Life is hectic as it is. There is the stress of school, the stress of job, the stress of doing a good job, the stress of being a good parent, child, friend, employee… you name it.
However, imagine, the added level of stress one has to deal with when it comes to diabetes and its management.
Having diabetes can cause both physical and emotional stress on the body, which in turn can further deteriorate ones’ health. When you are stressed, your blood sugar levels rise. When your blood levels rise, we all know the implications and complications it can cause to your body.
In order to respond better to our readers. we recently interviewed experts in the field of mental health for some of their wise advise.
We asked 28 experts (psychologists and psychiatrists) to answer the following question we are asked often: How people with diabetes can better cope with the stress that diabetes can lead to?
Please read below their responses.
We hope that this article is useful to you and teaches you some tools and techniques which can help you cope with your diabetes. Learning to better cope with your diabetes will help in keeping your stress levels lower and therefore, your blood sugar levels low as well. We would love to hear from you so please share with us your thoughts or any other comments in the box below.
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1. Dr. Mark Komrad MD
There are well-established links between diabetes and clinical depression. First, we know that depression is associated with a 60% increase in the risk of developing diabetes, due to poor lifestyle habits common in those with depression. Second, if you have diabetes, you are 50% more likely to develop clinical depression, even if the diabetes is properly treated. Finally, those who have diabetes and depression are much less likely to adhere to dietary and medication treatments for their diabetes, and therefore have diabetes that is less well controlled.
These relationships between depression and diabetes mean that it's very important to open yourself to the possibility that you might be more than just stressed and demoralized. If you have diabetes, you might also have clinical depression that is worth treating. Treatment of depression will enhance your diabetes treatment; your feelings of well-being and your psychological capacity to engage in the health and lifestyle behaviors required to get the best outcomes.
Somewhat confusing is that certain symptoms of diabetes can also be symptoms of depression, such as abnormalities of sleep, energy, appetite, and sexual functioning. Sorting out the whether symptoms are due to depression, diabetes, or both is something that your primary care physician or diabetes specialist is trained to do. Only the more severe cases need to consult a specialist like a psychiatrist. However, it may be necessary for you to initiate some conversation with your doctor about your emotions. Just as you might ask your doctor "do I have kidney problems or eye problems from my diabetes?" take the initiative to also ask "might I have depression with my diabetes?" Your doctor can ask you more questions to figure that out, as well as provide either medication, a referral for counseling, or both. You deserve state-of-the-art help for depression, as much as you deserve evaluation and treatment for any other complication of diabetes.
2. Carl Pickhardt Ph.D.
The best anti-stress strategies I have found working with people who must observe a medical self-management regimen to survive are preventative, and they are two:
- Regular self-maintenance. Essential needs are routinely observed and never neglected. “I place the highest priority on meeting my daily needs for basic self-care.”
- Moderate investment in change. Energy is not invested in change (doing new, different, better, more, or faster) at the expense of maintenance.
“However tempting a change might be, I don't undertake too much.”
When these principles are violated, there can be under-supply of energy (one's limited potential for doing and action) in the first case, and over-demand on energy in the second. In both cases, stress can result.
Stress is not a bad thing. It is a survival response we depend on to force our system to generate emergency energy when some crisis arises. On occasion, most people will resort to stress, However, when it becomes ongoing or constant, then the health costs of lifestyle stress begin to take their toll. Progressively and additively, this is roughly how the stages of stress can unfold.
- Stage One: Fatigue —feeling worn out all the time and developing a more negative outlook.
- Stage Two: Pain — feeling in emotional (anxious) or physical (aching) discomfort more of the time.
- Stage Three: Burn-out —feeling a loss of what has traditionally mattered as historical caring diminishes.
- Stage Four: Break-down — experiencing an inability to meet normal expectations and perform normal functions.
Because long terms stress is unhealthy, it is particularly dangerous for people who live with a serious health problem to be managed.
The person who shorts themselves of sleep to get more done reduces energy when they need more, resulting in stress. “I feel run down all the time!"
The person who can't say “no” to a tempting enjoyment, opportunity, or request ends up pushing themselves to meet over-demand, creating stress in the process.”I can't get it all done!"
Personal energy requires basic daily maintenance to keep up, while careless continued overspending of one's energy on enjoyable or exciting change can feel overwhelming.
We have a cultural problem here. First, we tend not to recognize or reward basic self-mainatence. We take it for granted. When was the last time someone said to you: ‘Congratulations! You've just made it though another day!”
Second, not only don't we reward maintenance, but we celebrate change — which is how people get noticed, get approval, and get ahead. “Do your utmost to achieve great things!"
So: self-maintenance should be priority number one; and don't invest in change at the expense of maintenance.
3. Dr. Robert Schnurr, Ph.D., C. Psych
When it comes to medical illnesses and managing these conditions, physicians and patients often overlook the role that psychological factors play. Stress affects every physical condition including migraine, blood pressure, skin conditions, the health of your hair, menstrual cycles, stomach, and, yes, your glucose levels. Managing your diabetes is not just about getting the right glucose levels but rather it involves a completely different approach to managing your overall health.
Stress develops from daily life and we cannot live without it. Some stress is good because it motivates us to succeed. Imagine not having any stress before a game, not being at least a little pumped up. But too much stress is harmful and can play havoc with your sugars.
I recommend reading the following articles:
So how does stress affect diabetes? Daily stresses such as commuting to work, dealing with the kids, deadlines, poor sleep, divorce, arguments, finances, work, and school can all impact on your diabetes. And then there is all the stress associated with managing your diabetes: checking your blood, managing medication, and watching what you eat.
There is no one simple answer to managing stress but there are many ways to manage daily stress. Take some time out to think about what things are stressful for you and make a list. Try and come up with simple solutions to each problem such as allowing more time to commute, getting the kids up a little earlier, finding time to exercise, joining yoga or meditation group, setting an alarm on your phone to remind you to check your levels, and following a diet but allowing for some leeway. If you feel that you are under a lot of stress and having a hard time managing this on your own, consider a few appointments with a psychologist or someone else familiar with diabetes.
