Diabetes can affect your emotional and psychological health just as much as your physcial health. Family members can also experience sadness, guilt, fear, anxiety, anger, depression and burn out. After being diagnosed with diabetes it is quite common for you, and your loved ones, to go through an experience of grief.
Diabetes requires self management on a daily basis. This means you are in the the driver’s seat. You are also at the centre of your diabetes management team.
Diabetes is often an unpredictable and tricky condition to manage. It can be frustrating, and feel pointless. Diabetes can be difficult to control no matter what sometimes, and it can complicate life in general!
However living life with diabetes can be wonderful. It is important to remember you are a person first. People with diabetes are human beings dealing with an extraordinary condition.
Diabetes targets can raise stress
Targets in diabetes are important. We know that taking care of your body and managing diabetes well, will mean better chances of a healthy life. The kinds of things you might need to check on include blood glucose levels (BGL), HbA1c or A1c (the average BGL over the past 8 - 12 weeks), blood pressure and so on. Sometimes all of these checks and targets can contribute to you feeling like you are sitting an exam every day. If you worry about how your health care professional will react to your numbers, this is also unhelpful.
Numbers are numbers. They are not the biggest part of your life and they definitely do not define you as a person.
The results of BGL checks, managing your weight, choosing healthy foods, managing insulin ratios and exercise, can lead to guilt, worry and stress. If you start to worry a lot and especially if you feel like it is your fault, it can contribute to diabetes burn out.
Changing the way you think and talk about your diabetes can really help. As a parent it can help your child if you model more helpful and empowering ways to talk about their diabetes.
Talking about "high and low" blood glucose and not "good and bad" can be a healthy place to start. Using the words "check" instead of "test" when it comes to blood glucose monitoring and try not to judge the numbers. See them as numbers and a guide about what to do next.
It is important to remember that these targets are guides to your health and diabetes management. The results on your blood glucose monitor or continuous glucose monitor, are a tool to helping you and your health care team to make adjustments and work towards a healthy happy you.
These numbers are not ends in themselves. How you choose to use them will depend on the type of diabetes you have, how long you have had it and your personal needs and choices.
Diabetes can lead to specific problems and increased stress, which we call "diabetes distress". These are experiences and feelings that someone without diabetes would never have, and they relate specifically to diabetes and what you experience in living with the condition.
Daily life and general stress levels can affect your diabetes. How well your diabetes is going can also increase your general stress levels – so it is a bit of a chicken and egg! It is very important to try and manage the general stress in your life, as this will help you in managing diabetes. Likewise, feeling settled with your diabetes will decrease your overall stress.
If you are struggling with stress at work, or in your personal life, it can be harder to manage diabetes, and it suffers. We all experience stress and life would be boring without some stress! Some people say they would rather not have stress in their lives, but in fact you need a balance between just enough stress and not too much, to keep you alive and active. Not all stress is bad believe it or not.
Some of the things that can contribute to diabetes distress include:
- Worrying about food choices and changes so much that food becomes a negative thing
- Experiencing problems with blood glucose levels, especially if they are difficult to manage, or not doing what you want them to do despite your best efforts
- Lack of change when you are putting in a big effort around your diabetes
- Worrying a lot about your weight and finding it hard to lose or put on weight
- Starting insulin and/or changes to medication - times of change to your diabetes management
- Frustration that you can not afford the technology that is available for diabetes management now
- Being part of social media groups where people seem to be on top of things, but you feel like you are not managing - social media and online community are wonderful and very positive. However, if you are feeling left out, bullied or alone from these experiences, it might be important to step away and find a different group to connect with
- Experiencing a significant hypo/s (low BGL), especially if you needed someone to help you to recover from the hypo
- Experiencing difficulties in your relationship and/or sexual problems
- When experiencing work related stress or discrimination in relation to your diabetes
- Feeling like people don't understand your diabetes
- Feeling isolated and a lack of support
- Guilt, fear, worry, panic or anxiety about diabetes and your future
- Worrying about the risk of diabetes complications or experiencing diagnosis of a diabetes complication or other health problem
- Seeing or hearing about all the things that can go wrong with diabetes
- Feeling that your diabetes is running your life
- Being ignored or having your health care professionals treat you like you are not part of the decisions around your diabetes
- Experiencing other mental health problems such as an eating disorder, anxiety or depression
- Feeling overwhelmed and exhausted
- Lack of sleep, exercise and things that increase your general wellbeing
- Lack of information
- Times of additional stress or grief in your life
- When you are going through change or transitions such as teenage years, leaving home, starting a new job, a new relationship, pregnancy, menopause, growing older
It is not all doom and gloom!
