When stress occurs, the body has a fight-or-flight response. Your heart rate, blood pressure, breathing rate, and muscle tension all increase - levels of many hormones shoot up. This makes a lot of stored energy - glucose and fat - available to cells. These cells are then primed to help the body get away from danger.

In people who have diabetes, the fight-or-flight response does not work well. Insulin is not always able to let the extra energy into the cells, so glucose accumulates in the blood. Hormones produced when you're stressed, such as epinephrine and cortisol, can also directly alter your blood glucose levels. As a result your glucose and ketone levels fluctuate and may become high. Also, stress can make your insulin less effective, which further limits your body's ability to regulate blood glucose levels.

Stress can also alter blood glucose levels in people with diabetes because someone under stress may forget to take good care of themselves.

People with Type 2 Diabetes may experience high blood glucose levels. People with Type 1 diabetes have varied responses. People with diabetes report high levels of personal distress, fatigue, frustration, anger, burnout, depression, and bad mood. This is because diabetes can be overwhelming due to the unending demands of self-management.

Some stress is unavoidable. Adults with type 2 diabetes have better blood sugar control when they report less diabetes-related stress. That is why learning to manage stress is so important. So, what can be done?

The good news is that diabetes distress can be managed and reduced. Following are some tips that may help. Not every tip will work for everyone, because every person has different situations, but I'm sure you will find some that will be useful to you.

• Set realistic, measurable goals
• Identify situations that cause you stress - ask for help if you need it
• Exercise - causes your body to release endorphins & serotonin. These hormones help you to relax and make your body more efficient
• Good posture - Avoid slumping, as bad posture causes muscle pain, resulting in increased stress
• Yoga can reduce stress and help you feel calm
• Meditation
• Massage
• Don't forget to eat and drink water
• Eat a healthier diet. Sugar and caffein can cause stress
• Take deep breaths - When stressed, you tend to take shallow breaths, which causes feelings of tension
• Slow down - speak slowly, think before acting. Create a list of priorities and do one thing at a time.
• Pace yourself with the changes that you are making in your lifestyle. This will enable your new behaviors to become more easily incorporated into your lifestyle.
• Involve others in your diabetes management routine. Walk with someone; Ask a family member to remind you to check your glucose level, join an exercise group, etc.
• Visualize (guided imagery) - Think about your favorite relaxing place for several minutes, until you start to relax
• Set realistic, measurable and achievable goals.
• Progressive relaxation therapy - This is where you tense your muscles, then relax them
• Control your thoughts - replace bad ones with good ones
• Take responsibility for your diabetes - Get engaged in your own care. Learn all you can learn about diabetes by reading websites such as this one, using a health library, reviewing the American Diabetes Association website

Dealing with stress and diabetes (frusration, fatigue, distress, depression, etc.) is a very important part of your diabetes care. Awareness of these issues is the first step in developing a good diabetes self-management plan.