How Stress and Anxiety Affect Diabetes

It seems that a lot of us are facing some degree of stress or anxiety, whether it is due to the recent elections, the upcoming holidays or just our day-to-day stressors. To build on Michelle Mendoza’s blog on stress reduction, I would like to discuss just how stress and anxiety effects blood glucose (BG) levels and some additional ways to help manage these two very real health issues.    

People tend to view stress in one of two ways; in a positive, motivating way, or a negative, anxiety producing way.  Of course, this can change with the situation.  I am a glass half full kind of person, so I typically look at stress as a motivator to push me to get something done.  I may feel pressured, but I’m excited to complete the project.  Now, on the other hand, if one of my family members is ill, I may react differently.  While moving toward getting them treated and well, I am worried and stressed in a negative way and my body is reacting negatively as well.  That’s an example of how different kinds of stress impact me.  Now think about how you may handle stress in general and in specific situations.

I have an anecdotal story from years ago I can use to illustrate how stress affects BG levels.  I was working with a 21 year old patient with Type 1 who was wearing a 3 day continuous glucose monitor (for diagnostic reasons) that graphed the effects of stress perfectly.  When we uploaded her data, there was a sharp spike from 100mg/dL to 400mg/dL for a one hour period.  She had journaled at that precise time, "fight with friend on phone for one hour".  She was flabbergasted at the direct effect of stress on her BG level.

I do not believe that we, Certified Diabetes Educators, have done a very good job of spreading the word of just how detrimental and significant stress can be for the body, but that is my intention today.  Please take heed and understand that the effects of stress and anxiety can be just as dangerous as not checking your BG or taking your diabetes medications.

Stress has a direct impact on BG levels causing inflammation in our bodies and the release of stress hormones such as cortisol, epinephrine and norepinephrine.  All of these hormones raise BG levels in people who have diabetes.   

Stress can affect all types of diabetes, but in Type 2 diabetes, it was found that stress can set off an inflammatory response in the body. This inflammation can lead to an increase in weight gain, especially in dangerous visceral or abdominal fat.  The weight gain leads to an increase in insulin resistance, which leads to higher BG levels of course…it’s a snowball effect, all starting with the stress.  

I can’t tell you how many of my patients have told me throughout the years they are eating sensibly, exercising and still cannot lose weight or gain control of their blood glucose numbers.  

Being aware that stress is a factor in your life and that it is actually having an effect on your BG is the first step.  My question for patients after a total assessment of all other variables is, “what is your stress level?”.  Identifying your stress levels and seeing how they correlate to your BG levels is the first step.  Sharing these results with your physician is the second step. 

Another patient I saw some years ago was a brilliant rocket scientist at NASA.  He decided to eat the same things at the same time for seven days straight.  He came back to see me and was completely exasperated because he couldn't understand why his BG levels were still all over the placel.  I explained that he had stressed himself out so much over trying to control his blood glucose levels perfectly, that he had caused them to go out of control.

So, let’s get to work.  How exactly can we combat stress?  Michelle gave you some great tips, here are some others:

  • Be aware of the foods you are eating and drinking. Eating a healthier diet can actually improve your mood.  We all know that when we are stressed, we tend to reach for something sweet or processed.  These types of food actually make us crave more unhealthy foods, which creates a snowball effect.  To practice mindful eating, start eating healthier and being more aware of the meal while you are eating it.  How many times do we gobble down dinner or eat seemingly unending snacks as we are watching TV?  That half bag of chips is suddenly gone, while we finish that episode of Greys’ Anatomy!  Being more mindful while we are eating is the key to stop overeating.  To start eating healthier, begin by reducing processed foods and replacing them with fresh (or frozen) fruits and vegetables, whole grains, nuts, lean meats and fish.  I’m a strong advocate for the Mediterranean diet which includes all of these.  
  • Learn yoga or meditation to reduce stress.  With any type of exercise your body releases helpful, happy hormones called endorphins!  You do not have to go to a yoga studio to either learn yoga or practice it.  Instructional yoga, meditation books, and DVDs are readily available either online (YouTube is a great resource) or in your local bookstore.  You can even download meditation apps on your smartphone.  If you’re uncertain that you can sit still to meditate, you can start off with some meditations as short as three minutes long!   
  • Eliminate excessive caffeine intake, cigarettes, or alcohol as these substances may make you think you can deal with stress better, but in fact, they may only worsen it.  The American Diabetes Association gives us some other great ways to combat stress in this handout too!  
  • I wouldn’t be a good Registered Nurse if I didn’t mention again, if you feel your stress and anxiety is impacting your daily life, please speak to your physician.  They may suggest attending a local support group or speaking with a therapist or psychologist which can be extremely beneficial to your health and happiness.

By: Tammy Shifflett, RN, BSN, CDE, CPT
Fit4D Certified Diabetes Educator