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Strategies for Handling Stress

     by Ivy Marcus, Ph.D., C.D.E.

If you're about to read this article, chances are good that you believe you have too much stress in your life and would like to eliminate it. Well, the bad news is that everyone has stress, and no one will ever get rid of it.
The good news, though, is that most people can learn how to manage the stress in their lives more effectively, and that can help them feel much less burdened. In fact, there are many benefits to effectively managing stress, ranging from more stable blood glucose control to an increased sense of well being.

Understanding Stress

It is important to understand just what we mean when we talk about stress, and theoretical definitions of stress abound. Probably the best definition was offered by the renowned stress researcher Hans Selye, who summarized stress as "…any bodily change produced as a response to a perceived demand being placed upon the individual." This definition highlights the notion that there are two important facets to stress: the psychological (or mental) and the physiological (or physical).

Stress can be typically negative events, called "distress," as well as the more positive happenings in life that nonetheless demand change and adjustment. After a demand is perceived, bodily or physical changes occur as a reaction. These biological responses typically include increased heart rate, respiration rate, blood pressure, and muscular tension, shallow (rather than deep) breathing, and the increased release of certain so-called stress hormones such as adrenaline and cortisol.

Such bodily changes occur for what is commonly known as the "fight-or-flight" response. The fight-or-flight response served a purpose ages ago, when acute, sudden stressors such as animal predators immediately threatened a person's existence. Successfully fighting off or fleeing from the threat greatly increased one's chance of survival. And, as with other creatures, our fight-or-flight stress reaction became "wired in" as a protective mechanism.

Stress continues to serve us today, as mild to moderate levels of stress can sharpen our alertness and motivate positive growth, spur the need to accept challenges, and promote change in our lives. Stress becomes a problem only when you consider the nature of some of our stressors. Unlike the saber-toothed tigers of long ago, today's stressors tend to be more chronic in nature. Most people struggle with the demands of health problems, interpersonal difficulties, financial worries, and negative or critical self-imaging, to name just a few. These concerns have a propensity to stick around. When you begin to experience any one of them, your body reacts with predictable changes. However, because these stressors usually stay around and dominate parts of our existence for long stretches of time, the bodily changes that get "turned on" stay "turned on," which can cause or influence numerous undesirable consequences.

Chronic stress can contribute to such physical problems as migraine headaches, lower back pain, ulcers, digestive disorders, TMJ (temporomandibular joint) syndrome, suppressed immunity, and, of particular concern to people with diabetes, difficulty controlling blood sugar. There is even some evidence that cardiovascular disease, high blood pressure, and certain types of cancer can be adversely affected by stress. Chronic stress also appears to contribute to many psychological and behavioral disorders such as depression, anxiety disorders, and low self-esteem.

Everyone attempts to cope with the stress in their lives, whether they do so consciously and deliberately or not. Unfortunately, many of the strategies people use to deal with stress actually produce additional sources of stress. Overeating, excessive alcohol consumption, cigarette smoking, and drug use are examples of stress management attempts gone awry.

Any effective strategy of stress management needs to do more than just distract you from that which is causing the stress. It needs to address both the physical and the psychological aspects of stress. To efficiently deal with stress, you must first get to know yourself and observe how stress tends to affect you, both physically ad psychologically.

Diabetes and Stress


You may already have some idea how stress affects your blood glucose level. In the past, it was thought that increased levels of stress contributed only to elevated blood glucose and that people with diabetes needed to compensate for this rise in blood sugar with less food, added insulin, or increased activity. Now, however, we also know that many people develop hypoglycemia in reaction to stress. This is particularly true for people practicing tight blood glucose control.

In addition to individual differences in blood sugar responses to stress, a number of other factors can influence the effects of stress on blood glucose levels. These factors include a person's coping style, personality, health benefits, attitude toward diabetes and diabetic complications, and degree of perceived social support. In addition, the nature of the stressor itself, and how well controlled a person's blood glucose levels were before the stressful event, can have an influence on blood sugar response to stress.

The mechanism through which blood sugar is affected by stress is thought to be a hormonal reaction. However, equally possible is a behavioral element, whereby when under chronic stress, a person changes her actions and routines. If her adherence to healthy habits weakens, her blood sugar will be affected. For example, for some people, stress on the job could lead to binge eating or less consistent exercising.

It seems probable that both hormonal and behavioral influences play a role in the reaction of blood glucose to stress. To find out how stress affects your blood sugar, test and keep an ongoing log of your blood glucose levels and observe any changes following stressful events. Once you are familiar with the impact that stress has on your glucose levels, you can take preventive measures when stress occurs.

