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How does stress affect blood glucose levels in type 2 diabetes?
How do you know if you have chronic stress?
Everyone experiences stress now and then, and some acute stress is even good for you. But when you feel stressed all the time, a condition known as chronic stress, it impacts your health in a number of negative ways — especially if you have type 2 diabetes and other risks for heart disease. Stress is a well-studied contributor to a range of health problems, and reducing it can contribute to better physical and mental health.
While stress can either increase or decrease blood glucose levels in people with type 1 diabetes, it generally increases blood sugar in those with type 2 diabetes. Whether you’ve had type 2 diabetes for years or you’ve only recently been diagnosed, keeping your stress under control is essential for managing your blood sugar and maintaining optimal health for the long haul.
How does stress affect blood glucose levels in type 2 diabetes?
People with diabetes can experience higher levels of stress and anxiety, which play an important role in the intensity and progression of the disease.
The body’s stress response is governed by the amygdala, the brain region associated with fear, which releases adrenaline, cortisol, and other stress-related hormones. These hormones cause an increase in your heart rate and blood pressure to get you revved up to fight the danger—or flee from it. That’s why the stress response is also known as “fight or flight.”
When you have chronic, or long-term, stress, these hormone levels remain elevated. Cortisol stimulates the formation of glucose to fuel your fight (or flight), but if your body cannot effectively convert the glucose into energy, it builds up in your blood.
But this is only one-way stress affects high blood sugar associated with type 2 diabetes. Long-term, general stress related to the disease itself may make it more difficult to manage your blood sugar—it can wear you down physically and mentally, sapping your energy and motivation. Additionally, stress is an important contributor to substance abuse, and having stress and type 2 diabetes can make quitting smoking or cutting down on alcohol particularly challenging.
How do you know if you have chronic stress?
The symptoms of stress aren’t always noticeable, and every person experiences stress differently. Stress can present itself in subtle ways, so recognizing the symptoms is the first step to reducing your stress.
Physical symptoms of stress may include:
- Headaches
- Fatigue
- Muscle pain
- Trouble falling or staying asleep, or sleeping too much
- Feeling unwell in general
Emotional symptoms of stress may include:
- A lack of motivation
- Restlessness
- Feeling depressed or anxious
- Feeling irritable or angry
- Feeling overwhelmed
Lowering your stress level has numerous benefits on your physical and mental health. In addition to helping you maintain your target blood sugar levels, reducing stress can help lower high blood pressure and cholesterol, which often co-occur with type 2 diabetes. Less stress can also improve your overall quality of life. Here are five of the best ways to lower your stress.
1. Change your ways of thinking
Let’s start with one of the most difficult—and one of the most important—ways to reduce your stress: Changing your thought patterns around stress is fundamental to changing the way you—and your body—react to it. Cognitive distortions are so common that many mental health professionals call them “stinking thinking.” Cognitive distortions are tricky little ways your brain convinces you—subtly or not-so-subtly—that things are bad. Everybody has distorted thinking to some degree, but it’s particularly common in people who have chronic stress, anxiety, depression, and other mood disorders.
It’s not easy to see our own cognitive distortions, especially as they’re happening. It takes mindfulness and practice, but once you begin to recognize distorted patterns of thinking and work on changing them, you’ll experience stress less often and less intensely. Some of the most common cognitive distortions that may be causing more stress in your life than necessary include:
All-or-nothing thinking
If you tend to think of certain things in terms of black-and-white, all-or-nothing, you may feel particularly stressed about making lifestyle changes to help you manage your blood sugar. For example, say you eat nutritious, diabetes-friendly foods for several days, and then the next evening, you have a couple of slices of pizza and two beers. You immediately regret it and realize you’ve just “ruined” your “diet,” and you feel frustrated and defeated and wonder if you’re ever going to be able to do this diabetes diet thing right.
Of course, you are! Managing your diabetes isn’t all-or-nothing, right or wrong. It’s a process, and it’s a long game. The better the choices you make, the better—but that doesn’t mean the occasional carb-heavy meal negates all of the progress you’ve made and continue to make. Give yourself grace—and leave room for the occasional, stress- and guilt-free pizza and beer night.
Magnification and minimization
When we automatically magnify the negative and minimize the positive, chronic stress is hard to shake, because we perceive so many things as negative and fail to see the positives, which can lead to a constant state of unhappy thoughts. A form of magnification is catastrophizing, which is when we imagine and expect the worst case scenario. Most of the time, the worst case doesn’t come to pass, making all of those unhappy expectations and negative emotions—including stress—all for nothing.
Take a closer look at all angles of a situation, and find a balanced way to regard them. Think more realistically about how “bad” something really is, and look for the positive aspects. Here’s where the practice of gratitude can help—when you’re feeling particularly negatively toward something, find two or three things about the situation to express gratitude for.
Should statements
If you find yourself thinking or saying, “I should [exercise more, eat a healthier diet, drink more water]…” you’re creating expectations that have one of two outcomes: you either do it, or you don’t. When we say “I should,” and then don’t, we’re likely to view it as a failure and feel stress, shame, and guilt because we feel like we really should do this thing.
