Stress. There are different kinds of stress. How is it affecting your diabetes?

Stress. It is well documented to have an adverse impact on our health. It can be destructive, but it can also be productive and for many of us, it is a necessary evil in our daily life.

It is also not a new phenomenon. One can imagine that our early ancestors found it quite stressful to evade wild, hungry animals and that our more modern ancestors were stressed as they explored the world. However, these were acute and likely infrequent events, and the term ‘stress’ was not actually used to describe a biological or psychological state until 1930.

So stress, as we now know it, is not a product of our modern environment but we are better at identifying it and recognizing that it has changed. Instead of infrequent, acute episodes of stress, many of us are now subject to constant, chronic stress at home, at work and even when we should be sleeping. It may impact not only our mental health, but our physical health as well, and it is something that we all really need to understand.

Types of Stress

It’s not all bad. Eustress or good stress is a positive response to a stressful situation. It’s a challenge that can be met, enhancing one’s function and can help us achieve a sense of fulfillment.  It’s that exciting feeling of starting a new job, getting married or jumping onto a rollercoaster. It’s a bit of the unknown.  It’s positive and motivating. In this state, we can function efficiently, productively and positively and maybe even over-achieve.

Distress is associated with negative connotations. It is feeling out of control, with the body unable to adapt to the stressor. If the perceived stressor is too great, our body looks for other ways of coping – becoming withdrawn, anxious or aggressive. It’s that sick worrying feeling of getting overwhelmed at work, a marriage breakdown or the loss of a loved one and not knowing what to do next. The way we deal with these emotions may cause more harm than just the feelings themselves – alcohol, taking excessive risks, lack of sleep or over eating.

Depending on the environment, eustress or distress can evolve from the same situation. It’s the perception of how we manage stress that can make us feel good or bad about a stressful situation.

This is where the concept of a ‘positive mindset’ can be of benefit. Looking for the positives in a difficult situation, and managing the negatives can have a profound effect on our experience. Chronic stress can evolve from both eustress and distress and it affects our health and wellbeing. Its symptoms can take many forms – anxiety, depression, headaches, nausea, lack of sleep and difficulty concentrating. It can raise blood pressure, impair wound healing, and affect memory. In some people stress may affects sugar levels profoundly but more on this later.

The Biology of Stress

We know the symptoms of stress, how it makes us feel and react. But what is going on in our body to cause these responses and emotions? Why is chronic stress so damaging to our health?

Stress is a complex response involving our nervous, endocrine and immune systems; it’s a disruption to our steady state of homeostasis. As you can imagine, constant disruption to the way our body operates can be disabling.

The main driver of stress is the hormone cortisol. The adrenal glands (that sit near the kidneys) are stimulated to release cortisol by hormones from the hypothalamus (CRH) and pituitary gland (ACTH) in our brain. Cortisol sends our brain into ‘hyperactivity mode’, triggering a fight or flight response. During ‘fight or flight’ many other hormones are released, including adrenalin and noradrenalin which increase the heart rate, breathing rate and muscle contractions.

These hormones also cause an increase in the amount of glucose and fatty acids in our blood. Muscle cells need these chemicals as energy to help you run away or defeat the threat in acute stress to hopefully help you survive another day.

However, in a state of chronic stress, the response continues incessantly. With consistently raised levels of cortisol, we have consistently higher levels of blood glucose and free fatty acids. We are constantly left in a state of being 'on guard' and the body and mind can find this exhausting.

To cope with elevated cortisol levels, our body craves high fat and high calorie foods which can lead to increasing body weight that may lead to further insulin resistance and a worsening of diabetes.

What is clear is that people handle stress differently and probably this is not so much a fault of theirs but rather it seems that some people produce a heightened cortisol as a response to stress that may be beyond their control. The good news is there are things you can do to reduce the impact of chronic stress (and therefore cortisol levels too)!

Does diabetes cause stress

The effect of stress on diabetes is only half the story, there is also the effect of diabetes on stress and this has been termed diabetes distress. It is the constant effort of having to manage a long-term disease which for some equates to 2 hours a day spent administering medicine, testing bloods, and dealing with hypos. Not to mention the constant feelings of guilt and worry from managing a condition that revolves around lifestyle choices.

No wonder that people become disillusioned managing diabetes and would rather pretend it did not exist. None the less it does and so strategies are needed to manage diabetes distress if the impact on diabetes is to be minimized.

Everybody can counter the effects of chronic stress to some extent with regular exercise, a nutritious diet and by ensuring that you make enough time for sleep and relaxation.

Please see the following articles for more information: