Stress and Fatigue

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We know that blood sugar has a lot to do with diabetes fatigue. High blood glucose levels make blood sludgy; low levels deprive cells of fuel. But stress is also a major factor — it can throw your blood sugar off and make you tired a dozen other ways.

Stress is a body’s response to a threat or challenge. Anytime we need to change something, stress kicks in. Historically, a major threat has been physical attack. The stress response, sometimes called the “fight-or-flight” response, enables our bodies to fight or run away from danger. Stress does this by raising our blood sugar levels (to provide fuel to the muscles) and increasing insulin resistance (so the other cells won’t use up the glucose the muscles need). It also raises our heart rate and blood pressure so we can run faster, and increases blood clotting in case we are injured.

By increasing insulin resistance, stress can make us extremely tired. Under stress, only the muscles and nerves being used for fight or flight will open to insulin and the glucose it’s carrying. All the other cells are supposed to take a nap. But if the stress goes on a long time, our bodies and brains will not have enough fuel, so they want to just keep napping.

The long-term effect of stress can be worse. According to the book Overcoming Adrenal Fatigue, by Kathryn Simpson, MS, stress puts pressure on the adrenal glands. Those glands produce adrenaline, cortisol, DHEA, and other chemicals that make up the stress response. If they have to keep producing at high levels — because stress is at high levels — they start to wear out. Sort of like beta cells are thought to wear out if they have to produce too much insulin.

When the adrenals wear down, cortisol levels will drop. That’s when fatigue really sets in. Cortisol helps us wake up in the morning. It also helps control the immune system: Cortisol starts inflammation when needed to fight an injury or infection and stops it when the problem is under control. When cortisol levels are too low, inflammation can go into overdrive and damage healthy cells.

We now know that inflammation is a major cause of the blood vessel and pancreas damage we see in diabetes. Diabetes is often called an inflammatory disease, and to the extent this is true, we need to control stress to deal with it.

Inflammation also makes you very, very tired. Your body is telling you to rest so the infection or injury can be healed. But when cortisol levels are low, you’ll get the same message when there is no injury or illness. It just goes on, and we feel constantly tired.

Stress-causing threats are not usually from wild animals. More often, the threats are economic or psychological. Or they can be environmental, like being too cold or too hot or being exposed to toxic chemicals. Any injury or illness sets off the stress response. Another major stressor is hunger. Unfortunately, some diabetes diets and most weight-loss diets can leave people feeling hungry, so those diets might need to be changed or avoided.

What Can We Do?
According to Simpson, we need to reduce stress while building up our adrenal glands. Since most stressors these days are emotional or economic, we can sometimes reduce stress by changing the way we think about the difficult things in our lives.

Say a person with diabetes is threatened with job loss. If they worry about this all day and night as a huge threat, they will be under a great deal of stress. But if they have confidence in themselves to survive whatever comes, if they have family and friends to help them, if they don’t worry about the future but make plans to deal with it (say by lining up how they can continue receiving health care,) the stress level will be much lower. Anything we can do to actually change situations that threaten us probably reduces stress even more.

We can also reduce stress by treating infections, by getting enough sleep, and by getting regular moderate exercise (but not overdoing the workouts! That’s stressful too.). It’s also important to eat regularly and not to go hungry. Simpson says five or six small, balanced meals a day may be ideal for most people’s adrenals. She advises protein, fat, and complex carbs at each meal. I don’t know how that will work for people with diabetes, but I don’t see why it can’t.

Effective stress reduction methods include prayer, meditation, breathing, and gentle exercise like tai chi or qigong. Getting help with stressful life problems, as from a counselor, coach, or friend can also reduce stress. Take it easy on yourself and enjoy life!

A number of supplements might help, including Vitamins C and D, chromium, zinc, magnesium, B vitamins, and fish oils. Simpson also suggests taking digestive enzymes and says taking small amounts of hydrocortisone (which is identical to natural cortisol) can be very helpful if your levels are low. Anti-inflammatory medicines like aspirin or salsalate might help, too.

We’ll look at other ways of managing and treating fatigue next week. In the meantime, try to relax!

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