COPING WITH THE STRESS OF DIABETES MANAGEMENT

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Do you constantly worry about your diabetes management? How can I stop eating white rice? What should/can I eat for lunch? How can I handle my medications? I really don’t have time to exercise! My blood sugar is higher than usual, what should I do? How can I keep track of my stress and blood sugar levels? What if I get diabetes complications in the future?

You might be suffering from something called diabetes distress.

Diabetes distress: The stress of diabetes management

The challenges of living with diabetes and managing your diabetes can be daunting and overwhelming. Diabetes distress is a distinct type of stress commonly affecting people with diabetes.¹ This differs from emotional stress, such as depression, anxiety, trauma and work stress, and physical stress, which comes from external sources including prolonged physical activity, physical trauma or injuries.²

Simply put, diabetes distress does not necessarily mean you are depressed.³

Diabetes distress is often neglected because of the hidden emotional burdens and worries that are part of managing a demanding and chronic disease such as diabetes.^1,3 It is associated with the constant demands of diabetes self-management, such as medication dosing and frequency, monitoring blood sugar levels, food intake, eating patterns and physical activity.¹

Similar to stress, diabetes distress can affect your ability to manage your diabetes – you may skip meals and exercises or forget to take your medication, which eventually causes poor blood sugar control.^1,3

When you are under stress, your body releases cortisol – the stress hormone.^4,5 Cortisol can be thought of as your body’s built-in alarm system – triggering the fight-or-flight response.^4,5 Cortisol manages how your body uses carbohydrates, fats and proteins; reduces inflammation; regulates blood pressure; controls the sleep and wake cycle; and boosts energy for the body to deal with stress.⁴

Cortisol also decreases insulin secretion, thus increasing blood sugar levels.⁵ This will be an issue if you are under constant / chronic stress and the alarm stays on – prolonged high levels of cortisol and low insulin secretion can cause dangerously high blood sugar levels. While stress may not cause diabetes, it certainly plays a part in keeping blood sugar levels high, i.e., hyperglycemia, which can in increase the risk of complications in persons with diabetes, and bring about a myriad of other health problems.

Tips for managing your diabetes distress

While it is impossible to remove stress and diabetes distress completely from your life, there are various ways you can better manage stress and keep your diabetes under control. Here are some tips:^6,7

• Pay attention to and talk to someone about your feelings – be honest about the problems you are having in dealing with diabetes.
• Reach out for support – join a support group or connect with loved ones so they can help you with managing your diabetes in ways that are useful to you.
• Self-care – take breaks, get enough sleep and rest, and do things you enjoy.
• Seek financial assistance if the cost of diabetes medicines is a concern – MediSave for Chronic Disease Management Programme (CDMP) provides financial support in managing chronic diseases including diabetes.⁸
• Practice mindfulness – acknowledge and accept your feelings and thoughts.
• Manage diabetes with technology – apps/reminders can help better monitor your diet and log exercise.⁹

Tips for supporting a loved one with diabetes¹⁰

Those with greater support from family, friends, or another person with diabetes tend to cope and adjust better than those who have poorer support.¹⁰ Here are things you can do to support a loved one with diabetes:¹⁰

• Learn more about diabetes and how to provide support e.g., remind them to take their medicines and attend follow-up appointments, help monitor their blood sugar levels.
• Make diet and lifestyle changes together.
• Work out together.
• Be understanding and do not judge others about having diabetes.

Managing diabetes can be hard. You may feel overwhelmed. It is important to pay attention to your feelings and reach out for the support you need to make decisions about your diabetes care.

References

1. American Diabetes Association. Diabetes Care 2017;40(Supplement_1)S33–43.
2. Pouwer F, et al. Discov Med 2010;9:112–8.
3. Fisher L, et al. Diabetes Care 2013;36:2551–8.
4. WebMD. What is cortisol? Available at: https://www.webmd.com/a-to-z-guides/what-is-cortisol. Accessed March 2022.
5. Verywell Health. Can stress cause high blood sugar? Available at: https://www.verywellhealth.com/can-stress-cause-high-blood-sugar-5116560#citation-1. Accessed March 2022.
6. Centre for Disease Control and Prevention. 10 tips for coping with diabetes distress. Available at: https://www.cdc.gov/diabetes/managing/diabetes-distress/ten-tips-coping-diabetes-distress.html. Accessed March 2022.
7. Health Hub. Diabetes management and stress. Available at: https://www.healthhub.sg/live-healthy/1440/diabetes-and-stress-problems. Accessed March 2022.
8. Ministry of Health Singapore. Chronic Disease Management Programme (CDMP). Available at: https://www.moh.gov.sg/policies-and-legislation/chronic-disease-management-programme-(cdmp). Accessed March 2022.
9. Healthline. Choosing the best devices and tech to help you manage type 2 diabetes. Available at: https://www.healthline.com/health/type-2-diabetes/best-devices-and-tech. Accessed March 2022.
10. SingHealth. How to cope with stress of diabetes management. Available at: https://www.healthxchange.sg/diabetes/living-well-diabetes/coping-diabetes-managment-stress. Accessed March 2022.