4. Dr. James Shaw, PsyD
To answer this question, I will discuss stress, thoughts, exercise, and getting enough sleep.
Stress
Getting told one has diabetes or pre-diabetes could be very stressful and lead to anger, depression and anxiety. However, none of these are helpful to our bodies and could actually worsen the situation. When we get stressed, our body releases the hormones cortisol and adrenalin to help us perform at our best (fight or flight), but there is nothing fight or run from. We can cope better by continuing to breathe deeply, use relaxation strategies and get the facts about this diagnosis.
Thoughts
Upon, receiving this diagnosis, thoughts such as “I'm going to lose toes and then legs and then I'll die”could lead to stress, anger, depression, and anxiety. To better cope, one would want to think realistically. Realistic thoughts would be, “I don't like that I got this diagnosis, but I want to understand the treatment of how to best control this illness.” Upon getting the facts, one might find that people can live a long life with Diabetes Type II and not lose body parts. It is important to note that I wouldn't expect anyone to change their thoughts to “this is great or wonderful”, but realistic thoughts that generally include, “I don't like this.” People have to face a lot of situations in life they don't like.
Exercise
John Ratey has published a lot on the benefits of exercise to reduce health problems, anger, anxiety and depression. We live in this civilized society which does not require exercise, but our bodies need exercise for both physical and mental health just like we did 4000 years ago when the world was more uncivilized. I would encourage all of us to find an exercise routine appropriate to our situation.
Sleeping
Sleep is also a very important component of physical and mental health. If one is not sleeping an average amount, this could lead to emotion problems. Find an article on good sleep hygiene that does not involve medication before seeking medication.
5. Dr. Owen Muir
Type 2 diabetes can be a frustrating illness at times. The constant vigilance, struggle to loose weight, unpleasant medications, even the frequent blood glucose checks and injections can all be painful and difficult to keep on top of. As a psychiatrist I deal with people struggling to make the right choices for their health every day, and many medication can cause weight gain or even lead to diabetes. Taking care of yourself in ways that feel good and not overly restrictive is key to maintaining wellness, and part of that is dealing with stress successfully.
My two favorite stress tips are learning how to focus on your breathing. Deep breathing, way down into your belly, and even towards your toes, slowly and evenly can take your stress and turn it way down. I often show people how to do this kind of breathing by having them place one hand on their chest and one hand on their stomach while they breath. The instruction is simple: feel they hand on your belly do the moving, not the hand on your chest. My other tip for stress management is for when the stress you were dealing with is overwhelming, and it takes it advantage of something called "the mammalian dive reflex". The technique is called "ice diving" --when humans dive in cold water, there is a reflex to slow your heart rate down to preserve oxygen. We can mimic the sensation by using a cold pack, or even a pack of frozen peas or ice cold soda. You place the ice pack so it touches under your eye on either side. Then you lean forward and hold your breath for 30 to 45 seconds. Stand up, put the ice pack on the other side of your face, and repeat. Once you do this five or six times you will notice your heart rate has dropped significantly. And your body will understand this drop in heart rate as being more calm, and the perception that you are more calm makes it true to your mind.
Being able to avoid unhealthy food binges and other bad health choices by managing you stress Will not only make your diabetes easier to control, it will make your stress better over time as well. This can naturally regulate cortisol levels, a hormone that can lead lead to weight gain if it is, and being relaxed makes it go down – stress and diabetes are closely related, and of course if things get too much for you to deal with yourself, there's a mental health professional ready to help.
6. Dr. Jillian Bellinger
Most people experience stress from time to time. While occasional stress is to be expected, prolonged or intense feelings of stress are cause for concern, especially if you suffer from diabetes. Stress can impact your blood glucose levels and as a result can exacerbate diabetic symptoms.
Below are tips to help gain control of your stress.
- Exercise. Exercise can decrease tension in your body, enhance cognitive functioning, improve concentration, reduce fatigue, and lower levels of overall stress.
- Restful sleep. Inadequate or poor quality sleep can make stress and anxiety worse. Try to get seven to nine hours of restful sleep a night.
- Be kind to yourself. Take time to do something you enjoy each day.
- Prioritize tasks and make sure the goals you are setting realistic goals for yourself.
- Write down your worry. Writing down your worries can help you think about the stressful situation more realistically and can also help you problem solve the issue.
- Seek help. The most important thing to consider is how stress is impacting your quality of life. If stress is interfering with your physical health, relationships, or career, it may be time to seek professional help. The earlier you obtain help, the quicker you will be on the path to recovery.
7. Dr. Josh Westheimer, PhD
My clients with diabetes often describe their struggle to a) consistently monitor blood sugar and b) adjust lifestyle habits to improve their numbers. While there is certainly no “one size fits all” solution for this, I do have a few recommendations.
Reach out to others
We are all social beings and having a chronic illness can cause us to feel isolated at times. So, get family and friends involved in your regimen. Talk to loved ones about dietary changes you want to make. After all, it is really tough to alter diet when a loved one is in the habit of providing food that is not on the diabetic diet. Another option for reaching out is to join a group of others who have the common goal of working on lifestyle improvements. This could be through your gym, your church, your school, or whatever community you may be part of. Some healthcare systems provide wellness groups to compliment the usual care.
Make a game of it
Those little log books your medical provider gives you can be enlisted for this purpose. Set a 7 day goal. Tell yourself and tell someone else that you intend to check your blood sugar at the appropriate times and log them each day for seven days. Don't get too caught up in the numbers themselves, you are just getting started. The idea here is to create a habit. After seven days, set a new goal, moving the goal posts just a little bit further out.
Get clear with yourself
Take a few minutes and answer the question: Why do I care about managing my diabetes? Write it down. Tell someone you care about.
8. Dr. Robert Puff
Dealing with the stress of diabetes…by living in the now.
Though diabetes can be a real challenge to live with, there is something we can do to reduce the stress and still find a beautiful quality in living with the condition.
This approach starts with a question. Is there something that I can do right now about improving or treating my diabetes? The answer is normally no. Not that there aren't things we can do to help us live well with diabetes. There are many things, like exercise, yoga, eating well, checking blood sugar levels, and talking with our physician about the most proactive treatment.