Since “should” statements—including “you should”—are so common, and we use them so often, recognizing them is challenging at first. But when you do hear yourself say, “I should,” ask yourself why you should do it: “I should exercise more.” Why? “So I can lower my blood sugar, stress levels, and feel healthier and more energetic.” Then, change your “should” statement to something like, “I’d really like to exercise more so I can feel more energetic.” A small thing like framing these types of statements as things you’d like to do helps remove the expectations and stress while putting a more positive spin on it.
2. Seek support
Managing type 2 diabetes requires a lot of lifestyle changes. It adds new stressors to your life in the form of medical bills, blood sugar monitoring, carb counting, and worrying about a multitude of other direct and indirect impacts from the disease. Getting support can be a game-changer for many people with diabetes in terms of both reducing stress and improving overall health and quality of life.
Many types of support are available to help those with type 2 diabetes. The support of a registered dietician can help you simplify a healthy diet and help you find your new favorite foods. The support of a personal trainer or exercise buddy can help you stay motivated to move. The support of a therapist can help you more quickly recognize and reframe cognitive distortions, reduce anxiety and depression, and help you “reinvent” yourself if your diabetes has become your identity. The encouragement, understanding, and resources you’ll find in a type 2 diabetes support group can go a long way toward helping you lower your stress and magnify the positive, while a practical stress management course can help you develop stress-specific coping skills and improve your self-efficacy.
A recent study published in Diabetology & Metabolic Syndrome investigated the effects of a stress management intervention in people with both type 2 diabetes and a high level of perceived stress. The intervention was based on the social cognitive theory, which focuses on the relationship between cognitive, environmental, and behavioral factors and, in this case, stress as it relates to blood sugar and other diabetes and heart health markers.
Two months after the intervention was complete, the study group showed a significant reduction in both perceived stress and hemoglobin A1C levels compared with the control group.
3. Meditate
Meditation is a complementary treatment intervention used in modern medicine for a variety of conditions. Regular meditation has a number of health benefits, including helping you reduce chronic stress—it can even change the way your body responds to stress when you’re not meditating. Research shows that the benefits of meditation may include pain relief, better sleep, lower blood pressure, reduced anxiety and depression, and fewer cravings.
The Forward Guide to Meditation for Stress Management offers easy, step-by-step instructions for meditating, plus some tips and tricks to help you get the most out of it.
4. Exercise
Daily exercise is great for helping you manage your blood sugar, and it’s equally beneficial for helping you reduce stress. Exercise produces endorphins, or feel-good brain chemicals, like GABA, serotonin, and norepinephrine. Just five minutes of aerobic exercise—a brisk walk around the block, dancing to your favorite song—can make you feel calmer in the moment. In the long-term, regular exercise can help reduce stress in a number of less-direct ways, including by:
- Giving you more physical and mental energy
- Lowering stressful, high health markers like blood pressure, blood sugar, and cholesterol levels
- Boosting your overall mood and mental clarity
- Helping you sleep better
- Improving your self-esteem and self-efficacy
5. Reduce stressors in your life
If life often feels overwhelming, and you frequently feel stressed, cutting down on stressors is a surefire way to feel calmer and more in control. Here are just a few ways to go about banishing some of the things that may be contributing to your chronic stress.
Practice saying “no”
If you have a hard time telling people “no” when they ask you to do something, imagine all of the possible scenarios in which you might be asked to work extra hours, host a party, chair a committee, welcome out-of-town visitors for a week, or any number of requests—and practice saying “no” in a way that doesn’t make you feel bad. Have a few outs that you’ve rehearsed out loud and start using them. It becomes easier the more you do it and realize that most people are not going to hold it against you. Of course, there will be times when you can’t say “no”, but whenever you want to and can, doing so will help you set healthy boundaries and remove obligations that can cause you stress.
Don’t put things off
Stress-ignoring emails and phone calls, procrastinating on getting a tough project started, and putting off the worst for last are some of the most common ways in which we compound our stress. Here are a few things you can try to get control over stress and procrastination:
- Get organized so that starting a task is easier.
- Manage your time better by scheduling your day, and allotting a certain amount of time to a task.
- Set a timer, and see how much you can get done before the alarm sounds.
- Find an accountability partner to check up on your progress.
- Plan a reward for when you complete the task.
- Minimize distractions that make it easy to put things off.
- Keep a perpetual to-do list, and check off at least one item each day.
- Delegate the task to someone else, if possible.
- Ask someone to help you get started, or to keep you company while you work on the task.
Set realistic goals and expectations
Sometimes, the stress we feel is self-created, especially when we set unrealistic goals or have extra-high expectations of ourselves. Set realistic and achievable goals, and put them down on paper with specific action steps to help you achieve them. Keep your expectations realistic too—maybe you wanted your house to be completely spotless before a dinner party, but will your friends notice that you didn’t shine the floors? Will they care that you’ve got a little clutter lying around? Probably not. Go the extra mile when it really matters, but when it really doesn’t, take it easy on yourself, and let good—or even “okay”—be good enough.
Let Forward help you take control of your health
As your primary care provider, Forward takes a holistic approach to disease prevention and management that encompasses your physical and mental health. Through our doctor-led programs, including our Heart Health Program and Weight Management Program, Forward helps you address a wide range of health issues with personalized care from a caring, dedicated team of health professionals. A variety of app-based resources help you monitor and improve your health, set and achieve your health goals, and track and celebrate your progress. Through the app, you can reach your care team 24/7, view test results, make appointments, and order prescriptions.