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The Stress-Diabetes Connection

Where It Comes From — How to Deal With It

By David Spero RN

Last Update: December 31, 2006

David Spero

David Spero

Stress is a major contributor to diabetes, but most people don’t understand what stress is or what to do about it. Here’s how stress works, and some things you can do about it.

Say you’re walking down the street, and you bump into a hungry, man-eating lion. (Don’t you hate it when that happens?) You would sense a dangerous threat, and your body would automatically respond. Your adrenal glands would pump out a number of hormones. Chief among these is cortisol, which tells your liver and other cells to pour all their stored sugar (glucose) into your bloodstream. They do this so that your leg and arm muscles can use the glucose as fuel for running away, fighting, or maybe climbing a tree or a fire escape.

At the same time, your other cells would become “insulin-resistant.” Insulin’s job is to get glucose into our cells to be used as fuel. In a crisis situation, most of your cells resist insulin, so the muscles involved in fighting or fleeing will have more energy. This reaction is called “stress.” In nature, the stress response is vital to survival. The antelope senses the lion (a threat) and runs. It either gets away or the lion eats it. In running, the antelope uses up the extra sugar and restores its hormonal balance. The whole thing is over in ten minutes, and the antelope can rest.

But in our society, threat isn’t usually physical. When you’re threatened with job loss or eviction or the breakup of your marriage or a child’s drug problem or the thousands of other potential threats in modern society, you can’t fight, and you can’t run. You just sit there and worry. And the stress isn’t over in ten minutes either; modern stresses often act on us 24/7, week after week. Over time, insulin resistance builds up. It is a major cause of type 2 diabetes, heart disease, overweight, and many chronic illnesses.

How does stress cause illness?
Since, under stress, most of your cells become insulin-resistant, some of that extra glucose stays in the blood and causes damage to nerves and blood vessels. The rest of it gets converted to abdominal fat, and your LDL (“bad cholesterol”) level goes up. Stress also raises your blood pressure and heart rate to pump blood to the leg muscles for the running away that we’re not doing. This is a combination likely to cause all kinds of problems.

Stress also causes diabetes through behaviors, because the easiest way to treat stress is with food high in sugar or saturated fat. These “comfort foods” raise our levels of endorphins and serotonin, our bodies’ natural “feel-good” chemicals. They make us feel more calm and more in control. But the good feelings don’t last long. Our blood sugars drop again when our insulin response catches up to them, and pretty soon you feel worse than before. You need another “fix.” Meanwhile, you will have added to your insulin resistance and your abdominal fat.

Another way stress hurts us is by depressing the immune system, the body’s natural repair and defense program. Stress doesn’t care about long-term health, because there will be no long-term unless we survive the immediate crisis. Repair can wait until the crisis is over.

But for people with less power  —  less money, less education, less social support, less self-confidence, lower self-esteem, a minority skin color or disapproved body type  —  the crisis is never over. The economic, emotional, and sometimes physical threats are always there. The immune system stays suppressed. So over time, chronic stress is like endlessly deferring maintenance on your car. Like your car, your body will tend to break down.

Where Does Stress Come From?
We have an image of stress as a very busy thing. The phones are ringing, we’re racing around town; we’ve got deadlines, high noise levels, and not enough time. All the little crises of life add up to this feeling we call “stress.” But this is a mild form of stress, akin to a roller-coaster ride, a reaction that many bodies actually enjoy. Real stress is something quite different. It’s a response to serious threat. Stress occurs when the threats we face exceed what we think we can control.

Now pay attention. If stress occurs when you perceive threats greater than your power to control them, then the less power you have, the more stress you will have. Let’s say that hungry lion is still on the corner, but this time you’re not walking; you’re riding in an Abrams tank. You wouldn’t be stressed at all. You might have a “cute lion” story to tell at work. When you have the power to cope, there’s no stress.

