Anyone who has diabetes must become aware of anything that encourages the release of glucose into the bloodstream. The result is an elevated blood sugar. This physical response is different in each person, due to individual emotional and physical factors as well as environmental considerations. As already noted, being diagnosed as having diabetes is stressful, as is being told that you have a complication of the disease. Having various pressures in life that influence the control of the disease is also stressful. Any event or information could be the "stressor." Any physical response you have to that event or information is called stress. When you experience stress, your body responds by circulating blood faster. Glucose is "poured" from its storage sites (the liver and muscle sites) into the bloodstream. Your blood pressure increases, as does your pulse rate (except in a frustrated type of stress response, in which your pulse rate may actually slow down). A variety of signs and symptoms may be noted, including dilation of the pupils.
Acute Response
The most frequent, rapid response a person experiences during stress is called the alarm (or acute) response. It is termed "acute" because the adrenaline release occurs within a short time. The brain sends a message to the adrenal gland, telling it to secrete adrenaline. This adrenaline release, which may take from seconds to minutes, occurs when the blood glucose is too low, when the person is scared or excited, or when the body thinks it is at risk. When adrenaline is released, there are many physiological responses. Adrenaline stimulates an increase in heart and pulse rate. It is also indirectly responsible for the cooling effect of the body (perspiration). Blood vessels in the hands and feet narrow. For the person with diabetes, the most common responses experienced with hypoglycemia are due to adrenaline release. This adrenaline release results in weakness, shakiness, and a strong, rapid pulse. These symptoms stop when the blood-glucose levels rise to normal. When the sugar in the system is already high, the person usually feels the response of high blood sugar rather than the adrenaline released. The major purpose of adrenaline release in a person with diabetes is the subsequent release of glucose into the bloodstream. It is thus both a blessing and a curse: a blessing in raising low blood sugar, and a curse in adding to the problems of diabetes control by rapidly raising the blood sugar above normal.
Chronic Response
In most cases, the acute response rebalances the body, making the person able to deal with the problem at hand. The chronic (day-to-day) problems associated with having diabetes affect the body somewhat differently. A little cortisol release is helpful; a lot is not. Cortisol is a steroid type of hormone, released from the outside section of the adrenal gland. The body’s response to cortisol is to increase blood pressure and to decrease the pulse rate. Other things that happen are a decrease in the number of white blood cells and the changing of amino acids (protein) into sugar (glucose). The release of these cortisol types of hormones occurs in minutes to hours.
Other hormones in the body that affect the blood-glucose levels, either directly or indirectly, are glucagon, thyroid-stimulating hormone, and growth hormone. Growth hormone is released even in adults; the result is a greater mobilization of fats for energy, leaving glucose in the bloodstream. All of these counterregulatory hormones wreak havoc on blood-sugar control. Even when no food is eaten, blood-sugar levels can be high at one time and low at others. Some doctors have termed this "brittle diabetes." Whether it has to do with lifestyle or with poor management, the results are the same.
Other Responses
Although there are multiple factors that lead to the physical stress response, it has been found that these factors are not as simple as originally described by world-renowned stress researcher Dr. Hans Selye. Multiple causes, which vary from person to person, are responsible for the body’s physical, mental, and emotional responses. Dr. Selye’s General Adaptation Syndrome can be adapted to assist you in knowing why you feel the way you do when your blood sugar is low, and why your body becomes your own enemy when your blood sugar is high.
The first phase is rightly called the alarm phase. The feelings you get could be associated with acute happenings such as diabetic ketoacidosis and hypoglycemia. The feelings are most noticed when you are in hypoglycemia. Blood pressure rises, the pulse rate increases, and you feel shaky, nervous, tense, and anxious. Sugar is made available to the body due to an adrenaline release.
The second phase is that of resistance. This is associated with the release of steroid-like hormones. The person has a sense that nothing can be done. If a person diagnosed with diabetes has difficulty adjusting to the disease physically, mentally, and emotionally, self-care may be ignored. The chronic high blood sugars lead to changes in the body cells, which can lead to complications.
