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Stress Management for People With Diabetes


Jul 1, 2005

Stress, anxiety, burnout—whatever you choose to call it, it’s clear that Americans have it.

Americans work longer hours and take less vacation time than people living in other Western countries. Our divorce rate is rising and stress-related health problems like heart disease and high blood pressure are also increasing.

Our society as a whole is experiencing a stress epidemic.

A Bigger Issue for People With Diabetes

For people with diabetes, the challenge of living with a chronic illness can increase overall feelings of stress. Not only are there career and family issues to be concerned about, but also “diabetes stress” to add to the mix—worrying about blood glucose results, struggling with daily motivation and anxiety about the possibility of complications.

“Many people with diabetes experience a kind of diabetes-specific stress,” says William H. Polonsky, PhD, CDE, president of the Behavioral Diabetes Institute and “Diabetes Burnout” author. “In the support groups that I run, that is the kind of stress that people with diabetes want to talk about—the daily grind of living with diabetes.”

But perhaps as important as expressing feelings about diabetes-specific stress is understanding the physiology of how stress operates in the human body. Richard Surwit, PhD, a psychologist at Duke University Medical Center, has been researching the link between controlling blood glucose and managing stress in people with diabetes.

“The key hormones involved in controlling blood glucose are also the key players in the body’s response to stress,” he says. “Our research on people with type 2 diabetes shows that with psychological management of stress, people experience a significant 0.75 percent drop in their A1C test level.”

In Surwit’s new book, “The Mind-Body Diabetes Revolution,” he explains how stress causes the release of our “fight or flight” hormones, which spur the release of stored glucose or fat into the bloodstream. Without enough insulin to balance the glucose or fat, blood glucose goes high.

Unfortunately, most people with diabetes don’t recognize that stress may be causing this reaction in the body. And to make matters more complicated, some people with diabetes whose blood glucose levels are low during a moment of stress experience their glucose dropping even lower, rather than rising.

Hope Lies in Learning to Relax

But studies done by Surwit and other researchers offer hope: People with diabetes who are able to manage their stress experience benefits not only in terms of peace of mind, but also in blood glucose control results.

A study published in the June 2003 issue of Diabetes Clinical Practice reports that diabetes patients attending group therapy stress-management training sessions had improved A1C results compared to a control group of patients who did not attend the program.

Although we can’t eliminate stress from our lives, we can change our reaction to stress by finding tools to help us cope. We can also observe how managing stress affects our overall glycemic control.

Options for Stress Management

There are many different strategies for coping with stress, and not every technique is right for everyone. Explore different techniques until you find one that feels right for you, that easily fits into your daily life and that helps you feel calmer and more at ease.

Mindfulness Meditation

The method is simple: Sit quietly and notice your breathing. Sounds easy, but being part of a culture that encourages us to multitask at every moment can make it extremely challenging to simply stop and be. You can begin by meditating for five or 10 minutes a day, and you can work up to 20 to 30 minutes daily. If you are interested in this technique, look for books and tapes by Jon Kabat-Zin.

Progressive Muscle Relaxation (PMR)

This is the technique that Surwit uses in “The Mind-Body Diabetes Revolution.” PMR is a technique of tensing and then releasing muscles; anyone can learn it. Based on teachings of Edmund Jacobson in the 1930s, PMR is now widely used by physicians to treat headaches, stress and some kinds of pain. See Surwit’s book for more details.

Biofeedback

This method uses noninvasive electronic equipment to monitor your body’s psychophysiological state. A biofeedback machine can show you changes occurring in skin temperature and muscle tension while you are in a relaxed state. When you see these signals, you can check what’s happening in your body at that moment, and the feedback signal acts as a reward for reaching a relaxed state. Over time, feedback from the machine becomes like a “sixth sense,” helping you determine what causes your body to enter a stressed state. Ideally, once you have this information, you can be more in touch with your body’s stress cues in your daily life and learn what kinds of stress aggravate you. This awareness may lead you to make changes to cut down on stress triggers.

Visualization and Guided Imagery

This is a technique that is used in many fields today, including business, professional athletics, performance, religion and health care. This technique is based in creating mental images of a desired outcome. By repeatedly focusing on those images, proponents believe that they can make their visions more likely to occur. It has been suggested, but not proven by research, that visualization can reverse negative attitudes and unhealthy views. Health practitioners who use visualization help patients imagine their bodies fighting disease and gaining strength and wellness.

Guided imagery is a form of visualization in which patients listen to the voice of a coach or use an audiocassette to go on a mental “journey” to a peaceful place (such as a tropical beach or a meadow filled with flowers). As the person imagines the sights and sounds of the place, the body enters into a calm, relaxed state and the “voice” encourages them to connect with their inner strength.

Physicians such as Bernie Siegal, author of “Love, Medicine & Miracles,” use visualization and guided imagery to help patients cope with a number of different illnesses. You can use visualization to imagine conquering your diabetes or gaining strength in any area of your life. It is a low-cost, low-hassle type of therapy; simply pick up an audiotape by Siegal or other guided imagery coaches.

The Right Technique for You

Don’t get stressed by the many options for managing your stress! You may need to experiment with a few different techniques until you find one that works for you.


Uniting Body and Mind—The Benefits of Yoga

Yoga (the Sanskrit word for “yoke” or “union”) is an ancient practice that is experiencing a contemporary renaissance. Yoga emphasizes the integration of the mind and body by practicing a series of postures (asanas), breathing exercises and, in some yoga traditions, meditation and chanting. That combination can calm the mind while stretching and strengthening the body.

Today, you can find yoga classes just about everywhere—at your gym, YMCA or at dedicated yoga studios. There are many different kinds of yoga, each with its own emphasis. Beginners can find “gentle yoga” classes that focus on stretches for people who have been sedentary or who have physical challenges, while those people looking for a cardiovascular workout can seek out a “Power Yoga” class. There are pre- and postnatal yoga classes and classes for people recovering from injury and illness, as well.

If using your body to calm your mind sounds appealing and you can’t find yoga classes in your area, go to www.yogajournal.com for a series of excellent videotapes to help you practice at home. The Web site offers a wealth of information about yoga and has a directory of teachers and studios arranged geographically.

As with any new exercise program, be sure to consult with your diabetes healthcare provider first.


Categories: A1c Test, Beginners, Blood Glucose, Burnout, Diabetes, Diabetes, Insulin, Type 2 Issues



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Jul 1, 2005

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