A, a successful businessman aged 45 years, came to us recently with very high blood sugar level of nearly 600 mg/dl. On further evaluation, it was found that A had been under a lot of stress recently. He had lost money in the stock market and his business had been badly hit by the recession.
Since his blood sugar was very high, he was started on insulin along with small dose of oral anti-diabetic tablets. In a couple of weeks his blood sugar came down and he was able to stop insulin and move to tablets. When we saw him recently, his blood sugars were normal and he was able to stop all his diabetes medication. The secret of this miracle “cure”: Stock market has rebounded and the recession is over!
B, a bank officer, was a diabetes patient for seven years. His blood sugar was under control with tablets alone. Recently, he was transferred to a small village, which meant that he had to live away from his family. As his wife was not well, he was worried sick.
At his annual check-up, we were surprised to note that his blood sugars were totally out of control and could not be brought down even with insulin. This continued till he was transferred back to the city on health grounds, when his blood sugars promptly returned to normal levels.
Common factor
Most doctors treating diabetes patients will be familiar with patients like these. The common factor in both cases is stress. Stress can not only raise the blood sugars in a diabetes patient, but can also precipitate diabetes in someone predisposed to it.
The Webster’s Dictionary defines stress as “a physical, chemical or emotional factor that causes bodily or mental tension and may be a factor in disease causation.” Stress can cause or worsen many diseases; diabetes is one of them.
How does stress affect the blood sugar levels? Blood sugar is controlled mainly by two groups of hormones. The first set reduces blood sugar; insulin is the only member of this group. The other set, called counter-regulatory hormones, opposes the action of insulin and increases the blood sugars. This includes cortisol and adrenaline (from the adrenal glands), glucagon and growth hormone.
Stress tends to increase the levels of the second set of hormones, particularly cortisol and adrenaline. If the levels of these hormones remain high for a long time, the result will be development of diabetes in a predisposed individual or worsening of diabetes in a patient.
It is important to detect high stress levels in a patient, since blood sugars will come down only if stress is relieved. Doctors should always think of stress when they see a patient with unexplained high sugars, or with uncontrolled levels despite optimum use of diet, tablets and insulin. Reduction of stress often leads to dramatic improvement or even cure.
Often, individuals do not realise that they are under stress; even if they do, they try to deny it, feeling that it represents failure. The initial step is to get rid of this guilt trap and appreciate that everyone is exposed to stress at some time in their lives. In fact a mild degree of stress may actually be good as it raises our level of performance. However, one should be alert to the signs and symptoms of excess stress, as they may be quite subtle.
Coping with stress
The ability to cope with stress requires a change in the individual’s mindset. One should try and interpret stressful situations as challenges, not threats. Most individuals use a “band-aid” approach, i.e. treating the symptoms of stress with medication without tackling the root cause. Though effective in the short-term, this is fraught with harmful side-effects over time. Another approach is the use of stress management techniques like diet, exercise, meditation, biofeedback, yoga and other relaxation therapy. This approach helps identify the underlying cause and correct it. A qualified clinical psychologist or counsellor can be a great help in many cases.
Stress is an inevitable accompaniment of modern life. Individuals differ, not in their exposure to stress, but in how they react to it. Following a healthy lifestyle with adequate exercise, correct diet and regular sleeping hours keeps one physically and mentally fit to face stressful situations. It is important that a person with diabetes learns to manage stress, since it can play 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.
The writers are Diabetologists at Dr. Mohan’s Diabetes Specialities Centre, Chennai Website: www.drmohansdiabetes.com
