water
{ Sitting down
{ Leaning back
{ Keeping your hands at your sides
{ Quieting yourself
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Book 7: Handling Stress
Diabetes and depression
Feeling down once in a while is normal, but if we feel a sadness that lasts for two weeks or more it may be a sign of depression. Like denial,
depression can pull you into a bad cycle. It can prevent diabetes self-care. Depressed people often have little energy. The tasks of diabetes selfcare may seem too much to handle.
What to Do
Spotting depression is the first step. Getting help is the second. If you have three or more of the following symptoms, or if you have just one or
two but have had them for two weeks or more, call your doctor.
{
{
{
{
{
{
{
{
{
{
Loss of pleasure
Change in sleep patterns
Waking up early
Change in appetite
Trouble thinking clearly
Loss of energy
Nervousness
Guilt
Morning sadness
Suicidal thoughts
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Book 7: Handling Stress
Stress and personality types
One factor affecting our reaction to stress is our personality type. People with type A personalities may have higher glucose levels when under
stress. Type A people tend to be more anxious, hostile or angry. In the same situation, type B personalities may have lower glucose levels. These
people are more likely to be easygoing.
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Book 7: Handling Stress
Dealing with stress
It is important to remember that the "situation" is not creating the stress. It's how we react to the situation that determines if the situation is
stressful. When something unexpected occurs, you can choose not to overreact.
Barriers to Being Stress-Free
Look over the following list and ask yourself if any of these characteristics apply to you.
{
{
{
{
{
{
{
{
{
Doing everything at the last minute
Wanting everything to be perfect
Never saying no
Taking on too much responsibility or too many tasks
Not planning ahead
Too busy helping others
Spending too much time on minor things
Easily distracted
Inability to handle unexpected events
Think about how difficult it would be for people to manage stress if they allowed these barriers to exist in their everyday lives. These are all things
that you can control. The next time you experience a stressful situation, think about it. Could you have changed anything to prevent the situation
from happening? Try making the necessary changes so these barriers no longer exist. Set goals to help manage your time and activities. Ask
yourself:
{
{
{
"What has to be done?"
"When does it have to be done?"
"How much time can I spend?"
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Book 7: Handling Stress
Quick ways to reduce stress
Below are things you can do when you feel stress.
Deep Breathing
Get in a comfortable position, close your eyes and breathe in deeply until your lungs are completely filled. Release the air at a slow comfortable
pace. Think of the "good air" you are breathing in as the solution, and the "bad air" you are releasing as the problem.
Progressive Relaxation Therapy
Get in a comfortable position. Close your eyes. Try performing this exercise while listening to relaxing music. Tense certain muscle groups and
then relax them, moving down the body from head to toe.
Positive Mental Images
After you have relaxed with a few deep breaths, picture yourself successfully completing an event or situation. Think positively, and see yourself
succeeding.
Exercise
Turn your stress into something useful. A bike ride or a walk will leave you feeling confident and in control.
Be Sociable
Call a friend or go to lunch with someone with whom you feel at ease. Talk about something enjoyable that you both share.
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Book 7: Handling Stress
Humor and laughter
Have you heard about the man with a terminal illness, and how he was able to laugh himself back to health? He was able to do this because,
unlike stress that is known to cause illness, laughing is known to increase your ability to fight off illness. A good way to deal with stress is to fight it
with laughter.
Laughter has often been referred to as "inner jogging." When you laugh, your muscles contract and your heart rate increases. Afterwards, your
muscles are more relaxed than they were before and your blood pressure dips below normal. Laughter also releases endorphins, a natural
chemical in your body that makes you feel good.
{
{
Bring comic books or fun little games to work and find time to play when you start feeling a little stressed.
Unwind with a tape of Monty Python or the Three Stooges at the end of a grueling day.
Open yourself up to humor and make an attempt to enjoy yourself.
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Book 7: Handling Stress
Using your personal power
Remember a time in your life when you felt good about something - a time when you were in charge and happy with yourself. Remember your
mood and how you behaved with people around you. Remember this feeling.
Look at the list of words below and check off the ones in the left-hand column that best describe how being in charge made you feel.
j Joyful
k
l
m
n
j Downhearted
k
l
m
n
j Confident
k
l
m
n
j Insecure
k
l
m
n
j Strong
k
l
m
n
j Weak
k
l
m
n
j Secure
k
l
m
n
j Vulnerable
k
l
m
n
j Happy
k
l
m
n
j Depressed
k
l
m
n
j Content
k
l
m
n
j Empty
k
l
m
n
j Controlled
k
l
m
n
j Scattered
k
l
m
n
Look at the words in the right-hand column. These words describe how we often feel when we are stressed. Personal power is the opposite of
what we feel when we are stressed. When we feel in charge, we are in control of the stress that is a part of everyday life.