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by Ann S. Williams, PhD, RN, CDE

One of the key skills you need to manage diabetes well is to learn to manage your reaction to the stresses of your life. Everyone has stress, and learning to manage your stress can help you manage your diabetes and stay healthy.

Because managing stress is such a big topic, I am planning to cover it over several columns. This month, I'll cover some introductory concepts. Over the next several columns, I'll cover some of the useful stress management tools and techniques that I have seen as especially helpful for people who have diabetes or other chronic diseases.

Stress is defined as a reaction to a change or a strain. The change or strain can be primarily physical, such as having an illness or an injury. It can also be primarily emotional, such as being worried, upset, anxious, or depressed.

Everyone has lots of small stresses every day, for example, getting stuck in traffic, dropping a plate, having a light bulb burn out when you need it, or having a disagreement with a family member. By themselves, these stresses do not do much harm. But if a lot of small stresses add up, the accumulation can feel like a large amount of stress.

Everyone also has large stresses at times throughout life, for example, the death of someone close, losing a job, having serious money troubles, or developing a serious illness. Even good changes in life can be considered stressful. For example, most people think of starting a new job or having a baby as good changes. And most people think these good changes are also stressful.

Diabetes researchers have gathered a large amount of evidence showing that stress management is very important for people who have diabetes. The hormones the body releases when people feel stress have often been called the fight or flight hormones. We know they increase blood glucose, blood pressure, and "bad" cholesterol. We also know that when people feel stressed, they tend to pay less attention to careful management of their diabetes. For example, people who are feeling stressed are less likely to check their blood glucose as often as they usually do; they are more likely to eat either too much, too little, or too often; and they are less likely to exercise enough, or to do physical activities that promote health.

On hearing about how bad stress is for diabetes control, many people think, at first, they should learn to avoid stress. After all, it seems obvious that if you avoid stress, you can avoid those negative consequences of stress. However, a little honest reflection will lead most people to the realization that you simply cannot live life and avoid stress. Here are two simple examples: (1) Job stress is a major problem for many people, but not having a job when you need one is also stressful. (2) Many, perhaps most, people feel a lot of stress in their family relationships. To avoid this stress entirely, one might live alone and avoid having contact with family members. But then you would have the stress of being lonely, and of having no one to turn to in times of trouble.

So what can a person do to avoid the bad health effects of stress? The research on stress shows that how you react to stress makes a big difference in how the stress affects your health. Some sorts of thoughts and actions make the stress worse, and others seem to decrease the effects of the stress.

For example, suppose someone close to you disappoints you in a way that really matters to you. Maybe your spouse forgot your birthday, or a close friend spoke unkindly about you behind your back, or a relative failed to keep a promise to you. You feel an emotional strain from this disappointment. In other words, you feel stressed. You have many choices about how you think about this, and about what you do next. A few of these choices are:

* You could spend a lot of energy thinking about how hurt you are, and how you cannot believe this person has been so thoughtless to you.

* You could list in your mind all the hurts you have suffered from this person in the past.

* You could loudly insult the other person and get into a shouting match with him or her.

* You could pretend you did not feel hurt, and tell the person it did not matter.

* You could realize you are upset and do something physically active to help you work off the energy of the upset feelings.

* You could talk with someone else you trust, and ask for advice.

* You could notice how hurt you feel, and decide you want to wait before you talk to the person who hurt you.

* You could decide never to talk with the other person again.

* You could acknowledge you feel emotional pain, and decide to calm your body and mind by meditating or praying.

* You could ask the person who hurt you to explain his or her actions, and listen carefully.

As you can imagine, some of these actions would create even more stress. Other actions on this list might help you decrease your feelings of stress. Still others might not affect your stress much even though they would really help someone else.

Recognizing your stress, and realizing you have choices about how you respond to it are necessary for beginning to learn to handle stress. A simple technique you can use to become more aware of your stress is to keep a record of the circumstances in which you feel stress and your reactions to those feelings. The simple act of putting your stressed feelings into words can help you begin to be aware how you react and how you might have more choices than you previously realized.

(to be continued)