“Your sugar levels have gone up”, I said, on seeing an HbA1c value of 8.5 per cent in one of my patients. “Everything was fine three months ago. You say you are careful about your diet, medication and walking. What happened?” “I have been under a lot of mental stress, doctor” said the young business executive. “Both at work and at home. Can that be the reason?” Was the young man right in his diagnosis? Most people believe that mental stress is a major reason for increase in blood sugar. But what does science say? Is it just a convenient excuse or is there some basis to this belief? According to the WHO, stress can be defined as a state of worry or mental tension caused by a difficult situation. Stress is a natural human response that prompts us to address challenges and threats in our lives. Everyone experiences stress to some degree. The way we respond to stress, however, makes a big difference to our overall well-being. Stress can be acute, like meeting a short deadline at work. Or chronic – like financial, job or relationship related. Can stress cause diabetes? Stress raises the levels of “stress” hormones like cortisol and adrenaline, which in turn can increase insulin resistance and, therefore, your blood glucose levels. Acute stress may just cause a temporary blip in your blood glucose profile, but chronic stress can keep the levels elevated for prolonged periods. Many like to believe that their diabetes was brought on by stress. This is not firmly established and remains an area of research. To put it simply, stress can elevate your blood sugar levels if you have diabetes, but it is unlikely to be the principal cause of diabetes in an otherwise normal person. Stress and anxiety can change your eating habits and lifestyle. You may feel excessively hungry or lose appetite. Late night comfort eating is common, as is missing meals. This can throw your glucose control into disarray. Does diabetes cause stress? The diagnosis of diabetes is often a cause of anxiety. The initial reactions are varied (Examples- “Why me?”, “the report is wrong”. “I will beat this condition, won’t take any medicines”, “the answer lies in alternative medicines”, “I don’t believe I have diabetes” and so on). People react because the diagnosis of diabetes conjures up visions of life-long restrictions, and for many, it seems that the joy of living is gone. One has to watch what one eats, take tablets or insulin shots, and check blood glucose regularly. Some may have fear of long-term complications (I have seen patients worry the most about their kidneys). Others may be afraid of getting a low blood sugar reaction with medication. Anxiety is 20 per cent more common in people with diabetes. Such anxiety or stress only aggravates the problem. The sooner the patient gets out of it, accepts the condition and treatment, the better it is. Most people with diabetes lead normal lives and accomplish as much as people without diabetes. Even for those who are doing well, there may be periods when there is difficulty in coping. The underlying fear of complications, and the guilt that accompanies indulgence, can produce depression-like symptoms. This can be compounded by underlying chronic stress due to other causes. Some may just get overwhelmed and allow things to escape. This phenomenon, called “diabetes distress”, can happen in as many as 50 per cent of people with diabetes and can lead to a burnout. This is a state of physical and emotional exhaustion where a person stops caring about their diabetes. One starts skipping medications or gives up healthy lifestyles. Some people with diabetes may get overt depression, which is twice as common than in people without diabetes. Symptoms of depression include: Feeling “low’ or sad, or unusually irritable Breaking down when talking to a friend Disinterest in everything- including activities you enjoyed earlier Change in appetite - overeating or not wanting to eat Change in sleep pattern - not being able to sleep or sleeping too much Brain fog- trouble in concentrating or making decisions Fatigue, bodyache, headache Excessive burping, belching, stomach cramps Having extreme negative, even suicidal thoughts It is important to share your concerns with your doctor or educator. Often a bit of empathy and reassurance can work wonders. You are not alone in how you feel. Many patients do not like the diagnosis of depression, as it adds another stigma, and makes them feel weak and inferior. However, it is usually treatable. Do not refuse medication if your doctor feels you need it. How can one beat stress? Everyone has different ways to beat stress. Some proven methods are listed below. Take your pick! 1. Physical activity- Walking in the park, or city forest, close to nature can have an instant calming effect. Even a short walk close to your home can help. Dancing is a great exercise. 2. Breathing and relaxation exercises – Do yoga, pranayama, meditation 3. Listen to music, read a book, watch a movie. Anything you enjoy. 4. Talk to friends, share, chat, gossip, anything 5. Spend quality time with the family 6. Limit caffeine, alcohol, smoking. 7. Try to get enough sleep. Let’s get back to our patient. The young man was going through a rough phase. Some talking, counselling and a change in approach helped him get out of his low phase. He improved without any change in medication.
