People with diabetes, as well as doctors and researchers, have long suspected that stress can affect blood glucose levels.

Although there is no clear evidence that stress alone can cause any disease, it is possible that it can bring on or worsen symptoms in someone already headed for disease.

Stress is a double-edged sword for people with diabetes, as with many chronic diseases. Stress may contribute to the symptoms of the disease, and living with diabetes can trigger stress.

How to handle diabetes and its associated stress is different for everyone. But you may find the strategies you use to handle other stresses can help with diabetes-related stress.

Stress is influenced by both the individual and the environment. Each of us defines what situations we see as stressful and how we respond to the stress. Both positive and negative situations can be stressful. Change almost always is. How stressful we perceive it to be depends on how good or harmful we find it to be and what else is going on in our lives. Something can feel stressful one day and not the next. Stress can have an effect on your blood glucose levels. Your body prepares for stress by sending out hormones. High or fluctuating blood glucose and ketone levels may result. If stress is short-lived and repetitive, levels of blood glucose and ketones may “bounce” considerably. Some people actually experience a low blood glucose level with an acute stressor.

It’s usually helpful to first recognize how you act when you are stressed out. Do you anger easily and take your feelings out on others? Do you cry easily or become depressed or withdrawn? Perhaps you feel emptiness or apathy. Maybe you reject help from those close to you or want extra attention from them.
Maybe you come down too hard on yourself.

One way to deal with a stressor is to eliminate it. If we can’t eliminate the stress, we need to find a way to deal with it. This is called coping. Everyone needs a variety of coping skills to use in different situations. Each person deals with stress in his or her own way. We usually behave in ways that are familiar to us.

Some of these strategies work and some leave us feeling tense, tired,  angry,  or sick.  Some,  such as smoking,  drinking too much, and drug abuse, cause other problems. Other techniques and ways of dealing with stress can help us to feel more in control, relaxed, and less tense after a stressful event. To determine if a strategy is effective, ask yourself, “Did it work? Did I feel better both temporarily and later? Is this an effective strategy to use in the future?” There are three important factors in coping -  having enough information, feeling in control, and having the support of others.

Some of the following stress management strategies might work for you

• Find someone to talk to and who will listen when something is bothering you. 
• Join a support group.
• Form a discussion or networking group on any topic or activity that interests you.
• Take up a new hobby or sport, learn a musical instrument, or join a dance class.
• Exercise - join a health club, sign up for an aerobics class, or just take a walk every day.
• Engage in volunteer work.
• Sign up for a class that interests you.
• Think of something you can do that relaxes you and do it read a book, take a bubble bath, get a massage, or watch a movie.
• Spend time with friends or alone, whichever will replenish you more.
• Pray or meditate.
• Do a relaxation exercise.
• Take a vacation or even a night away.
• Get a babysitter to give you some extra time alone or with your spouse.

Recognize that everyone has choices in life and you make your own choices. Pace yourself. Make it a point to identify and anticipate stresses, and create ways to deal with them ahead of time. You may not be able to control traffic jams, an angry boss, or a crying baby, but you do have some control over the way you react to these situations.

—
Martha M. Funnell, MS, RN, CDE
Michigan Diabetes Research and Training Center
University of Michigan Medical School
Ann Arbor, Michigan

Robert M. Anderson, EdD
Michigan Diabetes Research and Training Center
University of Michigan Medical School
Ann Arbor, Michigan

Shereen Arent, JD
National Director of Legal Advocacy
American Diabetes Association

American Diabetes Association Complete Guide to Diabetes