In a previous post, Krystal M. Lewis, PhD, talked about the importance of managing stress for health care professionals. Here she focuses on how health care professionals can support their patients with diabetes in managing stress to avoid complications.

Q: What kind of stress do people with diabetes face?

A: People with diabetes face similar stressors as other people without diabetes, but due to their medical status they face additional challenges. Sources of stress can be both routine and nonroutine personal experiences as well as systemic issues of inequality, such as having to deal with racism within the healthcare system, inadequate health resources, or lack of access to basic food and shelter.

People who have diabetes might also experience diabetes-related stress. This is a response to living with diabetes, which is a life-threatening illness that often requires chronic and intensive self-management and awareness in regard to such things as medications and eating. Also, among people who have chronic illnesses such as diabetes, depression is more common, which is associated with poorer health outcomes.

Q: What are the specific risks of stress for people who have diabetes?

A: The type of stress can matter. If you look specifically at mental stressors, they can cause an increase in blood glucose levels for people with type 2 diabetes, but they can have a more variable response, either increasing or decreasing blood glucose levels, for people with type 1. Physical stress can increase blood sugar in people with type 1 and type 2 diabetes.

The experience of stress might lead to unhealthy behaviors such as poor eating or smoking, which we know can lead to an exacerbation of diabetes-related health problems, including high blood pressure, heart disease, and obesity. These conditions can make managing diabetes even harder.

Q: How can health care professionals help their patients with diabetes manage stress?

A: Health care professionals can discuss with patients the impact of stress on health and why it’s important to manage it. They can engage with the patient about stressors they might be experiencing and help them figure out ways to manage the stress. It’s important that health care professionals normalize the experience, by letting their patients know that everyone experiences stress, so they don’t feel bad for experiencing it.

Health care professionals can also screen for diabetes distress and depression—this is recommended by the American Diabetes Association (ADA). If you notice that your patient is struggling with any type of mental health difficulties, refer him or her to mental support as well. The ADA provides evidence-based guidelines for psychosocial assessment and patient-centered psychosocial care.

Q: What specific guidance for managing stress can health care professionals offer their patients?

A: It’s three-fold: having conversations with your patients, referring them to or giving them resources, and encouraging them to join support groups so that they can educate themselves and have a network of people whom they can lean on for support. Being part of a group will help normalize their experience and provide a sounding board for their concerns.

It’s important also to encourage patients to do brief exercises—for example, meditation or a quick body scan where you focus on each part of your body from head to toe—and to keep a journal in which they track their stress levels. These stress-reduction practices can be helpful for the health care professional as well, and it’s a great investment to learn them yourself, because when you are doing these practices on your own, it’s easier to talk to your patients about them.

Q: How does the health care professional fit discussions about stress into the constraints of a brief patient visit?

A: There’s definitely a lot to cover in a visit, so you can use the ADA guidelines to figure out the most important questions to ask in each particular clinical encounter and how to integrate those questions into your conversation. In an initial visit, once you get through the basics of a new diagnosis of diabetes and talk to the patient about what he or she should be doing, you can also make sure that you ask questions about other stressors that might be coming up and barriers that could prevent the patient from managing their diabetes and practicing self-care.

There are a lot of resources that professionals can refer patients to. There’s also a great toolkit from the Centers for Disease Prevention and Control that providers can use to learn how to help their patients.

• Cope With Your Diabetes in Healthy Ways, NIDDK
• 5 Things You Should Know About Stress, National Institute of Mental Health (NIMH)
• 10 Tips for Coping with Diabetes Distress, Centers for Disease Control and Prevention

How do you help your patients in managing stress?