by Wesley W. Wilson, MD
NOTE: If you have any questions for "Ask the Doctor," please send
them to the VOICE editorial office. The only questions Dr. Wilson will be able
to answer are the ones used in this column.
Wesley W. Wilson, MD, has retired as an Internal Medicine practitioner at the
Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type
1 diabetes in 1956, during his second year of medical school. He remains interested
and involved in diabetes education for patients and professionals.
Q: I have type 2 diabetes. Most of my life I've been a real type "A"
person, full of conflicts and stresses. Well, I've been seriously reducing the
stresses in my life, and now my foot problems are a lot less, and my blood sugars
are better. Is this valid? What is the link between being a high-stress type
person and good blood sugar management? What happens when I achieve a lower
stress lifestyle?
A. Congratulations on being able to achieve a lower stress lifestyle. Now tell
us how you did it! Changing a life-long behavior pattern is very difficult.
Many people wish they could somehow control the stresses and problems in their
lives but can't find the way to change their responses to the troubles and concerns
we all must deal with. This is particularly true since individuals vary so much
in their response to problems or stresses.
Hormonal changes do occur with a "high-stress" state. Increases in
epinephrine, cortisone and growth hormone may be seen with stress and anxiety.
But even more important, I"d feel, is the effect anxiety can have on your
attention to the routines required to maintain your diabetic control. Careful
attention to diet, exercise, and blood sugar testing is much harder during periods
of stress than it is when things are on a fairly even, smooth routine.
Certainly you are the one to answer the validity question. Perhaps the most
convenient way to determine the degree of improved control is to compare a hemoglobin
A1c taken after several months on your lower stress period with a previous HbA1c
taken during a higher stress time. You can get some idea of control by looking
back on your blood sugar diary; but the HbA1c gives a more accurate look at
your degree of control over a several-month time period. That's why physicians
use the HbA1c to check on diabetic control.
It's generally agreed that some high-stress situations lead to higher blood
sugar levels. Surgery, a heart attack, or an acute illness do lead to higher
blood sugars, and these often require greater efforts to control blood sugar.
Emotional turmoil has a similar effect on blood sugar.
So, to answer your question, lowering your stress level is good for you, good
for your heart, and good for your diabetes control.