But most of the time there that nothing that we can do right now. Instead, we just suffer in our minds with worries and concerns, and this does not help us right now. Instead of all this worry, when there is nothing we can do about our diabetes, we can live well now. Life is replete with beautiful things that we can give our attention to, like listening to relaxing music, going outside and focusing on nature, calling up a friend and going for a walk.
Since your mind can only be on one thing at a time, and if there is nothing you can actively do about your diabetes right now, then the solution is to live well now. There is always something beautiful to be with. Perhaps we can focus our attention on these things instead.
And when our minds wander back to worry and stress, we just remind ourselves that these thoughts are not going to help us, so we will give our attention to something beautiful right now. This is a skill we can all learn, whatever we are struggling with. Life can be a beautiful adventure when we live in the now.
9. Dr. Mara Karpel
While being diagnosed with diabetes, as well as all of the life-changes that go along with this diagnosis, can lead to feeling stressed-out, the stress reaction can actually make it even more difficult to control blood sugar. The production of stress hormones, cortisol and epinephrine, caused by the fight-or-flightreaction or stress reaction, has been found to cause increased blood sugar levels in people with diabetes. Therefore, it's important to create habits that build resilience to stress and to regularly induce the relaxation response. Not only is this important for preventing emotional distress and increasing joy and vitality in life, but it's crucial for keeping control of blood sugar and for maintaining good health, in general.
Here are 9 tips to build resilience to stress:
1. Meditate. Try this simple meditation: Breathe in slowly and gently through your nose to the count of six. Breathe out slowly and gently through your mouth to the count of four. As you inhale, try to expand your belly. As you exhale, notice your belly sinking. With each inhalation and exhalation, think of this recitation from, Peace is Every Step by the Vietnamese Buddhist monk, ThichNhatHanh, “Breathing in, I calm my body. Breathing out, I smile. Dwelling in the present moment, I know this is a wonderful moment!”
2. Try Alternate Nostril Breathing:
- Place your right thumb on your right nostril, closing it, and gently and slowly breathe in through your left nostril. Hold for two or three seconds. Then, gently and slowly breathe out through your left nostril.
- Now place your right ring finger on your left nostril, closing it, and gently and slowly breathe in through your right nostril. Hold for two or three seconds. Then, gently and slowly breathe out through your right nostril.
- Repeat this for nine cycles. And then breathe normally.
3. Be like a child again and color. Adult coloring books are the new craze and for good reason. Coloring has been found to calm the mind, slow down thoughts, and ease anxiety and stress.
4. Use relaxing imagery. For example, close your eyes and imagine that you are floating on a giant leaf and gently drifting along with the slow current of a lazy river.
5. Listen to relaxing music in combination with any of the above techniques.
6. Do yoga.
7. Take a twenty-minute Epsom salt and lavender oil bath.
8. Get a massage.
9. Practice acceptance. One of the greatest causes of stress is our lack of acceptance of what is. “What is” includes how things are right now, as well as the fact that everything changes. It is when we cling to things or to situations that we feel stress because no matter how hard we try we can't stop this reality of life. Ironically, when we don't fight the unchangeable rules of life, we not only avoid the stress of clinging to try to control things that can't be controlled, we find a deeper happiness and appreciation for the miracles of life.
The bottom line is that what happens outside of us is the story of our life. It's not who we really are. Of course, we have emotional reactions to the events in our lives. But, if we can stay mostly calm, understanding that our true nature is peace, then the storms that happen around us, the ups and the downs, do not shake us to our core and we can ride these waves without feeling sick, and perhaps even enjoying them. If we can find ways of working with the “is-ness” of life, even if that means that we're dealing with a health issue, such as diabetes, we will find more satisfaction and fulfillment and experience less stress and despair, which, in turn, often leads us to better health.
10. Dr. Matthew Zimmerman, M.D
A diagnosis of diabetes has the potential to cause significant stress. One has to come to grips with what it means to be chronically ill, including the lifestyle changes bound to be encouraged by the treating physicians. The potential for serious medical sequelae may be frightening—even paralyzing. Friends and loved ones may not recognize the degree to which a diabetic is impacted by his illness, which can lead to feelings of loneliness and isolation.
Difficulties coping with diabetes, whatever the specifics, have the potential to negatively impact a person's treatment and his life in general. For some, the stress may even contribute to the development of clinical depression or anxiety. Fortunately, there are ways to address stress of any level of severity.
To start, some of the same strategies for healthy living with diabetes, like regular exercise, healthy eating habits, etc., can also help to relieve or even preempt stress. In order to make the most of these behaviors, establishing a sustainable routine is crucial. In addition to the direct physical and mental benefits, meeting goals helps to remind a person that he still has control over his body.
Support from others is central to coping with stress and can help when it is too much for one person to bear. The form can vary: an unexperienced, empathic listener; company to help take one's mind off of the stress; a shrewd medical advisor; a support group for diabetes or medical problems. If those are hard to come by, supportive psychotherapy from a professional social worker, mental health counselor, psychologist, or psychiatrist can help to fill in the gaps. Ideally the pro's can also help to strengthen a person's ability to help himself.
When stress leads to clinical depression or anxiety, help from a mental health professional is not just an option; it is advised. Some key indicators that suggest this route may be the best course of action include: too little motivation to seek diabetes treatment; excessive worries about physical health despite reassurance from physicians; changes in sleep; trouble focusing or remembering things; panic attacks; thoughts that life as a diabetic or life more generally is not worth living. The doctor treating a person's diabetes should be willing to weigh in on whether seeing a mental health professional is advisable.
In a metropolitan center like New York City, a diabetic could likely find a psychiatrist who has special interest in treating patients with medical problems, or even diabetes specifically. Sometimes such people are board certified in 'psychosomatic medicine'. These psychiatrists tend to work with medically ill people when they are hospitalized with general medical problems. However, in the not-uncommon case that a specific expert is not readily available, many less specifically-oriented treaters offer services that are very likely to be helpful nonetheless.