It is not inevitable that you will have all or any, of these problems. Even if you do, in many cases they will pass. You may need to acknowledge the issues, understand them and be gentle on yourself. Some problems will need professional support and help is vital - never do diabetes alone.
You may or may not experience some ups and downs with your diabetes and this might lead to increased stress.
We are all different.
What is important is to understand that diabetes is in itself a full time job and managing it can bring increased stress. This can make it easier to be gentle on yourself when things get tough and to seek support in managing. Relaxation and mindfulness are very useful tools.
What is stress?
In basic terms if what you are being asked to do at this point in time is too much for you, you will experience stress. What you can handle will vary from day to day and even within a day, and will vary from person to person. This means your ability to cope with stress will also vary.
Stress is caused by a range of different events or circumstances. Different people experience different aspects and identify with different definitions.
Stress and worrying
Even imagined change can be a stress. This is what we tend to call "worrying". If you worry that you will not have enough money to pay your rent, or that you might suffer the complications of diabetes, that can lead to increased negative stress. This kind of stress is something you can learn to manage. You can tune into the way you are thinking about things, and stop this worry in its tracks, minimising the impact on your body and your life.
- Regular relaxation and time out can help you to minimise worry.
- Talking to other people about your worries, rather than keeping them to yourself, can also help.
"Catastrophising" when something goes wrong also increases your stress - this is the "it's the end of the world"; "everything happens to me" kind of thinking. If one small thing goes wrong it is easy to start linking it to all the other things that have happened and then see this as "the end of the world". Learning how to keep this thinking in check can really help minimise stress.
A major source of stress is overdoing things. If you push yourself too much you have less rest time. Eventually you will "hit the wall. If ongoing, permanent damage may be done.
What happens to our body when under stress?
Fight or flight response
When faced with a threat an automatic response is set off in your body – the fight or flight response. This was an essential tool for human survival, developed over many thousands of years living in wild and dangerous places. To us, living in today's world, it is often an ineffective response, which can actively prevent you from responding usefully to a problem situation – just think about road rage!!
Fight or flight is a response to anything which is perceived as a threat, or a potential threat by your body – it is not something you think about – it just happens.
This begins when certain primitive parts of the brain send a message to the adrenal glands which release a number of hormones including adrenaline, whose purpose is to prepare the body for vigorous emergency action.
The main changes that follow are below:
- Non-essential processes are immediately switched off by your body. Things you don’t need right now are turned off. In particular, if the body is digesting food, that is stopped immediately, and you can notice a feeling of churning or 'butterflies' in the stomach, or feeling nauseous or sick.
- A number of other changes follow, to make the muscles as strong as possible
- The liver releases stored glucose into the bloodstream.
- Fats are released into the bloodstream from the fat stores in the body. These are fuel for the muscles, so oxygen is needed to burn them - and so the breathing increases. Those under stress may notice feeling breathless.
- The body needs to get fuel to the muscles - (remember, the body thinks this is a life or death emergency) - so the heart begins beating far faster - some people notice palpitations.
- Blood pressure rises, some people notice feeling hot or cold - breaking into a sweat, as the body seeks to spread out the heat that will be generated by vigorous muscular activity, for which body is preparing.
- Becoming ready for instant action, muscle tension increases, and a person may notice shaking, or becoming restless and fidgeting.
Some people feel like this often and if this pattern is continued for long enough, chronic headaches, backache and other physical complaints may result i.e. chronic stress.
At the same time as all this muscle action is happening, blood supply to the front parts of the brain, responsible for higher levels of reasoning is reduced, while the blood supply to the more primitive parts, near the brain stem, is increased. These parts of the brain are responsible for automatic, or instinctive, or impulsive decision making & behaviour.
A person undergoing a stress response may be prone to impulsive thinking and behaviour - which they may thoroughly regret later – this means we can say and do things without thinking clearly.
There are a number of ways in which chronic stress can impact on your body and general health:
- Brain -fatigue, aches & pains, crying spells, depression, anxiety/panic attacks, sleep disturbance
- Gastrointestinal Tract - Ulcer, cramps & diarrhoea, colitis, irritable bowel
- Glandular System - Thyroid gland malfunction
- Cardiovascular (important for diabetes) - High blood pressure, heart attack, abnormal heart beat, stroke
- Skin - Itchy skin rashes
- Immune System - Decreased resistance to infections
How does stress affect diabetes?
Stress can cause BGL's to rise.
Feelings of distress, especially when intense and long lasting, can show an increase in HbA1c (or A1C) with this typically higher in those struggling with difficult conditions at work, home or problems such as depression. Yet laboratory studies have not shown that stress consistently raises BGL – some studies show that it does and some show that it does not!
