Diabetes Forecast

Stress Less

Regain your sanity--and lower your blood glucose levels--by learning to relax. Really.

By Tracey Neithercott , ,

Crawling traffic threatens to make you late for work. Your intolerable boss pushes your deadline forward 3 days. The kids are on vacation and at each other's throats. And the extended family just confirmed they'll be flying in for the holidays--and staying an extra week. Face it: Stress is everywhere. In fact, some people think they thrive on it--or at least they don't realize they can, and should, do something to lessen this insidious pressure.

What does stress do?

If you've ever experienced a quickened heartbeat during stressful situations, you understand that stress affects more than just your mind. In fact, research shows that stress--including the rush you feel when watching your favorite football team score the winning touchdown, the heart-thumping you experience while watching an edge-of-your-seat action movie, and the sweaty-palms anxiety you get before giving a presentation at work--influences your blood glucose levels. "[Stress] impacts counterregulatory hormones. The impactof counterregulatory hormones leads to increases in blood sugar. It's just that simple,"says Richard S. Surwit, PhD, ABPP, CL, professor of medical psychology in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center and author of the book The Mind-Body Diabetes Revolution: The Proven Way to Control Your Blood Sugar by Managing Stress, Depression, Anger and Other Emotions. Counterregulatory hormones (like epinephrine and norepinephrine) are those primal forces that give you zip when you really need it, such as when you must flee an attacker or survive a car crash. But they're also released when your body senses smaller stressors, like a pending exam.

According to Surwit, having diabetes means you have a greater chance of being affected by life's stressors. "Some people are more responsive to stress than others,"he says. "Their bodies, because of their diabetes, are more susceptible to the physiological effectsof stress."In addition to showing up physically in the form of heightened blood glucose levels, stress also has a dangerous behavioral element. "What we've seen is people's blood sugar gets elevated because they get preoccupied with activities [and] they tend to minimize or avoid activities like monitoring,"says Carolyn Swithers, RN, BSN, CDE, director of the Center for Nutrition and Diabetes Management at Hunterdon Medical Center in Flemington, N.J. "Those things they have in their normal schedule--they get compromised."

How is it affecting you?

Sure, it's easy for someone to tell you "don't stress, just relax!" But how do you actually lower stress levels in your life? There are things you can do to minimize your contact with stressful occasions, like opting not to move to a new home and start up a new business at the same time. But most of life's stressors are spontaneous. "You go out on the road and deal with the cars. You go into work and deal with a boss and coworkers who are less than congenial," says Surwit. "It's not so much a question of avoiding the stress. It's learning to deal with it better."

Start by taking stock. "The first thing is identifying the stressors," says Swithers. "If it's something you can't do anything about, then it's [about] learning to cope. If it's something you can do something about, then it's [about] preparing: How can you prepare the [holiday] meal? Who can help?"

Once you realize what's stressing you out, consider how it's been affecting your health. Swithers says recognizing the symptoms of stress will help you distinguish times when you need to relax. Ask yourself, "How am I feeling? Am I sleeping? Am I eating less, or am I eating more? Am I exercising?""A lot of times people don't recognize the effect it has on their body,"Swithers points out.

What can you do?

The art of relaxing is a learned practice; simply flopping onto the sofa and trying to zone out for 5 minutes while watching The Simpsons won't give you the mind-clearing benefits you need to see changes in your blood glucose levels. "When you're watching TV, while you think you're relaxing, you may not be reducing your stress hormone levels. It may be pleasurable, but it may still provoke stress hormones," says Surwit, citing a former patient whose blood glucose would spike while he watched intense basketball games.

Relax the right way by first altering your environment. Both Surwit and Swithers suggest finding a quiet place where you won't be interrupted for 15 to 20 minutes. If your pulse is racing or your mind is heavy with worries, take a few minutes to clear your mind before starting any relaxation exercises. The ability to relax is a discipline that takes practice, so Surwit suggests you start with a guided program. (See "Relaxing for Beginners," for more about Surwit's progressive muscle relaxation program.)