The third phase is the exhaustion phase. While complications during the other phases are usually reversible, in this phase they are less so. If control is established so that stability is maintained, a little improvement might be noted, but problems are still likely. However, in individual cases in which there have been some eye, kidney, and neurological changes, some women have chosen to become pregnant once these problems have been contained. With teamwork, a positive outcome of a healthy baby and a stable mother has been shown to be possible. Keeping the blood-glucose levels normal throughout the pregnancy can thus enable a woman to have a good pregnancy despite her body’s being in the exhaustion phase of stress due to diabetes.
Stress Management
What can you do about stress? There are a number of ways to handle it. Becoming your own parent is one.
Positive Thinking
Believe it or not, you can increase the release of the hormone endorphin, which leads to increased physical strength, if you think positively. If you consider a person you know to be a negative thinker, you may also recognize how frequently that person is ill. Positive thinking is thus associated not only with physical strength but also with an improved level of health.
Attitude
Your attitude comes from the beliefs you have and thus develops from the inside out. Your attitude affects your diabetes by supporting you to make correct choices. Therefore, a good attitude is very important in self-management.
Relaxation
There are many ways to relax. These may be partial relaxation or complete relaxation. It is interesting that after spending much of our lives conditioning ourselves to respond to stress, most of us actually need training to learn how to relax properly. First, you need to become aware of whether what you are currently doing to relax is really relaxing to you. Check this out by getting an alcohol thermometer. Hold the bulb lightly between the thumb and forefinger until the red-dyed alcohol is stable, indicating the present body temperature of your hands (this is called "peripheral body temperature"). This temperature indicates how relaxed you are. When the temperature of your fingers is in the seventies or eighties, it usually means that you are more tense (or cold!). When it is either in the nineties or four degrees higher than your previous temperature, you are more relaxed. The more the peripheral blood vessels open (dilate), the more the muscles have relaxed and the more blood flows unobstructed to your fingertips.
After you have noted this temperature, do what you normally do to relax (for example, read, watch TV, walk, or work on a hobby project). After 10 or 20 minutes, sit quietly for about a minute with your hands in your lap, then take your peripheral body temperature again. If you have completely relaxed, this second temperature should be four degrees higher than the first temperature, as noted earlier. If the temperature hasn’t changed or is lower than the previous temperature, note that the activity you tested, while not necessarily bad, is not an activity to undertake if you want to relax your body.
The training goal of relaxation is to get into a state in which you "get out of the way of yourself." Any process may be used, but all approaches must have one thing in common: they must focus your mind on something other than your problems. Deep breathing, progressive relaxation, autogenic therapy, meditation, and imaging are some of the techniques that can be used. The training process for any of these techniques will take anywhere from 6 to 10 weeks, with practice periods of 10 to 20 minutes, preferably twice a day.
Deep breathing—Two to three deep breaths are taken for immediate release of tension. For deeper relaxation, seven to eight breaths are recommended. This is deep, abdominal breathing, and lightheadedness can occur if you get up too quickly afterward.
Progressive relaxation—This is a process of contracting and relaxing the muscles, beginning with the toes and moving up to the face. You learn to sense how the muscles feel by contracting the muscles for 10 to 20 seconds and sensing how they feel in that contracted state, then relaxing these same muscles and sensing how they feel in the relaxed state.
Autogenic therapy—The same muscle sequence can be followed as in progressive relaxation. In this approach, you imagine that your muscles are very heavy (relaxed). When the muscles surrounding the blood vessels are relaxed, these muscles become warmer due to unobstructed blood flow. This is a physical, or mechanical, response rather than an imagined response.
Meditation—Traditionally, the focus here is a sight or sound. For example, a mantra or other specific sound might be repeated over and over again. Dr. Herbert Benson, associate professor of medicine at Harvard, is a leader in the stress-management field. Dr. Benson has people focus on the repetition of the word one as part of his program involving the "relaxation response." Other people use prayer or a scripture. Still others concentrate on a picture or on a spot on the wall. As relaxation ability improves, the relaxation response can occur within a shorter period of time.
