Every life is filled with many stresses. Your brain is the main driver of your response to stress, as well as its main target. It decides when there is a problem and acts automatically to gives the body the tools it needs to fight, survive or quickly run away (known as the ‘fight or flight’ response). The intensity of any stress response is determined not only by the perceived intensity of the threat, but also a host of other factors known cumulatively as your resilience. These include things like your genes, your gender, previous stressful experiences, coping skills and personality traits.
Having type 2 diabetes is a very stressful experience. Over and above your glucose control and any other aspect of your diabetes care, how you respond to this major stress in your life is also a major determinant of your subsequent health and wellbeing.
When stress gets the better of you it can cause many problems, including interfering with your ability to achieve and maintain control over them. In general, stressed people with type 2 diabetes have worse glucose control. This is not simply because they are too stressed to take their medication consistently or adhere to diet and lifestyle programs (although this doesn’t help). The chemicals that are released by the body in response to stress also serve to directly drive up glucose levels while at the same time cause resistance to the actions of insulin.
At the same time, if you take people with type 2 diabetes and teach them yoga, meditation, tai chi or other relaxation techniques, on average they will achieve improvements in their glucose control roughly equivalent to adding in an additional glucose-lowering medication. Over and above its effect on your glucose control, chronic activation of the stress response can also increase your risk of:
- Heart attacks and strokes – Up to one-third of all heart attacks may be attributable to chronic stress. For example, people reporting stress at work or marital stress have twice the risk of having a heart attack or stroke. The increase in risk in those suffering from acute or chronic stress is about the same as having a high cholesterol level or being a smoker.
- High blood pressure – In susceptible people (especially those with diabetes), stress can drive the blood pressure higher. By contrast, effective stress management invariably lowers blood pressure and improves the function of blood vessels.
- Infections – When you are stressed you seem to pick up every bug that is going around. Stress also reduces the effectiveness of vaccination to diseases like the flu. These are just some examples of the effects that stress can have on your ability to fight off infections. Of course in diabetes, when your immunity is low anyway, stress is the last thing you need.
- Brain function – Any stress can make it difficult to concentrate, learn and focus. But prolonged stress will actually cause some areas of the brain to shrink.
- Depression and mental illness – In certain susceptible individuals, chronic stress can trigger depression and other mental illnesses.
- Sleep – Stress can interfere with you getting the sleep you need each night. This can lead to even more stress.
- Sexual function – Stress can also interfere with your sex life.
One important way to cope with having diabetes is to manage your (inevitable) stress better. Some people will need more help than others, based on their resilience and the size of their burden. But everyone will need some help sooner or later.
There are many different ways you can handle stress: some you can do yourself (also known as self-help programs) and others you perform with the help of different health practitioners. Some of the best-known and effective stress management techniques include yoga, relaxation, mind–body techniques, mindful breathing, biofeedback, hypnosis, tai chi, exercise, mindfulness meditation, guided imagery, conditioning and time out. When used routinely, each serves to build resilience to stress in some people.
But it’s not the same for everyone. Not everyone can do yoga. Not everyone likes exercise. The most effective strategies are the ones you can enjoy, the ones that put your mind at ease and the ones you want to do again and again.
There are many medicines that can also be useful in some people suffering from severe and chronic stress. Each one has its side effects and limitations. In addition, most lose their effectiveness in the long term, especially on their own. The combination with other stress management techniques better allows these medicines to be used just for short periods, when the stress is most acute, with other techniques coming into their own and taking over once control is achieved.