11. Dr. Paul DePompo, PsyD, ABPP
Stress can certainly impact one's glucose levels. Emotions like anxiety cause a lot of "What If's" to ruminate around in our heads. The more "What If" rumination, the higher anxiety and increased glucose levels. We need to stop the rumination by taking those "What If's" and turning them into "Then What's." We need to hold those thoughts accountable and actually come up with a coping plan for if those 'What If's" were to actually occur. By doing so, we are building the confidence that whatever happens we WILL be able to cope and be able to seek out the resources for help. So, divide a paper in half: one side write a list of your 'What If's" and other side create a coping plan of "Then What's" and keep working those "Then What's" until you see your anxiety decrease. Take one or two steps from that plan in real life to build that confidence further. It is important to face these fears and hold them accountable or else the brain will be tricked in believing that you cannot cope .. which we know you can, because you are still here!
12. Dr. Brian Clinton MD PhD
Diabetes can lead to anxiety and stress that gets in the way of life. It can also get in the way of caring for your illness. Diabetes is a wake up call for you to take care of yourself, both physically and emotionally. First, consider keeping a gratitude journal. There are many good things in your life, and it's worth putting them front and center in your mind. You are much more than your diabetes! Work on keeping your spirits high, because it will help you get through tougher times. Also, say no to others when you need time for yourself-it takes time to do things that are healthy for you. Don't over-commit yourself. Next, don't go it alone! Enlist a family member, friend, or support group to discuss your diabetes care. It makes all the difference to have a teammate. Of course, if you are feeling hopeless or depressed, or concerned you have felt overly stressed for several weeks, consider meeting with a therapist or psychiatrist without delay. They can do a lot to help you! Next, find a favorite way to distract yourself and schedule it in regularly - maybe that is exercise, volunteering, music, or a religious/social group. Seeking out activities that are meaningful to you makes caring for yourself worth all the effort!
13. Dr. Sue Varma, M.D. P.C. FAPA
Managing one's diabetes can be very difficult for some people. It requires a certain degree of planning and a good degree of lifestyle modification. By the time diabetes develops for many, they are already set in their ways. My patients will tell me that "I just don't feel my meal is complete without rice, bread, pasta etc.". They will cite that these staples are an ingrained part of their cultural upbringing. Food represents customs, habits, traditions and expectations- so you are asking a lot of a person when you are asking for dietary modifications. Moreover, they may be at the mercy of other family members in the household who may or may not have an understanding about the need for these modifications. One of my Taiwanese patients with diabetes grew up in a farming community and can't kick the rice habit- "We grew up poor- rice, rice water, you name it- rice was a part of every meal- and I can't imagine my day without it."
One tip is to remind patients that they are not giving up their favorite foods, completely and forever. It's not an all-or-nothing proposition-but rather developing a more conscious and deliberate approach to eating it in moderation, with close contact with health care professionals monitoring their glycemic status.
It's also helpful to get at the underlying fears by asking certain open ended questions. "What does it mean for you to have diabetes? What will you have to change/give up as a result of it?". One patient had big Sunday Italian pasta feasts with his family and was afraid that he wouldn't be able to enjoy it in the same way.
Physical activity can also be daunting for many who are new to it. Moderate physical activity, brisk walking with a friend, even getting a consultation with a personal trainer and nutritionist (most insurance companies will pay for 1-3 diabetes nutrition consults).
14. Dr Elayne Daniels
Coping with diabetes can certainly be challenging. It is a complex disease that affects every aspect of life, for life. It is literally a 24/7 job.
Poorly managing the stress that goes along with this diagnosis only makes the diabetes worse due to higher glucose levels. Coping with this chronic condition requires more than "just deal with it."
As a psychologist, I like to focus on what TO do, as opposed to what NOT to do. (In contrast, often times guidelines emphasize what to do less of or avoid.)
My recommendations focus on including MORE methods of stress reduction. Find what works best for you, and be willing to experiment.
Helpful stress management ideas may include:
- Support from family and friends
- Enjoyable exercise, either in one 30 minute period of for example three 10 minute intervals to break it down.
- Meditation practice (supported by a 2014 Behavioral Medicine article demonstrating improved sleep)
- Professional therapy - to help with reframing negative self talk and to have a place to vent
- Helping others as a way to take the focus off yourself and to feel good about the positive ways you can impact others' quality of life.
15. Dr. Elizabeth Waterman, PsyD
Clients with diabetes can reduce stress related to their condition by engaging in the following practices on a daily basis:
- Mindfulness exercises to enhance awareness of their body and changes in bodily sensations to identify early warning signs of complications.
- Radical acceptance (total acceptance of their condition and treatment/monitoring protocols) to reduce denial of physical status and promote a proactive approach for seeking medical attention when needed.
- Make a 100% commitment to following treatment plans they have created with their physician and other health care providers.
- Self- compassion and gratitude exercises to increase appreciation for life in the face of obstacles and challenges that arise daily.
16. Connie Yip, NP
5 ways to manage stress if you have diabetes:
1. Start your day with a positive thought about yourself, someone you're grateful to have in your life, or something you are looking forward to
Oftentimes, negative thoughts influence how we feel. By making a concerted effort to start the day with positivity, you can set a positive tone for the rest of the day!
2. Take as little as 1 minute to pay attention to your breathing pattern and heart rate, practice breathing deeply and slowly
Our bodies know we're stressed before we're aware of feeling stressed. Pay attention to your body's cues of heightened stress and practice relaxation techniques. When anxious or stressed, we tend to take shallower breaths and have tightened muscles in our neck, shoulders, or other places in our bodies. Take advantage of available apps, some free to download, and practice calming your body, which can help regulate your blood sugar!
3. Schedule and plan a small way to treat yourself for all your daily efforts to manage diabetes
Whether it's taking a scenic walk, bathing in lavender bubbles, engaging in physical activity, trying a new recipe with your favorite ingredients, or listening to music, it's important to find ways to take care of yourself that are enjoyable.
4. Connect with supportive people who understand how diabetes affects your life and encourage your healthy habits
You're not alone with diabetes and others share your struggles or know people who have diabetes. It may be refreshing to relax during a meal in the company of others who choose to eat food compatible with your needs.
5. Appreciate your hard work with self-praise and kindness
Stress is something we all experience. Stress can also contribute to altered blood glucose levels. You may feel frustration, irritability, or tired of the challenges you face due to diabetes. Your fluctuations in blood glucose levels can influence how you feel. For instance, your irritability may be a signal that you need to increase your blood glucose level. It takes diligence to manage your diabetes, give yourself some kindness and recognition!
17. Dr. Anjali DSouza
As a physician, I am very aware of the impact of Diabetes on our population. Almost 10% of the US population has elevated fasting blood sugar, 27% are pre-diabetic, and if current trends continue ⅓ of the US population will have Diabetes in two decades. I would argue this is one of the most important health conditions of our time.
As an integrative physician, I try to pay attention to the the primary causes which I believe include: our industrialized diet, chronic stress, physical inactivity, sleep deprivation, disrupted microbiota, and environmental toxins. In this article, we are going to focus on those variables which are self-modifiable: chronic stress, physical inactivity, and sleep deprivation. I hope to illuminate some tips on how to approach these three important aspects of supporting proper health, and how in turn they can help with decreasing the overall stress of living with Diabetes.
Chronic Stress: Stress can both be part of the precipitating factors towards diabetes and a perpetuator of illness. The diagnosis of Diabetes causes stress itself! Its important to find tangible ways to decrease stress in your life.
- Simplify: if there are things, tasks, or people in your life that are not serving you or your family: try to find a way to decrease or even eliminate those things. And fast! Life is complicated at baseline. So, decipher what matters and what does not.
- Begin a practice of daily stress reduction: There are numerous free sources for meditation online and via your smart phone. Make a commitment to at least 10min a day of restful meditation. Headspace and Buddify are two I recommend daily to people.
Physical Inactivity: A sedentary life has been shown to impair metabolic function and reduce insulin sensitivity. But, making lifestyle changes and getting moving with exercise can be so hard!
- Keep goals manageable: Dont let perfect be the enemy of good. Start with a home practice of 10-15min a day: 30 seconds on and off of whatever movement feels right to your body. Obviously modify to your physical ability and move up slowly as you tolerate more.
- Find group support: Exercise with friends! The team approach keeps you accountable and makes movement more fun! It can even be something to look forward to if you agree on an “exercise” that matches your interests like hiking, or dancing, or rock climbing.
Sleep Deprivation: Alterations in sleep can negatively impact levels of cortisol, ghrelin, and leptin which are all involved in supporting proper blood sugar maintenance.
- Invite your body to rest: One hour before bed, turns lights down, turn off the television, and terminate emails/internet work. These actions are imperative in allowing your body to release melatonin: the conductor of sleep in your body. A bath or meditation practice before sleep can also be very helpful in decreasing stress hormones and therefore allowing for optimal rest.
- Prioritize sleep: We live in a culture that glorifies being busy. Make sleep a priority and protect at least 8 hours or more for rest every night.
18. Dr Marlynn Wei, M.D., J.D.
Yoga is a helpful resource to reduce stress and improve cardiovascular health. Yoga reduces the harmful effects of chronic stress on diabetes. Adding meditation to walking has helped people with type 2 diabetes better control their blood sugar and lower the stress hormone cortisol levels compared to walking alone. Yoga also reduces harmful inflammation in the body, a process that scientists believe may be linked to diabetes. Studies have shown that yoga postures one hour weekly have an anti-inflammatory effect on the body in six week and can increase levels of adiponectin, an anti-inflammatory protein hormone that helps with blood sugar control.
For people who want an accessible form of yoga, restorative yoga is a great option and has been rated highly by people who are new to yoga. This style of yoga uses such props as bolsters, blankets, and blocks to help you support poses for longer than you can with other forms of yoga. This relaxing practice releases muscle tension, improves sense of well-being and energy, and decreases stress. Other styles of yoga that integrate calming breathing, such as yin yoga or Viniyoga, can also be helpful as well. Vinyasa yoga is a flowing movement style of yoga that has positive cardiovascular benefits. Chair yoga is practiced in a chair and can be useful for seniors or people with less mobility. If you are interested in trying yoga, talk with your doctor first to see if yoga could be a safe and healthy part of your diabetes treatment.
19. Dr Ryan Seay, Ph.D
A Mindfulness Approach to Diabetes
If you were told that you had to do a job that required management throughout the day, without a day off, and no vacations, most of us would not take that job. We would completely reject it. Without realizing it, sometimes that is the reaction to being told, and living with, a diagnosis of diabetes. It is a normal reaction, but a reaction that can make living with diabetes much harder.
Strong negative emotions impact target goals and the management of diabetes. It may sound odd, but being able to accept a diabetic lifestyle with mindfulness can go a long way towards positive management of diabetic goals. Difficult thoughts and feelings about all that is involved in the care, and self-care, can be softened. As we know, the mind and body are connected.
By learning what acceptance of diabetes is, and how to apply mindfulness towards its' management, an easier path with diabetes can be found. It sounds radical, but a small change of mind can make a significant difference in keeping in range of target goals, reducing negative complications, and generally…..being happier and healthier.
20. Dr. Lanre Dokun
I specialize in Cognitive Behavioral Therapy (CBT) and the primary issue that my patients with diabetes face is a general sense of overwhelm. This sense of overwhelm comes from chronic negative thoughts related to diabetes, leading to a desire to avoid. This may mean not checking your blood sugar or taking your medications as prescribed. Not surprisingly, it is this avoidance that often leads to the outcomes we feared in the first place.
My advice to clients is to take note of the types of things they are thinking on a daily basis. It is our thinking that most influences our feelings and our actions. If you challenge the negative thoughts that routinely cross your mind, you'll begin to notice just how skewed they really are. Imagine if thoughts like “I can't keep this up day after day” became “So far, I've been able to do what's needed and I know that I'm not alone in this fight.” This would have a profound impact on your day to day emotions, motivation and energy. So, if ever you're feeling overwhelmed, do not retreat. Simply stop and think.