Women and Stress

Women have special reason to take an interest in stress management. Research shows that women and girls are at least two to three times more likely to experience anxiety and mood disorders than men and boys. The reasons for this are many, ranging from biology to socialization. Luckily, women are also more likely to talk about and seek out help for distress.

The types of stressors that girls and women typically encounter change throughout the life cycle. Throughout childhood and adolescence, most girls struggle with issues of peer acceptance, as well as issues of independence and autonomy from their families. Growing up with diabetes adds a layer of pressures that girls and their families must learn to overcome.

Young adulthood brings with it the challenges of career choices, intimacy, partnership, and sexuality, and possibly choices about becoming a mother. Body image concerns can also become paramount for young women.

Middle adulthood, sometimes called the "sandwich years" because women are generationally sandwiched between their children and their parents, presents challenges of balancing and redefining roles, financial pressures, aging, and health-related concerns.

The elder years generally bring additional health concerns, the loss of significant others, and the opportunity to reflect upon-and, one hopes, not regret-the way one has lived one's life.

Regardless of the stage of life you are in and the types of stress you are facing, you can benefit from learning to manage stress. And, given the ever-changing roles for women and the lack of a variety of female role models, helping yourself through stress management training can be a real gift.

Management Techniques


Any strategy you use to deal with stress must focus on both the physical and the psychological aspects of stress. The techniques themselves can be divided into two broad categories:

  •     Those that specifically target the physical changes that occur in reaction to stress and that bring those changes back to normal, and
  •     Those that target the perceptual or cognitive component of stress and help to change unproductive or destructive thoughts into rational, productive, and beneficial perspectives on living.


Physical Strategies


Deep-breathing exercises, relaxation training, yoga, meditation, biofeedback training, massage, and prayer are all examples of coping techniques that target the bodily changes that occur as a result of stress. Each of these strategies involves learning skills that focus on regulating your breathing so that it becomes deep and abdominal, rather than shallow and centered in your chest, and so that your respiration rate slows. All of these approaches tend to relax and loosen muscle tension. And, with consistent training, they can readjust and regulate heart and pulse rate, blood pressure, and body chemistry, bringing them in line with healthy levels.

Physical exercise such as walking or aerobics is often recommended for stress reduction. The benefits of regular physical exercise cannot be overestimated, and exercise has long-term effects in reducing stress. However, in the immediate sense, physical exercise does not lower heart and respiratory rates. Instead, it increases most of the physical manifestations of stress. So, although exercise is an important resource for stress management and can be an acceptable way to blow off steam, other methods of stress management are still necessary to bring the fight-or-flight changes back to normal.

All stress-management techniques involve learning new skills, and that can take time. They also must be performed consistently and seriously to get long-term benefits. Here's an exercise to get you started practicing deep relaxation breathing:


  1.     While sitting or lying down, place one hand on your abdomen and the other hand on your chest.
  2.     Close your eyes.
  3.     Breathe in through your nose to a count of three, and breathe out through your mouth to a count of five. Continue for several minutes

If you're performing deep relaxation breathing correctly, you should feel the hand on your abdomen move out and in, while the hand on your chest stays relatively still. This exercise can be useful in combating acute stress: It can be preformed almost anywhere and is immediately available. Practicing deep relaxation breathing for one to five minutes each time you feel yourself becoming stressed can help you calm down enough to address the stressor directly.

Psychological Strategies

There are a number of psychological or cognitive-behavioral approaches to stress reduction. What they all have in common is a focus on helping you change your perceptions and attitudes toward stressful events.

It is important to accept the idea that stress will be ever-present in your life before you can unburden yourself from it. Like it or not, for every stressful situation that resolves or affects you less over time, a new one will eventually crop up. Once you can embrace the inevitability of stress in your life, you can proceed with dealing with the particular stressors in your life.

Following is a list of steps you can take that may help in problem-solving your way through stress. Keep in mind as you read, though, that each step may be a lot easier said that done. After all, change doesn't happen overnight; it can take weeks, months or even years of hard work.

Remember, too, that you may need help at some steps along the way. Sometimes talking with friends or family members can help you see things from a new perspective. If you have a mentor, you might also want to talk with him or her about some issues. For problems that just seem to stick around or that repeat over and over no matter want you do, you might consider talking with a licensed professional such as a psychologist, psychiatrist, or social worker.

Ten Steps Toward Reducing Stress


The following ten steps form a logical way to confront what which is stressful for you.

1. Identify just what it is that is causing you stress. Seems obvious, doesn't it? Well, it isn't always. Oftentimes, people who are feeling overwhelmed by stress incorrectly assume that everything in their lives is going wrong. There may be stressors in your life, but rarely does everything go wrong at once. It is important to clearly and specifically define just what your stressors are.

2. Identify exactly what portions of the stressor are beyond your control. There is always a part of any situation that is outside your influence.

3. Make peace with that which is beyond your control. It's not easy, but it's necessary. Acceptance of your limitations is an important step toward mental health and contentment.

4. Identify exactly what portions of the stressor are within your control. One portion that is always within your influence is your outlook and perspective. Ultimately, we are in charge of how we choose to perceive the world. However, long-held beliefs based on past experiences can sometimes cloud our interpretations of events. That's why getting a second opinion-preferably from someone uninvolved with the stressful situation-can sometimes serve as a sort of "reality check." Besides your perspective, it is important to identify any other aspects of the stressful situation at hand that are under your control.


5. Decide on the way you would realistically and practically want things to be. Specify how you'd like things to change, and establish short-term and long-term goals to bring about those changes. Make sure your goals are not unrealistically high and impossible to attain.

6. Identify the steps you need to take to achieve those goals.

7. Anticipate obstacles to achieving those goals. There will almost always be obstacles on the road to change.

8. Generate possible solutions to break through obstacles and setbacks.

9. Learn from your mistakes, and reward yourself for your achievements.

10. Never give up.

How They Work

To see how these steps might be applied to an actual stressful situation, let's take being diagnosed with diabetes as our example of a stressor and go through the ten steps:

1. Identify the fact that being diagnosed with diabetes is a stressful event in your life.

2. Portions of this stressor that are outside your control include the fact that diabetes, at present, has no cure, and you cannot undo the diagnosis, nor can you control exactly how events unfold.

3. Accepting the diagnosis and the full range of possible emotional reactions to being diagnosed with diabetes is something to be made peace with. Resisting denial and embracing the feelings of having a chronic illness are important aspects to managing the course of this stressor. Oftentimes, people do benefit from professional help with these issues.

4. There are many potions of this stressor that are within your control. Following a healthy and appropriate meal plan, taking medications regularly and on schedule, testing your blood glucose consistently, exercising, visiting your endocrinologist regularly, and taking responsibility for a major part of your prognosis are all within your influence. Additionally, modifying your attitude and outlook on having a chronic illness so that you see it as a challenge rather than a threat is crucial.

5. Given the nature of the stressor, your goals are likely to include developing a specific meal plan, insulin (or other drug) regime, and exercise schedule, and determining acceptable blood sugar ranges.

6. To meet your goals, you might decide on such matters as when you will do you grocery shopping, as well as what kind of exercise you will do and when you will do it. You might also decide to learn proper blood glucose testing procedures and insulin administration and, perhaps, to collect information and data on diabetes so that you stay well-informed.

7. Some possible obstacles to meeting these goals might include your tendency to forget to test your blood sugar, your weakness for ice cream, or your general dislike of exercise.


8. To break through these obstacles, you might set alarm timers to prompt you to test your blood sugar at appropriate times, and you might add an additional walk to your schedule so that you can occasionally have ice cream. To make exercise more enjoyable, you might ask your spouse or a friend to join you for daily walks. In addition, considering who you will talk to about your concerns and issues related to diabetes is an important step in avoiding and overcoming obstacles.

9. When you achieve a goal successfully, try reinforcing yourself with a special something. When you have difficulty achieving a goal, examine your difficulties with curiosity and a willingness to learn preventive measures in the future, rather than looking at them with a punitive, critical eye.

10. Never give up. You may need to try out several solutions to a problem until you find the right one. Seek out help when you need it. None of us can do it all by ourselves.

Sticking With It

Keep in mind that learning to cope with stress involves learning skills that take time to master. Be patient with yourself, and don't forget that stress management should be a nurturing and nourishing process, not a punishing one.

You don't need to work constantly. Give yourself a break now and then. We all need to occasionally distract ourselves from stress, through reading, watching TV, listening to music, or doing whatever strikes our fancy.

But remember that we all need to ultimately confront and deal directly with the stress in our lives if we are going to reduce it. The complex demands of being a woman, combined with maintaining tight glycemic control over diabetes, can be quite taxing. Stress management can be a real asset in handling these challenges.

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