Why is diabetes (and life) so stressful?

By Adam Brown

Twitter summary: Why I feel #diabetes/life stress & my four personal strategies for overcoming it: Mindset, Movement, Mindfulness, and Morning routine.

Have you ever felt stress related to your diabetes?

There’s no question – this can be a tough, unrelenting disease. It’s 24/7 with no breaks. It affects nearly every aspect of life. The management is repeatedly annoying, unpleasant, time-consuming, and worry-filled. It’s expensive.

So perhaps it’s no surprise that up to 48% of people with diabetes will experience high levels of diabetes distress in any 18-month period (Diabetes Care 2012). Stress can also increase blood sugars. And according to a Harvard survey last year, 49% of all people (with and without diabetes) reported a “major stressful event or experience” in the past 12 months.

But it’s not all doom and gloom! Many experts believe that stress can be managed, whether it’s related to diabetes or simply life in general. This article starts with two question prompts to get you thinking about your own stress. I also share what triggers stress for me, as well as the four strategies I’ve found most useful for overcoming general and diabetes-specific stress (4M’s): Mindset, Movement, Mindfulness, and a Morning routine. As always, I would caution that my sources of stress and calming strategies are what works for me – these are meant as examples for people, but I know they won’t all apply to everyone. “Your mileage may vary” as they say! 

A Starting Point – Why Do You Feel Stress?

Stress tends to vary by individual, so you may find it useful to pull out a piece of paper and answer the following questions:

1. I feel the most stress when ________. (Note – You may find it helpful to distinguish between diabetes stress and stress that is not related to diabetes.)

2. ________ helps me reduce my stress levels.

If this is a hard exercise, you can take notes on your mood and stress levels over the course of a few days to better understand trends. I highly recommend the app, MoodMeter (available for iPhone and Android) to do this.

In case it’s useful, I’ve shared my responses to these questions below.

I feel the most stress when...

• I do everything “right,” but still see out-of-range blood sugar values. There are so many variables (22+!) to think about and consider – it can be stressful and frustrating when 1+1 does not equal 2, and exhausting to figure out what caused what.

• I ride the rollercoaster of low, then high, then low, then high, etc.

• I tend to be a perfectionist and very achievement-oriented, so out-of-range blood sugars feel like a “bad” grade. I stress myself out with self-criticism and frustration.

• I feel like I have way too much to do and not enough time to do it. This mostly happens during the workweek, when my to-do list and email inbox grows faster than I can complete it.

... helps me reduce my stress levels

1. MINDSET: “The greatest weapon against stress is our ability to choose one thought over another.” Psychologist William James said this over 100 years ago, and it rings very true for me.

• Appreciation of how hard diabetes is – perfection is challenging with current tools. I’m trying to replicate what the human body without diabetes does so elegantly – perfect glucose sensing, the perfect amount of insulin delivery in seconds, and perfectly functioning hormones like glucagon and amylin. I must be kind to myself – I’m doing the best I can with the tools I have.

• Stay in the present. Much of my stress comes from judgment about what I did in the past (e.g., Why did I eat that?) or worries about the future (e.g., Did I pack everything I need? Will I have enough time to exercise?).

• Remember that blood sugars are not “good” or “bad.” They are just information. I really, really struggle with this in practice, since glucose numbers feel like a grade, and I’m competitive with myself. I like the Behavioral Diabetes Institute’s recommendation: putting a label on my meter that says, “It is just a number.”

• The “Zoom out” visualization. An outstanding book, The Charisma Myth, recommends this exercise for neutralizing stress. In my head, I zoom out to see planet Earth hanging in space. Then I zoom in to see my continent, my country, my city, and the room I’m in. I imagine myself sitting in that room, with little electrical impulses whizzing across my brain. I’m one person having one stressful experience at this moment in time.

2. MOVEMENT. Exercise, especially outdoors, helps clear my mind and gets me focused on the task at hand – not on worries about diabetes or things I need to do at work. But I’ve found there are a few critical nuances to this stress-busting strategy:

• Find an activity I actually like doing. If I’m not enjoying it and it feels like a chore, it doesn’t reduce my stress. Plus, life is too short not to enjoy my free time! This is a helpful quiz for anyone struggling with this question.

• Do it before the workday starts. Otherwise, I will stress about getting my activity in all day long. Setting up a really basic home gym has helped me.

• Going slow to go fast. It’s tempting to ramp up super quickly, especially when my friends are faster or stronger than I am. I’ve learned to start slow and gradually build; otherwise, I end up de-motivated, injured, and more stressed.

• Take walking breaks. These are especially helpful during the work day – it’s amazing how a 20-minute walk outside can lift stress off my shoulders (and lower BGs too!).

3. MINDFULNESS (deep breathing). If I’m feeling overwhelmed at any point during the day, sitting down and focusing on slowly breathing in and out often calms me down. This felt intimidating, uncomfortable, weird, and very difficult at first – I’m still not good at it, but the following resources have helped me add mindfulness into the busyness of daily life.

• Buddhify: App available for Apple devices ($4.99) and Android ($2.99). Includes 80 guided soundtracks chosen based on one of 16 environments you are in (e.g., “At work,” “Before bed,” “Can’t sleep”, “Walking,” etc.). I use the “waking up” and “walking” options very frequently.

• Calm: Free app available for Apple devices and Android, as well as a website. Both guided and unguided soundtrack options that help calm me down. I especially like the variety of nature sounds.

• Headspace: Free app available for Apple devices and Android. A more structured approach to mindfulness with a community of users.

• Mindfulness in Plain English by Bhante Henepola Gunaratana – A highly informative how-to book on the basics of mindfulness, with over a quarter of a million copies sold. If you want my highlighted notes, please email me.

• Way of the Peaceful Warrior by Dan Millman – My favorite book ever! It’s a story rather than a how-to-guide, but it always reminds me how to live a more mindful life. If you want my highlighted notes, please email me.

4. MORNING ROUTINE. Nailing the first couple hours of my day makes everything much less stressful. On weekdays, I try to wake up at 7 am, do some deep breathing while my water for tea boils (I love the eight-minute “Good” – Waking Up track on Buddhify), read for fun, exercise, and then start work at 9 am. It’s rare that I accomplish this every day of the work week, but even on the few days that I do, it makes a tremendous difference.

• I try not to look at my phone or email in these first two hours of the day, since that’s where a lot of my weekday stress comes from. I admit that I’m not always successful. Using “Do not Disturb” mode or leaving my phone turned off are helpful self-control strategies.

Concluding Thoughts

Stress inevitably comes with living in the 21^st century, and especially as part of living with diabetes. I’ve found the 4Ms to be useful stress reduction strategies: Mindset, Movement, Mindfulness, and Morning routine. There’s no question that I still feel plenty of stress on many days of the week, but I always know that at least one of these approaches can help.

I definitely don’t have all the answers to this article’s title, so I would love to hear from you! What makes you feel diabetes stress? What techniques are helpful for you? Let me know by email or on twitter.