Access to money, a source of power, reduces stress. Say my company is sending my job to Bangladesh. If I had a million dollars in the bank, I wouldn’t worry much. It might hurt emotionally, but it wouldn’t affect my health. And if I knew I could get another job easily, it would be even less stressful. But if I had twelve cents to my name, and knew getting another job would be very difficult, and had a family depending on my income, worrying about job loss might keep me up all night and keep my blood sugars up too, even if the actual move never happens. My body would be screaming, “Run! Fight! Climb a tree or something!” but I couldn’t. My body would pay the price with long-term health problems.

Coping with Stress
For the mathematically minded reader, here’s a useful stress formula:

STRESS = (perceived) THREAT / (perceived) CONTROL

If you want to reduce stress (and believe me, you do), this formula shows several ways to do it. We may be able to reduce the threats we face  —  for example, getting a roommate to help pay the rent, or moving to a safer neighborhood to avoid violence. You may be able to reduce your perception of threat  —  for example, realizing that if your husband yells at you, it’s not the end of the world. You’re still alive and you’re still a good person.

We can also reduce stress by increasing our ability to control some threats. If you’re a young man in a neighborhood where the police harass young men, you may be able to learn skills for avoiding the cops or dealing with them. If you have diabetes and are deathly afraid of complications, learning to control your blood sugars through diet, exercise, relaxation, and/or medications will give you more perceived and actual control and reduce stress.

Other people are a major source of power, and their support will increase your perceived control. Strengthening connections with family, friends, neighbors, your congregation, or other people who share your problems (as in a support group) will reduce your stress and help you cope.

Family relationships themselves can be a source of healing or a source of stress. If your family seems to cause you more hard feelings than good ones, perhaps you can get some help with that, through counseling or learning better communication skills. Maybe you just need to reach out to them with some honest communication.

Threat and stress can be spiritual as well as economic, emotional, or physical. We all need positive goals and reasons to live  —  a life without meaning or connection can be perceived as a threat to your soul. Sometimes we need to spend time figuring out what’s important to us and commit to spending more energy on positive things. It’s OK to get some help with this process.

Self-confidence is a major element of power and perceived control. You can build self-confidence by accomplishing small goals, by learning more skills (take a class!), or by seeing people like you accomplish something. If they can do it, you can too.

We can combine all four of these strategies by getting involved with other people in changing threatening situations  —  for example, organizing for more youth employment programs, cleaning up toxic pollution, or starting a neighborhood walk. You’ll be reducing threat and increasing social support and sense of control at the same time.

Relaxation, meditation, and prayer are powerful ways of reducing stress. They reduce perceived threat and make you feel more in control. Perhaps you can get some relaxation tapes, go to meditation or yoga class, join a church you believe in, or just take some time every day to sit and breathe. Spending time with animals or even with plants can relax us and give us a sense of peace and connection, reducing stress.

Get Active -- The Indispensable Step
The healthiest way to deal with stress is the way the animals do, with physical activity. Stress tries to help us survive the only way it knows how, by getting us to move. If you don’t exercise, most of the glucose your body puts out will turn into abdominal fat. That’s why stress and inactivity are a lethal combination.

So get out and run or swim or bike or walk your dog. Consider exercise that makes you stronger and tougher  —  kick-boxing, weight-lifting, martial arts. You’ll wind up feeling more confident and therefore less stressed.

Getting active means more than just exercising. We’re usually better off taking a more active role in our own lives, meaning we don’t let the media and the dominant culture decide what we eat and what we do. We decide for ourselves. When we can decide what’s important to us, when we connect with other people to live in ways that are meaningful to us, we will have less stress and better blood sugar control.

For more information, read my books Diabetes: Sugar-Coated Crisis or The Art of Getting Well or Robert Sapolsky’s book Why Zebras Don’t Get Ulcers or see me on line at  

This article originally appeared on on December 19, 2006.

    Adapted from Diabetes: Sugar-Coated Crisis  — Who Gets It, Who Profits, and How to Stop It by David Spero RN (New Society Publishers, 2006). Please feel free to download and disseminate, as long as you keep this source information.

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