Probably the most difficult aspect of diabetic management relates to the influence of stress on insulin sensitivity and blood sugar levels. Early studies by Dr. Hans Selye first brought attention to the harmful effects of stress on the human body. His research demonstrated that the body responds in a non-specific manner to stress, and that long term stress is harmful to the body. Recent studies have begun to elucidate the short and long term effects of stress. Research has shown that a variety of stressors act through final common pathways mediated by the autonomic nervous system and the endocrine system. When a person is under physical or psychological stress there is an outpouring of adrenaline and noradrenaline. In addition, under stimulation by the pituitary gland, the adrenal glands release cortisol. The magnitude of the overall response, the relative magnitude of each aspect of the response, and the duration of the response varies enormously depending on the stressor and the individual. To varying degrees all of these responses raise blood glucose levels, sometimes quite rapidly to high levels.
Jacobson reviewed the literature on the psychological care of patients with insulin dependent diabetes. Not surprisingly, it was found that many patients with diabetes experience sadness, apprehension, irritability and pessimism about the future. It was also noted that patients commonly report that sources of stress in daily life cause unpredictably high and low blood glucose concentrations. Also, he noted that anxiety syndromes are common in the diabetic population, and they may be associated with poor control of the blood glucose levels. While stress mediators are clearly beneficial to protect against damage to the body in an emergency “fight or flight” situation, prolonged and / or inappropriate release of stress mediators can cause damage to the body. Chronic stress may cause a sense of fatigue, hostility and demoralization, as well as insulin resistance. Again, the prolonged perception of stress causes prolonged exposure of the body to excessive levels of epinephrine, norepinphrine and cortisol. In addition, the individual variability in response to stress appears to be a learned phenomenon, since there is a lack of concordance in identical twin studies in the response to stressors. This suggests that intervention may influence a person’s response to stress.
Over the past decade a number of studies have addressed the issue of stress management in diabetics. McGrady, Bailey, and Good assessed the effectiveness of a 10 week program of biofeedback assisted relaxation on blood glucose values in a small randomized study. They found that the group that received biofeedback training had significantly lower blood glucose values compared to the control group, and that the lower values could not be explained by increases in insulin dose. This suggests that in the biofeedback group there was a reduction in insulin resistance associated with the biofeedback.
Rice and Schindler assessed the effect of biofeedback on blood circulation in the lower extremities of a group of diabetics. Each of 40 subjects used a relaxation method of their own choice, and measured toe temperatures daily for 4 weeks. Subsequently, the same subjects were taught a biofeedback assisted relaxation technique focusing on raising the temperature of the extremities. Again, toe temperature was measured for 4 weeks. The data demonstrated that the toe temperatures rose significantly, indicating increased peripheral blood circulation, when the patients practiced biofeedback-assisted relaxation.
Surwit, Feingloss,et al. published a study in which two groups of patients with type II diabetes were randomized. One group participated in 5 half-hour educational sessions about diabetes. The other group had 5 half-hour sessions which incorporated stress reduction techniques into the educational sessions. The patients were followed for one year. At the end of the year the group that was taught stress reduction techniques had a significantly lower HgbA1c level compared to the control group.