April 04, 2024 Stress SOS

Charlene Lavergne has spent many years worrying about her feet. Her church gave her a treadmill so she could exercise at home, but what if she loses a foot? She also worried about her eyes. What if her vision gets worse and she cannot afford new glasses? And about having a heart attack. “Every time I do something, like hop on the treadmill, I worry about whether I’ll be able to do it tomorrow,” says Charlene, who lives in Oshawa, Ont. Now 69, she says “I still have concerns about my feet, eyes and heart but being retired, things seem to feel a little less worrisome.”

Charlene has lived with type 1.5 diabetes—type 2, with some features of type 1, known as LADA (Latent Autoimmune Diabetes in Adults)—since she was a teenager. Adding to her stress is the stigma of the conditionin her Métis community. (She has shared her story with Ontario Members of Parliament on behalf of the Canadian Diabetes Association, now known as Diabetes Canada.) “I couldn’t tell my relatives that I shouldn’t be eating a certain food,” she says. “I couldn’t tell them my blood sugar was high. Even my children didn’t want to know.” The lack of openness compounded her stress, which “made my blood sugar climb still higher. You could see it in my logbook.”

What kind of stress are you dealing with?

While life throws stress at just about everyone, there are some particular challenges for people with diabetes:

Diabetes self-management “Most people aren’t wired to pay attention to something 24/7,” says Dr. Michael Vallis, a health psychologist and associate professor at Dalhousie University in Halifax. “Even the things we enjoy, such as golf or knitting, we enjoy in spurts.” Having to think about diabetes every time you eat, exercise, or change your routine can create significant stress over time, says Vallis. “It’s not for nothing that we talk about diabetes distress."

Health Diabetes-related complications such as vision problems and foot ulcers can make day-to-day activities more challenging. Even if you are not dealing with complications now, they are a long-term concern.

Financial “Every month I've worried about whether I’ll be able to afford the insulin I need,” says Charlene, who gets a modest disability pension with a limited drug plan. When she was employed, the fear of losing her job kept her up at night. “I had a supervisor who had a problem with me injecting insulin in view of others,” she says. “I dreaded going to work and kept worrying I would get fired.”

Social “If you have diabetes, you’ll likely have some stress dealing with people in your social circle, particularly around food,” says Dr. Vallis. He gives the example of getting a dinner invitation, where you tell your host that you need to eat by 7 p.m. to keep your blood sugar on an even keel. “The host may say, ‘Sure, no problem,’ but then you get there and dinner isn’t ready until 8:30 p.m. That’s stressful.” Not only can the delay affect your blood sugar levels, the stress of being delayed can also worsen your physical health.

Stress: it’s not just in your head

Stress causes your body to produce cortisol and adrenalin—hormones that raise your blood sugar and give you the energy to “run from danger,” also known as the “fight or flight” response. These hormones also raise your blood pressure. If this happens just once in a while, your body can recover. But if stress becomes chronic, it can contribute to conditions such as chronic pain, digestive problems, and even heart disease. That is because high blood pressure can damage the blood vessels, causing them to form plaque that limits the flow of blood.

Trying to cope with chronic stress can also mean you are less likely to maintain behaviours that can help you stay healthy; that can raise your risk of developing diabetes complications over time, says Dr. Norbert Schmitz, a professor of psychiatry at McGill University and researcher at Douglas Mental Health University Institute and Montreal Diabetes Research Center. These complications can create more stress, which can worsen your health and lead to what Schmitz calls a negative feedback loop. He says,

Getting stress under control can break the cycle and improve your ability to manage your diabetes effectively.

What can you do about stress?

Exercise Some research suggests that exercise increases a chemical in the brain that reduces stress and anxiety—as long as it is an exercise you enjoy. If you do not like walking on a treadmill, you might walk around a mall instead, or buy a badminton racket and find a buddy to play with.

Relaxation techniques Yoga, meditation, deep breathing, and progressive relaxation therapy (tensing and relaxing your muscles in sequence) are popular options. “Focusing on your breathing for a period of time has been shown to decrease activity in the stress centres of the brain,” says Dr. Howard Nathan, a retired physician and former funded scientist at the Ottawa Hospital Research Institute.

Mindfulness A related approach, called mindfulness-based stress reduction, involves paying attention to what is happening in your mind and body at the moment. For example, lie down and notice the sensations in your right foot—is it hot, cold, sore, tingly, or itchy?—without judging or reacting to them. “If we develop the ability to be with unpleasant sensations or emotions without reacting to them, our quality of life improves,” says Dr. Nathan, whose research has shown that mindfulness and other relaxation techniques improve physical and mental functioning as well as quality of life. There is also evidence that “mindfulness leads the body to produce less cortisol,” he adds.

Positive self-talk When Charlene feels down about her diabetes, she reminds herself that “other people have it worse, and I’m lucky to be alive.” At other times, “I need a good cry,” she says. “The important thing is to carry on.”

Social support Research continues to find links between a strong social network and physical health. Charlene has drawn strength from her Bible study group. For others, friendships based on common interests may help. A word of caution from Dr. Vallis: “If your current friends don’t have time to hear about your struggles, seek out other friends.”

Doctor support According to Dr. Vallis, negative experiences with your doctor can add to your stress. If he or she never asks you how diabetes is affecting your quality of life, Dr. Vallis suggests you make the first move. “Tell the doctor how you’re feeling—including if you’re feeling judged for not being the perfect patient—and what you need.”

Mental-health support If you cannot manage your stress on your own, a psychologist, social worker, or stress-reduction program can help you identify and cope with the sources of stress in your life. Contact your doctor or Diabetes Canada to help you find the right support. So where do you begin? Dr. Vallis suggests choosing one of these strategies, getting comfortable with it, and going from there. “The more sources of support you have, the better,” he says.

Positive changes

There have been positive changes in Charlene’s life. She says, “I have tried to take control of these issues, and before the pandemic I swam every night. That in itself made a huge difference in both my physical outlook but my emotional one as well.” She also achieved a goal of losing weight.

She adds, “The pandemic was difficult but with today's technology such as video messaging I stayed in touch as much as possible. I think I can say without reserve that today's Charlene is happier, stronger and in better control than [she was five years ago].”

Did you know?

Accepting the realities of having diabetes won’t happen overnight, or all at once. The most important thing to remember is that you are not alone. Talking to your family, a friend, someone else with diabetes or a healthcare professional will help you deal with the ups and downs of your new life with diabetes. Learn more in Mental Health and Diabetes.

This adapted article originally appeared in Diabetes Dialogue.