21. Dr Douglas J. Van der Heide, M.D
Adult Onset Diabetes above all requires adaptation. Adults who receive this diagnosis must be concerned about the consequences of the illness on multiple organ symptoms. Optimal management of symptoms and outcome demands a complete reassessment of one's relationship to one's body and lifestyle. This is a difficult process partly because human beings resist change ever more strongly as they age. To make matters worse, many of those changes, at least at the beginning can feel depriving and painful. Worse still some diabetics, although by no means all, have led sedentary life-styles with the excessive consumption of unhealthy foods or alcohol. Such folks can feel that they have “caused” their illness, and can adopt a “who cares” and “it's too late” attitude which can accelerate tissue injury.
But it is never too late to begin the road back to a healthier lifestyle and an improved diabetic outcome. From my perspective as a psychiatrist and psychoanalyst, It is actually accompanying demoralization on receiving a diagnosis of diabetes which is most dangerous. Obviously, with an illness often profoundly affected by life style, you hear from caregivers and know yourself, that it is important to make changes to optimize outcome. What are frequently referred to as life-style ”choices” may often seem as if they are not choices at all. But the mental trick is to appreciate that they are indeed “choices” even if they have been so routine and automatic that they blend into your self-image.
One large reason for failure at adaptation is that patients try to make too extreme a change; in human life a Goldilock's “just right” approach is almost always optimal. This means that for the individual who works at dynamo speed and has no down or personal time, it is imperative to create some; on the other side, for an individual who is sedentary and has a low activity level, it is time to find a hobby or interest and get moving.
Life is beautiful and a healthy pain-free life even more so. Every day you must remind yourself of your plan which is to give yourself and your body another day of healthy life. You have no time for negativity “I'll never get the weight off,” “I can't even walk a block,” “I just don't have time to relax.” Every day all you need to focus on is one thing more and then make sure to celebrate it. Another half a block, one more night without ice cream, one more set of stairs, believe it or not do burn calories, lower blood pressure and increase muscle, but most importantly they help you realize you have more control than you thought and greater courage and determination that you knew.
Pursuit of “a little more every day, or maybe every other day” works. Sometimes, a Fitbit or step counter can be helpful to fix the sense of progressing in mind. For those who can connect socially, participating with others in bird watching or hiking clubs or Yoga or Pilates can help to reinforce healthy patterns as can Weight Watcher's when being overweight is a contributing factor.
Diabetes can be triggered by, but almost always contributes to a diminution in self-regard and a rejection of the wonderful miraculous body we have. Many of the life style issues can represent an effort to satisfy an inner sadness or unmet need. Health is possible but each person must confront what he or she can to make life better. One saying worth remembering is: If you love the world and yourself, it will love you back.
I understand such an attitude cannot arrive with a snap of the fingers. If you sense that there is an underlying pessimism which may well be aggravated by the reality of diabetes, I would suggest that psychotherapy may be indicated to reestablish that core of self-esteem. Such work can be crucially helpful in refocusing energy to do what can be done, which is a lot, to undo the disease process and ensure many years of great energy vitality and health.
22. Dr. Kim Sage, Psy. D., M.A.
"We are living in a world where chronic stress has become normalized, but the impact of stress upon on bodies is anything but normal. The stress response in the body was originally designed to help protect us from predators, whereby the release of "stress hormones," helped us fight or flee in the face of danger. This release of hormones helped give our hearts, brain and lungs more oxygen and opportunity to survive dangerous situations.
Unfortunately, however, our bodies cannot tell the difference between a stressful morning where we were running late for work or had conflict with our spouse, or a giant T-Rex chasing us through a dense canyon!
Chronic stress impacts every system in our bodies, including our immune, gastrointestinal, cardiovascular, reproductive, respiratory, endocrine and central nervous system, just to name a few.
However, for people who are living with Type 2 Diabetes, the stress response creates increased glucose produced by the liver which would normally improve reaction times by providing extra energy. But for those with Diabetes, blood sugar can become a serious problem, so learning to control blood sugar by learning how to manage and control stress can literally be life-changing.
Here are a few ways to reduce and manage stress:
- Learn to identify what tends to trigger your stress.
Does always running late or putting off projects until the last minute make you feel out of control? Then work on getting a calendar, creating a schedule or getting up 15 to 30 minutes earlier so you can stop rushing and stressing. Even better, get up earlier so you can begin your day with exercise, yoga or meditation and have time to prepare for your day, without starting it off with chaos which sets the tone for your whole day.
- Learn to identify where you feel stress in your body.
Does your stomach or your chest become tight? Or maybe you feel increased neck pain, headaches or back aches? Once you can identify what it feels like in your body, you can take action by beginning a breathing technique, taking a brisk walk or doing a guided imagery exercise on your cell phone or computer.
- The minute you begin to feel stress, begin a breathing technique like the the 4-7-8 or just take some slow, deep breaths focused on feeling your belly rise and fall.
Use these breathing techniques at least 4 times in a row (just don't do them while driving or somewhere you need to stay focused for safety!)
- Implement the use of a mediation app like Insight Timer, Calm or Headspace.
Try a guided imagery exercise on these apps, they are easier to follow than typical think-about-nothing meditations and a quick way to calm down and regulate your heart and breathing rates.
The more you learn to use guided imagery, the more you will know when you need to use one, and you will become addicted to feeling peaceful and happy-- rather than addicted to feeling out of control, stressed, worried and chaotic.
I also like to listen to mediation music while walking or driving in my car because the music is simple, repetitive and soothing. Eventually, just hearing the music helps me relax and feel calm because the association between the music and being relaxed has become established in my brain.
- Commit to frequent exercise and a healthy sleep plan for increased well-being.
You already know these two because you probably hear about them all of the time! Frequent exercise where you get your heart rate up 3 or more times per week for at least 30 to 45 minutes, and committing to getting enough sleep are two of the best ways to reduce anxiety and depression, stress and exhaustion.
