Stress Management for People With Diabetes

Stress, anxiety, burnout—whateveryou choose to call it, it’s clear thatAmericans have it.

Americans work longer hours and takeless vacation time than people living inother Western countries. Our divorcerate is rising and stress-related healthproblems like heart disease and highblood pressure are also increasing.

Our society as a whole is experiencinga stress epidemic.

A Bigger Issue for People With Diabetes

For people with diabetes, the challenge of living with achronic illness can increase overall feelings of stress. Notonly are there career and family issues to be concernedabout, but also “diabetes stress” to add to the mix—worrying about blood glucose results, struggling withdaily motivation and anxiety about the possibility ofcomplications.

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

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

“The key hormones involved in controlling blood glucoseare 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 DiabetesRevolution,” he explains how stress causes the release ofour “fight or flight” hormones, which spur the release ofstored glucose or fat into the bloodstream. Without enoughinsulin to balance the glucose or fat, blood glucose goeshigh.

Unfortunately, most people with diabetes don’t recognizethat stress may be causing this reaction in the body. And tomake matters more complicated, some people with diabeteswhose blood glucose levels are low during a moment ofstress experience their glucose dropping even lower, ratherthan rising.

Hope Lies in Learning to Relax

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

A study published in the June 2003 issue of DiabetesClinical Practice reports that diabetes patients attendinggroup therapy stress-management training sessions hadimproved A1C results compared to a control group ofpatients who did not attend the program.

Although we can’t eliminate stress from our lives, we canchange our reaction to stress by finding tools to help uscope. We can also observe how managing stress affects ouroverall glycemic control.

Options for Stress Management

There are many different strategies for coping with stress,and not every technique is right for everyone. Exploredifferent techniques until you find one that feels right foryou, that easily fits into your daily life and that helps youfeel 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 encouragesus to multitask at every moment can make it extremelychallenging to simply stop and be. You can begin bymeditating for five or 10 minutes a day, and you can workup to 20 to 30 minutes daily. If you are interested in thistechnique, look for books and tapes by Jon Kabat-Zin.

Progressive Muscle Relaxation (PMR)

This is the technique that Surwit uses in “The Mind-BodyDiabetes Revolution.” PMR is a technique of tensing andthen releasing muscles; anyone can learn it. Based onteachings of Edmund Jacobson in the 1930s, PMR is nowwidely used by physicians to treat headaches, stress andsome kinds of pain. See Surwit’s book for more details.


This method uses noninvasive electronic equipmentto monitor your body’s psychophysiological state. Abiofeedback machine can show you changes occurring inskin temperature and muscle tension while you are in arelaxed state. When you see these signals, you can checkwhat’s happening in your body at that moment, and thefeedback signal acts as a reward for reaching a relaxedstate. Over time, feedback from the machine becomes likea “sixth sense,” helping you determine what causes yourbody to enter a stressed state. Ideally, once you have thisinformation, you can be more in touch with your body’sstress cues in your daily life and learn what kinds of stressaggravate you. This awareness may lead you to makechanges 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 isbased in creating mental images of a desired outcome. By repeatedly focusing onthose images, proponents believe that they can make their visions more likelyto occur. It has been suggested, but not proven by research, that visualizationcan reverse negative attitudes and unhealthy views. Health practitioners whouse visualization help patients imagine their bodies fighting disease and gainingstrength 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 differentillnesses. 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 integrationof the mind and body by practicing a series of postures (asanas), breathingexercises and, in some yoga traditions, meditation and chanting. Thatcombination can calm the mind while stretching and strengthening the body.

Today, you can find yoga classes just about everywhere—at your gym, YMCAor 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 outa “Power Yoga” class. There are pre- and postnatal yoga classes andclasses for people recovering from injury and illness, as well.

If using your body to calm your mind sounds appealing and youcan’t find yoga classes in your area, go to for a series of excellent videotapes to help you practice at home. The Web site offers awealth 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.

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