Wednesday, March 16, 2011

Stress and Diabetes - Often Left out of the equation?

In my experience as a PWD  who helps  people diabetes on a daily basis I often question why stress isn't one of the priority discussions that should take place.

Health professionals  have their routine during diabetes visits that usually include: diet, blood glucose readings, BP, Wt, A1C, feet, kidney's, then the time is up and it's time for the next patient.

I propose stress and mental coping be added to this equation as part of the team's repertoire or interviewer's strategy in discussing diabetes during a visit.  You'd be amazed at the responses you get when you simply ask, "So, how are you feeling about your diabetes?"

I personally use a four legged approach to my discussions with PWD I am trying to help.  I call it my diabetic stool, so all the legs need to be stable for decent control. I discuss  Diet, Activity, Medication, and Stress.  If all these are in check the you tend to achieve fairly decent diabetes control.  This is my discussion strategy with PWD.  But the first question I ask is; "So, how are you feeling about your diabetes?" I know I am repeating myself, I heard once it's good for emphasis.

"Sorry about the image quality, it is word document that wouldn't paste"

After going through the above I flip it so the stress is on the top, to basically say, unless your stress and mental health is in check then all these other components are even harder to control, and you may indeed fall off your stool.  It is very visual and they usually ask to take it home with them as a visual reminder. 
Most folks have not been given a good explanation how stress may effect their diabetes.  They are  usually aware hat having a common cold or serious illness can effect control, but they don't realize that mental Health, Anxiety, and prolonged stress can seriously hamper diabetes control.

Why is this?  I suspect it is because where the mind goes the body will follow.  If you are mentally well you are going to physically take care of yourself.  But there is also the biology  to consider.

When you are experiencing stress, acutely, or prolonged, you are more resistant to insulin. Your body releases hormones that inhibit insulin from doing its job, that is, letting the glucose into the cells to be used appropriately for energy.  Some of the stress hormones are cortisol, and adrenaline. The body also starts producing more glucose from your liver, getting ready for the "Fight or Fight" response. This used to be handy thousands of years ago when extra sugar was needed to feed the muscles in case you needed to attack a woolly mammoth or flee from a saber tooth tiger, but not so good now. This extra glucose simply increases and floats around wreaking havoc and leading to complications if not corrected.

What I am getting at is patent's and PWD need to know that stress impacts there diabetes control just as much as food.  It needs to be brought up, discussed, dealt with.  But the problem is our health care system isn't designed for health care workers to spend an hour talking about how PWD are feeling about their chronic process they deal with 24/7/365, every second of every day. 

On a positive note, we as a system in Canada are moving toward Primary Health Care, where by Allied Health Professionals work with physicians to assist them in improving patient care.

I work in this area and as a result I spend an hour dealing with all aspects of an individuals chronic disease, including Stress and Diabetes.


Well guess what, we need to.

1 comment:

  1. What if your cortisol levels are out of whack? Does this mean managing diabetes will be harder?