23. Dr Chelsea Vaughan, Ph.D
Diabetes is an exhausting condition to manage. One often-overlooked area of functioning that has huge implications for diabetes symptom control is sleep. Insufficient sleep time (meaning less than seven hours of sleep per night) has been linked to marked alternations in glucose metabolism, including decreased glucose tolerance and insulin sensitivity (Speigel et al., 2005). Additionally, ongoing sleep deprivation affects the hormones that control hunger and satiety, which, in turn, can contribute to overeating and obesity. The important takeaway for diabetics is that chronic sleep deprivation can contribute to both the development and maintenance of diabetes. Implementing sleep hygiene techniques (e.g., maintaining a regular sleep schedule, minimizing electronics usage within two hours of bedtime, ensuring the sleep environment is dark and cool) can go a long way toward helping patients get the restorative sleep they need. If sleep hygiene alone doesn't improve sleep problems, behavioral treatment for insomnia is another extremely effective method (as effective as sleeping medications in the short-term with lower rates of relapse long-term). For more information, visit http://drchelseavaughan.com/treatment-for-sleep-disorders-faq/
24. Dr. Carol Garfinkle, Psy.D
Diabetic? Don't Fret It!
Diabetes stress management tips (passed along from the clients, friends and neighbors I know who have let me in their lives and taught me so much for which I am grateful):
You control diabetes, you cannot let it control you.
Like coping with most things in life, diabetes is a team effort, medically and emotionally.
You have an inner team and an outer team. Pay attention to your inner team: your body, your heart and your mind. Notice the cues your body gives you so you can respond accordingly. Notice the stressed or angry parts of you that may be activated in response to what is happening in your body, so you can listen to and comfort them, rather than let them lead. For example, notice the parts that tell you to restrict yourself unrealistically, such as to plain water, and see if other parts have a better approach, like finding a mixture of fruit flavored low carb beverages. You may find internal compromises help reduce extreme behavior, such as eating one or two cookies in order to avoid eating the whole box later. Try not to tell yourself you can't have any amount of something because you may trigger another part of you that rebels and ends up eating it anyways in a larger quantity. Listen to your outer team: Include people that you trust to work with you in a supportive and helpful way, knowing you are doing the best you can.
Life is in the repair: Talk to yourself in a positive way rather than allow parts of you to stress over a single blood sugar. Some parts will want to give up just because of one bad day or a high blood sugar, but you don't have to let them. Look back and see if it was a simple miscalculation of your insulin dose. It is never too late in the day to stop and reevaluate where your blood sugar numbers are and work on fixing it. This is true of all mistakes in life. Focus on repairing versus berating yourself, as that is all the Judgment part probably wanted in the first place was for you to do your best. Remember, your best will change from day to day.
Keep in mind information is power as you can do something about what you know.
An hA1c is a marker of the past 12 weeks and provides an opportunity of knowing what you need have to change. Remember every 20 points you lower your blood sugar, results in a lower hA1c. Don't set your blood sugar reduction goals too high as it will set you up to fail. Let your medical and emotional support team help you learn what you need to know.
Let others know how they can support you:
Suggestions: Let them know if you say you are okay, they can trust you. Let them know they need to try to understand sometimes a person with diabetes cannot go out or do things because of a high or low blood sugar. Help them realize that if you are moody, it could be because your blood sugar is high so don't take it to heart.
What diabetics wish others who were trying to help knew:
It is okay to check in with me about my blood sugar because it shows you care. Never assume what you think you know is correct. Ask me first as I am unique and my needs are too. Some of the miracles and cures you hear or read about actually could kill me. Always ask for my opinion before you begin preaching to the choir. Know when to support me, but take cues for when you need to back off. It's okay for me to make a mistake and only I can fix it. It does take a village to raise a child, and everyone needs to be responsible for their part and assist when asked. However, don't run over the diabetic because you are trying to prove who is right and the best team leader. I, the diabetic, am the leader.
Find and use stress management techniques that work for you. For instance: Talk to friends often and seek out support from other people with diabetes who get you. Exercise. Take long baths with a few drops of your favorite smelling oil and place candles around you. Treat yourself to a massage or use one of the Brookstone massager products on yourself. Meditate. Make yourself a music playlist for when you are feeling stressed. Use a fun coloring book. Play with a pet. Take a short nap, knowing that you will wake up in a better frame of mind. Sit in front of a campfire and zone in on the colors, sounds and smells. Go for a walk in nature. Remember, nature is not perfect either.
Get as much work done as you can when you feel good so you won't be forced to work as much when you feel sick. Balance equal amounts of work, play and rest across the week whenever possible. Keep things in perspective and remember, not every day is going to be a good day and that is okay. Reset your goal to be for the next hour. Shorter goals can be much more successful and uplifting. Do something proactive: take a favorite recipe and try to rework it to make it lower carb and healthier without forcing yourself to eat only perfect for you foods.
Follow the age old adage: take a deep breath and take things one step at a time.
25. Dr. Julie Olson, PhD, Clinical Psychologist
Stress Management is an important part of Diabetes Management
“Why?” or “Why me?” are common responses to being diagnosed with Diabetes. Denial about the signs and symptoms and the resulting treatment plan makes for more problems. It is important to get past the surprise of having a chronic illness and find ways to make your life work around it. If we deny the diabetes, we can expect more serious conditions to follow; such as heart attacks, strokes, kidney failure, vision loss, and perhaps amputations. The best way to handle stress is to change our perceptions of the problems into “challenges we can solve.” Most people avoid fear and go towards pleasure, so think about what good may come from this. Accepting that you have Diabetes can actually make you happier in the long run, because you will probably learn more self-care techniques.
Well-being and self-care
We feel better overall when we take good care of ourselves. And we take good care of ourselves when we feel we are worth it. Our self-esteem is tied to our perceptions of our worth and our body/mind/spirit. If you can imagine life becoming easier rather than harder, you will want to change up your lifestyle.
Watching our calorie and carbohydrate intake takes some planning and awareness of how we have been eating. We need to learn new ways of eating well. Again, look for the good part of eating well. With a steady blood sugar level, we won’t be so moody or have so many weight changes up and down. Don’t think of it as going on a diet, think of it as changing your lifestyle.