Many people report that stress does raise their BGL and we know that when life becomes busy, stressful and overwhelming, diabetes can take a back seat. In this case the stress raises BGL as the situation causing the stress interferes with diabetes management, rather than a direct effect on blood glucose levels.
The best answer to how stress affects diabetes is taken from Dr William Polonsky – “Diabetes Burnout” book :
- Stress can have a negative effect on diabetes self management, but only for certain people at certain times
- Stress can have a direct and immediate effect on BGL but only for certain people at certain times
If you are significantly distressed over a long period of time it is likely that you will begin to have problems managing your diabetes. Stress might affect your ability to exercise or follow a meal plan for example. In this case it is how you understand and respond to stressful events that is the key to managing diabetes when under stress. Interestingly not all types of stress appear to make BGL rise.
Situations where you feel trapped (in that you can not make changes) or where you feel things are out of your personal control appear to be most likely to influence BGL directly.
How sensitive are you to Stress?
Some of us are more sensitive to stress than others. Scientists believe that there are 3 types of people:
- Stress insensitive – BGL not directly affected by stress
- BGL rises under conditions of stress
- BGL drops when stressed
Some people might experience elements of all of these at different times. You can experiment to see what happens to your BGL when under stress. This might be by tracking your BGL when under a particular stress to see what happens and/or checking BGL prior to and following a relaxation session over a week or so, to see if your BGL decreases.
Diabetes Burn Out
Diabetes Burn Out is a common problem. Diabetes is like a full time job and the day to day effort to manage can become overwhelming. This is especially true when the results are not what you would like them to be and you know you have done all you can.
Burn out is much more than feeling a little down. It is an overwhelming feeling of helplessness and hopelessness that you can not go on with your diabetes management - people often give up at this point, and depression can also occur.
If you think Diabetes Burn Out has or may happen to you these tips may help:
- Think about what particular areas of diabetes are causing you problems. Sometimes people say it is “just diabetes” that is the problem, but often there are specific areas that are causing problems and you are actually doing ok with other areas. It can be helpful and very positive to see that it is not everything about your diabetes that is difficult. For example you may be ok with checking your blood glucose and exercising, but not so happy with the way you are managing your food intake. Seeing the things you are doing well with gives you something to build on and gives perspective.
- Consider what’s happening in your life that might be conflicting with diabetes care? What is making it harder at the moment for you to manage diabetes? What blocks and barriers are there and how might you deal with these other parts of your life? Sorting these things out will in turn make diabetes management easier.
- Work out what your expectations are for your diabetes management at the moment? What are your targets? What do you want?
- And are your goals realistic right now? Sometimes we expect too much, or too little of ourselves. You may need to work harder, or ease off on your diabetes management depending on what else is happening in your life and with your health.
- Look at whether there difficult emotions you need to deal with? Emotions such as sadness, anger and grief may be present due to diabetes diagnosis, depression or another event in your life. These emotions can be uncomfortable but very important. Acknowledging and accepting these feelings, then working through them so you can move on with your life can help.
- Finally do not suffer in silence. Always seek support if needed. This may be from your usual doctor, diabetes educator of other team member. A friend, family member or someone else you trust. A counsellor or psychologist. Or a service such as ours where you can access counselling, support and understanding in one place.
Stress and Relaxation
Too much "fight/flight" activity (or in other words too much stress), without corresponding rest and relaxation, leads to distress. Importantly you can bank your rest and relaxation times. By practicing regular relaxation and rest times you give your body some time to heal itself and stay strong in the face of the inevitable stresses of life.
This may be listening to quiet music, getting out in the garden, walking in the sunshine, playing a game with your child, or using guided relaxation practices. We highly recommend learning and practicing guided relaxation. It gives a much deeper relaxed state for the body and mind than many other things and can make a large difference to depression and anxiety.
Stress Management and Exercise
Exercise is critical to overall health. The current recommendation for adults is 30 minutes moderate every day if you can and at least 4 - 5 times week (60 minutes a day for children). We now have so many convenience machines and often sedentary lifestyles, that structured exercise is even more important. This does not need to be at the gym!
Walking is one of the best forms of exercise and it is free! Swimming and water based exercise are great for people with mobility problems. If you need help to work out the best exercise for you, an exercise physiologist can be great. You can access one via a diabetes care plan - just ask your GP to refer you to someone as part of your 5 allied health care visits. They can then set this up and work out an exercise plan that will work for you and your abilities. Hop across and have a look at our Diabetes and Exercise page.
Apart from the obvious physical health benefits exercise is also vital to stress management as it encourages that parasympathetic (rest and relaxation) response, calms body and mind and uses excess energy and muscular tension.
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