Diabetes and Stress

(As seen in Business Focus March/April 2015 p100)

The seasons of gift exchange and indulgences, affection and revelry, gave way to the tax season, which may have caused some distress; financial or otherwise. Stress is defined in Psychology as a person’s response to an external stimulus that may be positive or negative. Eustress has been defined as a positive motivator or challenge that keeps a person moving forward in a healthy way. Distress on the other hand, is the opposite of happiness.

The primitive ‘fight or flight’ mechanism induced by stress can manifest itself in the onset or worsening of endocrine disorders such as Diabetes. Diabetes is a metabolic disorder that results in absence or dysfunction of the pancreatic cells that produce insulin, and insulin resistance. While diabetes is not usually diagnosed at times of stress, diabetes is influenced by stress, specifically distress, which increases blood glucose levels via counterregulatory hormones.

Physical or emotional trauma, illness, sleep deprivation or other stresses can result in persistently elevated blood glucose levels, because of the actions of cortisol, adrenaline and growth hormone, among others. This can result in diabetes and its complications. For example, stress can trigger diabetic ketoacidosis (type 1 diabetes) which can be fatal. Other studies show that stress may lead to immunologic surveillance defects which can increase the frequency of infections or tumours. In addition, persons with stressors and diabetes have more risk factors for heart disease than persons without stressors. Cognitive dysfunction and memory loss are greater with diabetes plus stress; memory of transactions, deadlines and appointments can suffer for those who work.

A recently published study indicated that working night shifts increased the risk of diabetes, especially for black women, partly due to the abnormal diurnal hormonal changes. In addition, sleep deprivation on night shifts may cause obesity which is linked to insulin resistance.  Especially for women, a link has been found between work that is high in demand and low in permissible decision making and up to 45% increased risk of onset of type 2 diabetes. High work related stress is also linked to increased health care expenses, long commutes and poorly controlled blood glucose of long duration.

Apart from the workplace there are other special groups of persons to be considered:

  • Hospitalised patients: blood glucose levels in acute illness may predict the risk of type 2 diabetes.
  • Pregnant women: maternal anxiety and stress during pregnancy can increase the risk of miscarriage and decrease birth weight.
  • Children: the Swedish diabetes study suggested that children aged 5 to 9 exposed to stressful events were more likely to develop type 1 diabetes in childhood. In a separate but similar study, psychosocial stress was proposed as a trigger for diabetes-related autoimmunity in infancy.
  • Marginalised groups: lack of acculturalisation and both sociocultural instability and physiological maladaptation (thrifty gene hypothesis) are linked to an increased prevalence of diabetes in these populations.
  • Older persons: stress increases cognitive decline and memory for older persons with diabetes.

The management of established diabetes becomes increasingly stressful with lack of family involvement or other dysfunction in professional or personal relationships, particularly when raising children. Persons with diabetes may feel “different” or “sick”, fearful of hypoglycaemia, and of the complications: amputation, heart disease, blindness, impotence. In addition, anxiety, depression, posttraumatic stress disorder and coping issues are directly related to poor diabetes control due to the hormonal and behavioural effects of stressors. Persons with diabetes may feel lack of control, poor adaptability to change, social withdrawal and “this is not me” denial as well as guilt and frustration over unhealthy crutches such as smoking, alcohol and comfort foods. They are more likely to make wrong decisions about self-management which manifests as persistently elevated blood glucose, high blood pressure and cholesterol, as well as high risk of heart disease.

Stress management has been found to improve long term glycaemic control. Education about all areas of diabetes and self management, including provision of tools such as glucometers and pedometers, improve overall health and quality of life. Mindfulness based stress reduction is the newest complementary medicine solution, but simple things like prayer, social support – communication with family, friends and your diabetes physician, normal healthful routines- exercise to elevate endorphins, getting enough sleep, eating healthy meals, are equally beneficial. Health education programs should be encouraged in the workplace. Most of all, a positive outlook and motivation are essential, no matter what the season.

References:

BMJ-British Medical Journal. “Shift work linked to heightened risk of type 2 diabetes.” ScienceDaily. ScienceDaily, 24 July 2014.

Diabetologia. “Black women working night shifts have an increased risk of developing diabetes.” ScienceDaily. ScienceDaily, 11 January 2015.

University of Edinburgh. “Stress raises risk of mental decline in older diabetics, study shows.” ScienceDaily. ScienceDaily, 27 February 2010.

Ranabir, Salam, and K. Reetu. “Stress and Hormones.” Indian Journal of Endocrinology and Metabolism 15.1 (2011): 18–22. PMC.