Whenever we think of the causes of diabetes, we usually think of heriditory factors (family history), overeating or lack of exercise leading to obesity as the most common causes. While this is true, we often tend to forget an important cause of diabetes – stress. Stress is defined as “a physical, chemical or emotional factor that causes physical or mental tension and may be a factor in disease causation”. Several diseases can be caused or worsened by stress and diabetes is also one of the important ones.

How does stress affect the blood sugar levels?

The blood sugar levels are controlled mainly by two groups of hormones. The first group of hormones reduces blood sugar but insulin is the only member of this group. The second group called counter-regulatory hormones, opposes the action of insulin and increases the blood sugars. There are several of these hormones and the list includes cortisol, adrenaline, noradrenaline, glucagon and growth hormone. Stress tends to increase the levels of the counter-regulatory hormones, particularly cortisol, adrenaline and noradrenaline. If the levels of these hormones are persistently elevated, this can precipitate diabetes in a predisposed individual or worsen the diabetes control in someone who already has the disorder.

Mrs. S, a 52 year old lady visited me some time ago. She had abnormally high blood sugars – over 600 mg/dl. Despite my best efforts to control her sugar with high doses of insulin and tablets, the sugar remained above 350 mg/dl. Then, suddenly one day after 3 – 4 months, the sugar levels started dropping. We had to withdraw the insulin and later, stopped all her diabetes tablets also. She told me that she was now eating sweets and chocolates every day but her sugars remained normal. She then opened out to me and said that her husband had been having an affair with another lady in his office which produced great stress in her life and that was why she had developed diabetes. After a few months, the other lady had got transferred to another city and her husband came back to her. Her diabetes disappeared! This may sound like a script from a movie but truth is stranger than fiction!

It is important to detect high stress levels in a patient, since the blood sugars will come down only if the stress is relieved or controlled. Doctors should always think of two things; when they see any patient with unexplained high sugars, or in someone whose diabetes is not under control in spite of optimum use of diet, tablets and insulin a hidden infection somewhere in the body or stress. Reduction of stress often leads to dramatic improvement or even cure of diabetes, as shown in the case above.

How can stress be dealt with?

Very often, individuals do not realize that they are under stress and even if they do, they deny it. The first step in stress management is to make the patient understand that everyone in the world is exposed to some stress or the other at some time in their lives. In fact, a mild degree of stress may actually be good for us as it raises our level of performance. Even Sachin Tendulkar recently admitted that even now he does feel mildly anxious every time he goes into bat. However, one should be alert to the signs and symptoms of excess stress, as they may be quite subtle and yet can be serious, and even dangerous.

One should try and accept stressful situations as “challenges” and not as “threats”. Many doctors tend to treat symptoms of stress with anxiolytic or anti-depressive medications without tackling the root cause of the stress. This approach could lead to harmful side-effects. Therefore, the correct approach would be the use of stress management techniques like diet, exercise, meditation, yoga and other forms of de-stressing. This approach would help to identify the underlying cause of stress and correct it. The help of a qualified clinical psychologist or counselor can be of great help in many cases as they would often have more time to spend with the patient than a busy physician.

Stress is a part and parcel of our modern, fast-paced lives. Following a healthy lifestyle with adequate exercise, correct diet and regular sleeping hours will keep one physically and mentally fit to face any stressful situation that may arise in one’s life. It is particularly important that a person with diabetes learns how to manage stress, since stress can wreak havoc with the management of diabetes. A healthy social life, taking time out to relax with friends and family is vital in reducing stress levels, thereby reducing the risk of developing diabetes and helping people with diabetes take control of their condition. We have seen many patients who were able to reduce their dose of drugs and several cases like the one described previously, who were able to completely stop all anti-diabetic medications. Find out if stress is the cause of your diabetes, and if yes, please start stress management measures today. You cannot avoid stress but you can certainly manage it!

TIPS ON COPING WITH STRESS

• Accept whatever has happened
• Practice better time management
• Improve organizational skills
• Resolve conflicts
• Yoga (eg, Pranayama) and Meditation
• Regular exercise
• Relaxation techniques
• Eat moderately and at proper times
• Proper sleeping hours
• Seek support whenever necessary either from a family members or professionally