Imagery—This technique takes your focus away from your problems. The imaging can take the shape of people, places, or things, or it can involve focusing on bright to calm colors (and back) or bright to calm music (and back). Visualizing an accomplishment, such as climbing a mountain with supportive aid as needed (from family, friends, or spiritual strength), gives an impression of accomplishing a goal and the peace and good feelings that accompany it.
Biofeedback—Biofeedback is a technique in which you learn to use information about changes in your body. Relaxation training may be enhanced through biofeedback, such as might be obtained by measuring skin resistance, muscle-energy output, or temperature of the hands or feet. The initial use of biofeedback is just to let you know how you are responding to changes in thought or position. Later on, it aids in training you to become more relaxed by letting you know which types of activities represent your "getting out of the way of yourself" so that your body automatically relaxes. The key is not to try. (Remember what happens when you try to go to sleep? You are more wide awake. Similarly, if you try to relax, you will become more tense.) Instead, allow yourself to become relaxed by focusing your thoughts away from the hectic problems of the day.
Exercise
Exercise is next. Exercise not only helps you to feel good about yourself, but, when done on a daily or every-other-day basis, it can decrease depression, increase the pain threshold, and improve cardiovascular strength. To be effective as a form of stress management, the exercise must be participated in for 20 to 30 minutes daily or every other day. When you are mentally tired, exercise will act as a stimulant. When you want to be more creative and more organized, exercise will stimulate these attributes. Too much exercise, or exercise performed when the body is in a stressed state (that is, with blood-sugar levels of 250 mg/dl [14 mmol] or greater, or during illness), will only lead to a stressed state or will aggravate the existing stressed state. Exercising wisely can aid in decreasing the physical stress responses of the body. Be sure that food and/or nutrients are timed and are in the proper amounts to give you the best support.
Nutrition
Nutrition is perhaps one of the most important anti-stressors available. Good nutrition is really very subtle in its actions. Just as with diabetes, outwardly you may not be aware of any difference, but inwardly the body is responding differently. As you become more aware of the impact of nutrition on your body, you will notice changes in skin tone, a sense of alertness, less bloating or other intestinal problems, and so forth. For stress management, you need to think not only about how much you eat but also about what you eat, when you eat, and how fast you eat.
As with earlier advice on nutrition, most of the directions for nutrition related to stress management apply to the nondiabetic person as well.
How is nutrition useful as an antistressor? Eating the appropriate amount for the activity or for growth and development is helpful. An overloaded stomach leads to sluggish thinking and sluggish activity. The composition of the food determines the nutritional status of the body. Purposefully planning to replace nutrients that have been used or to take in the right nutrients at the right time leads to better health. Eating at erratic times can throw the body out of balance, not only in terms of the digestive functions but also in terms of the action time of medication taken to control blood-glucose levels. Sweets are empty calories and don’t make you feel good. And too much of any one food—whether it is sweets, high fiber, or anything else—can throw your body out of balance and result in some organic effects.
Touch
There are a variety of different definitions for the term touch. If you reach out to others, you in turn feel the effect in yourself. Touch also relates to therapeutic massage-that is, the loosening of muscles through touch so that you achieve a relaxed state both physically and mentally. Massage can give relief to tense and stiff muscles, and it can increase joint flexibility and range of motion. It aids in reducing blood pressure. It can assist in improving the capacity for clear thinking, and it gives a feeling of well-being.
One technique of therapeutic touch is taught by Dora Kuntz and Dr. Delores Krieger. In a sense, it involves very little actual physical touch but is a process to determine and smooth the energy fields of the body. You could learn to do this to help another person or to teach another person to do it for you when you are in some discomfort.
Then there is the exhilarating touch of giving or receiving a hug. A hug increases the heart rate and circulation and aids in an all-around feeling of being "okay." June Biermann and Barbara Toohey prescribe four hugs a day. Others have stated that we all need four hugs a day for survival, eight hugs for maintenance, and twelve hugs for growth!
Stress management involves taking responsibility for your own self—for your thoughts and your actions. It means that you may become more mature, that you are able to take the "good news" of self-care and turn it into a level of self-management that leads to a healthier mind and body.
As you learn how to include stress management in your own life and how to relax, you may find that your blood-sugar levels are getting lower and more stable. Keep in touch with your health professional(s), since less medication may be needed.