Testing our blood sugar is important to make sure the extremes don’t sneak up on us. Think of testing as a way of feeling more in control of your body. If it is difficult to find a happy balance, get with your doctor and create a plan that will help you better.
Being more active and exercising regularly no matter your age, will keep you from experiencing the aches and pains of growing older. Yoga and other gentle ways of exercise can bring huge results.
Getting good sleep may simply mean turning the TV or gaming equipment off a little earlier than usual. Just a walk a day will help your body go to sleep easier. If you have trouble turning your brain off at night, first turn the computer lights out or any screen out at least an hour before bedtime. Reduce caffeine drinks to before 4:00pm, schedule time to worry the next day, and learn to breathe deeply while doing a progressive muscle relaxation exercise. If these ideas do not work, you may find that you have a sleep disorder and need help with a “sleep study” to know what to do. Ask your doctor about it.
You are the boss
When it comes to your health, it’s a good idea to create a healthcare team. Consider your Endocrinologist one person on your health team. Signing forms so that your doctor team members may communicate with each other will keep any confusion about your goals down. Your GP and any other medical providers you use, including physical therapists, psychotherapists, etc, should be on this team. Remember that you hire them. You are the boss. But, it’s important that they all know the idea is to help you be as functional as you can be.
Happiness is not a goal—it’s a result of a life well-lived.
If you are having trouble relaxing, changing your habits, or you are uncomfortable, feel shame or frustration with diabetes, it is time to go see a counseling professional. Look for a psychologist who has experience in health psychology and can teach you self-management skills, how to keep it from ruining any family or personal relationships, and essentially work with your perceptions, thoughts, and feelings about life with diabetes.
26. Dr. Seth Bricklin
We all have a list of daily chores and responsibilities that cause us stress. One way we manage that stress is to take a “mental health” day or even an extended vacation. You have the added stress of managing your daily diabetes care routine. While you will experience some burnout and want to take a vacation from your care routine, you know that it's not as simple as calling in sick. If you're feeling burned out, it's easy to get caught up in negative thinking, focusing on all of the reasons you don't like your routine or perhaps thinking of all of the things you should be doing differently. If you're telling yourself what you “should” have done or are lamenting the things that you “have to” do, stop it! Instead, change the word “should” to “would like to” and the words “have to” to choose to. Using the word “should” is demotivating. It assumes that you did not follow through on your routine because of some problem with your character. If you believe that, you will stop looking for real solutions. When you change “should” to “would like to”, you take away the guilt and will be more motivated to evaluate how you can do better. Similarly, saying “have to” will make you feel as if you have no choice and are helpless. The truth is everything we do is a choice. If you focus on the reasons that you choose to maintain a proper care routine (you want live a long and healthy life to spend time with your family, you want to set a good example for your children, you want to take control of diabetes and not let it control you, etc.) you will feel more in control of your diabetes and your life.
27. Dr. Jim Seghers
One of the most stressful aspects of diabetes I see in my patients is the feeling of hopelessness - the feeling of being at the mercy of something ominous you can't control. In contrast, asserting a sense of control over your life is empowering, and can reduce stress significantly. First and foremost, educate yourself, and learn what you can do to improve your situation through diet and exercise. There's a whole world to that. Second, look at other valued parts of your life, and ask what you can do to create a greater sense of meaning, purpose, enjoyment, and connection. Stress and worry goes in circles, leading nowhere. When you feel stressed or worried, look for a way to translate that fear into a constructive action.
28. Dr. David M. Davis, MD
When one gets the diagnosis of diabetes, it can often evoke powerful feelings, including shock, anxiety, anger and sadness. These are normal reactions. You must, however, accept the reality that diabetes is a chronic illness, and at this time, there is no cure for it. Accepting this reality will enable you to more positively adapt to the stress of having this illness.
It is important to be proactive rather than to respond in a passive and helpless way. Start learning about the illness via books, magazines and on-line sources.
Use common sense with your reading, and do not make it a full-time job. You should be well informed but not obsessed with the illness.
Being well informed will enable you to ask better and more specific questions of your physician who is treating your diabetes. It is important that you keep your appointments and are compliant with the treatment regimen. Diabetes requires following a diet, exercising, having the required laboratory tests, and most of the time medication. It is important to commit to being an active participant in your treatment. This will help to prevent or delay any long-term complications, such as renal and eye problems. A consultation with a dietician is often very helpful in finding the diet that you will be able to follow. A diet that will work but is not followed is useless. In addition to keeping the appointments with your physician, it is often necessary to see other specialists, such as an ophthalmologist and a dentist.
It is also important to have a positive attitude. You can live normal and fulfilling life despite having diabetes. It is best to continue living your life the same as it was before you got the diagnosis, including work, family relationships and socializing with friends. Support groups are often helpful in teaching you how others are coping with the illness. The American Diabetes Association is a good source for locating support groups in your area and obtaining other information.
Try to take charge of what you can control, rather than trying to manage things that are beyond your sphere of influence. For example, put yourself first with respect to your family. It may be necessary to re-distribute some of the family responsibilities. It is important to take good care of yourself so you can be at your best to care for others in your family and enjoy life’s activities, including sports and socializing with friends.
Further reading:
Stress can worsen diabetes by increasing your blood glucose level, so relaxation exercises can be very helpful in reducing the stress of your illness. Techniques, including meditation and mindfulness exercise performed daily, can reduce stress. There are some free phone Apps to aid in stress reduction, such as “Breathe,” “Smiling Mind” and “Headspace.”
It is important not to socially isolate yourself and keep your diabetes a secret. Share that you have this illness with your family and close friends. Having their support is helpful in reducing stress.
If despite your best efforts you find yourself troubled by anxiety, insomnia or depression, seeking the help of a mental health professional can be of great value. Psychotherapy alone is often helpful in managing the stress of your illness and resolving your feelings. If necessary, medication can also be prescribed to help you recover emotionally and feel normal again.
Disclaimer: The views and opinions expressed in this article are those of the contributors and do not necessarily reflect the official policy or position of TheDiabetesCouncil.com.
TheDiabetesCouncil Article | Reviewed by Dr. Christine Traxler MD on June 2, 2020