Achieving relaxation isn't as easy as it looks. Surwit recommends trying guided meditation audio programs. Listening to commands will take your mind off stressors and force you to focus on the exercise. And if you thought relaxing was only for freak-out moments, think again. According to Swithers, practicing the techniques when you're calm and collected will make the relaxation process easier when you're under stress. "The important thing is that you do it. And you do it when you don't need it. Take advantage of that peacefulness you have, " says Swithers. "Grab it when you can so that when you need it it'll be there for you. Because when you need it, you're not going to want it. You're not going to want to sit still."

Stressed about the time commitment de-stressing requires? Surwit says many people who have stuck with a 15- to 20-minute relaxation program for about 6 weeks can parlay their skills into 30-second practices. Reminding yourself to take a half-minute break every so often during the day (try attaching stickers to everyday objects like your computer or dashboard, as reminders) will help you remain de-stressed, even if tensions rise.

In addition to setting aside time to relax daily, try taking up a hobby that calms your nerves. Swithers says diversions like knitting or doing crosswords can help you move past your stress. Don't forget the power of a good support system. Sometimes--like when planning a holiday get-together leaves you frazzled--asking friends or family for help could restore your sanity. Then, at the end of the day, make sure you get a good night's sleep. Swithers says this often-overlooked component is essential; you'll need to feel restored and rejuvenated to face the stresses that tomorrow is sure to bring.

Relaxation for Beginners

Relaxing does more than make you feel calm. According to Richard S. Surwit, PhD, ABPP, CL, professor of medical psychology in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center, proper relaxation should lower your blood glucose, too. Surwit's been studying the connection between diabetes and stress for 20 years, and in a 2002 study showed that stress management can reduce A1C levels in people with type 2

The program Surwit used in the study and continues to recommend to patients starts with a 6-week CD course that focuses on 15- to 20-minute exercises once or twice a day. To get an idea of how it works, try this:

  • Slowly tense your feet by pulling them up to your knees as far as is comfortable.
  • Hold them in this position for 10 seconds, thinking about the tension you feel.
  • Then, think the word relax and let the tension go. As you do this, be mindful of the relaxation.
  • Gradually work your way from your feet to your head, tensing and releasing each muscle slowly and mindfully.

The purpose? To get people to become aware of what it feels like to experience tension," Surwit explains. "Most people aren't even aware of it. We use the muscle as a monitor. The muscles are something you can sense.

Once you've mastered long-form relaxation, you should be ready to incorporate multiple 30-second relaxation exercises into your day. "When people stop themselves 10 or 15 times a day and access their level of stress and do something about it, that's where people lower their blood sugar," Surwit says. Since they are aware of their tension and the feeling of relaxation, people who use the mini exercises can zap stress as it buds. "It's a process of becoming mindful for 15 to 20 seconds. The more you do it, the betteryou'll be," Surwit says. "This is something everybody can learn. It's so universally applicable."

When Too Much Is More Than Enough

For some people, stress is manifested in ways more serious than a tough deadline at work or the hassle of an hour-long commute. People in an abusive relationship or those whose overly stressful job is causing them emotional and physical health problems may find more help in making a life change--such as ending the relationship or finding a new job--than they would in managing the stress. "In the end, it boils down to this: If after you do all you can to manage the situation the stress continues, then it's time to extricate yourself from it," says Surwit. "If your boss keeps up the pressure despite all of your efforts to deal with it, then it's time to get another job. If you can't adapt to your spouse's behavior and your spouse won't adapt to you, then you may bebetter off leaving the relationship."

That doesn't mean that you should find a new job every time your boss treats you unfairly or get a divorce if you and your spouse have an argument. But, if you think a stressor may be controlling your life or causing you to be depressed, take time to assess whether you should change your life. "In general," Surwit says, "I recommend that people get some professional help in making those types of decisions so that they have a point of reference from which to judge whether they have really tried to manage the situation before they leave it."

For more ways to de-stress, click here.



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