Identify and tackle your stressors to keep blood sugar low and diabetes under control
By Richard Rubin, PhD, CDE
If you could check your stress level as easily as you check your blood sugar, where would it be most of the time – nice and low, or sky-high?
How diabetes adds stress to your life – let me count the ways
I have a good friend, Dr. William Polonsky from The University of California in San Diego. Bill and some colleagues developed a questionnaire called the Problem Areas in Diabetes (PAID) questionnaire to see how people felt about living with diabetes. Of the hundreds of people who completed the questionnaire, 99% said they experienced diabetes-related stress. So if you feel stressed about diabetes you have lots of company.
The most common stressors mentioned by people who completed the PAID questionnaire were:
• Worries about getting complications
• Guilt about getting off track with diabetes management
• Frustration with unpredictable results
People I talk to sometimes use words like overwhelmed and burned out to describe how stressed they feel living with diabetes.
Stress is serious
Stress is really awful. That tense, uncomfortable feeling is only one bad consequence of stress. Stress can also push blood sugars up really high, really fast for some people. Many years ago my son checked his sugar just before taking his driver's exam. He was about 130 mg/dl (7.22 mmol/l), and that seemed a perfect level for the occasion. Just a few minutes later, after he had failed the exam, he felt so high we tested again. This time he was over 400 mg/dl (22.22 mmol/l)! Since Stefan hadn't eaten anything for a couple of hours, his sky-high reading was probably caused by stress.
Even if stress doesn't jolt your sugar level through the roof, it can still affect your diabetes control. Stress can sap your energy, and that could mean less active diabetes care, higher blood sugar levels, and even more stress. Dr. Polonsky and his colleagues documented this pattern: people who reported high levels of diabetes stress on the PAID questionnaire did less to care for their diabetes and had higher A1c levels.
Over the years I've picked up lots of tips for relieving diabetes stress. Here are some of my favorites.
Figure out where it hurts. A man told me he felt he was doing everything wrong when it came to diabetes care, until he realized most of his stress came from one big problem – he "snacked" almost nonstop from dinner to bedtime. Figuring out exactly "where it hurt" was a big relief – he realized that lots of his stress came from one source, so doing something about that stressor would help a lot.
Talk to yourself. If your major source of stress is guilt about self-care or frustration about the results of your efforts, make sure your expectations are realistic. No one, and I do mean no one, manages diabetes perfectly or even close to perfectly. If you are setting your standards too high, lowering them to more realistic levels could lower your stress level as well. So take a clear-eyed but sympathetic view of your self care and see how you are really doing. Don't overlook the things you are doing well.
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...