Is Stress Raising My Blood Sugar?

Q: I have a really stressful job. I find that when I test my blood sugar at work or in the evening after work that my levels are markedly higher than on the days I don't work. I take my food to work with me, so my diet doesn't change from day to day. Is it the stress that is boosting my levels?

A: Is your physical activity level also the same during both times? If not, the difference may be simply because you are burning more calories during your off-work days. But if your diet and activities are similar during your on- and off-work days, it is possible that occupational stress is the cause of your higher sugar levels. Psychological stress from a demanding job or other life situations has been implicated in high glucose levels in otherwise healthy individuals. This is true especially among those who have limited social support or who have little authority to make changes at their job.

We are also learning that in people with diabetes, stress complicates glucose control. The mechanism for this is twofold. First, some individuals eat more while under stress, which then raises their sugar level. Second, during stressful times the body produces hormones as a survival mechanism to ensure that there is enough energy to respond to the particular stressor. These hormones facilitate the breakdown of stored fat and glycogen. In this process, glycogen is converted into glucose, increasing its concentration in the blood. These hormones also affect blood pressure, heart rate, and the immune system.

Stress reduction is one of the key elements of diabetes management. Unfortunately, there is no specific method that works for everyone. I recommend consulting your doctor or a psychologist to find what works for you.

Beating Family History

Q: There is a history of diabetes in my family, and I've been worried about getting it. Now my older sister just got diagnosed, and I feel it's hit my generation for the first time. I'm a little overweight but not too much, and I try to watch what I eat. Is there a specific diet I should try to follow so that I don't end up getting diabetes, too?
— Susan,

A:Congratulations! First, you recognize the predisposition you carry to the disease. Second, you are motivated to beat the odds. The good news is that there is something you can do to prevent diabetes. Two recent large studies have found that healthy habits can stave off diabetes among those who are at risk. These habits include eating a balanced diet, getting regular exercise, and maintaining a healthy weight. Of course, I understand if your eyes are glazing over, since this is the same mantra for everything from improving skin health to reducing the risk of heart disease and certain types of cancer. But seriously, a healthful diet should accomplish several things:

1.Provide an adequate amount of vitamins, minerals, proteins, and essential fatty acids
2.Help you lose weight
3.Be pleasing to your palate
4.Be a plan that you can maintain for the rest of your life.

There are many registered dietitians who can help design a plan for you. The specific composition of a diet that meets your body's needs depends on your age, current health condition, and health risks, including diabetes. But simply put, if you make sure that every meal contains a variety of sources of vitamins and minerals, two of your meals contain one source of protein, and you use olive or canola oil (in lieu of animal fat), you should be able to meet most of your needs.

A quick way to ensure that you are consuming all that your body needs is to make your plate as colorful as you can. The colors of vegetables and fruits are an indication of the different vitamins they contain. You should also think outside the box when it comes to protein sources, which should include not only animal products such as meat, chicken, fish, cheese, milk, and eggs but also plant-based products such as soybeans/tofu, nuts, and legumes. Generally, the more plant-based protein sources you ingest, the fewer calories you consume.

While you concentrate on including vitamins, minerals, and proteins in your diet, you mustn't forget that carbohydrates matter. We need carbohydrates as energy sources, and whole grains as a source of various vitamins and fiber. There are two categories of carbohydrates: simple and complex. If you remember anything, remember this: Avoid simple carbohydrates such as white bread, white-flour pasta, cakes, candy, and table sugar. Instead, focus on fruits, vegetables, and whole-grain products that contain complex carbohydrates and are a great source of energy.

More words to the wise: Don't forget to pay attention to portion sizes and cooking methods, as both are very important in limiting caloric intake. Again, you must determine the amount of energy you need to reach your ideal body weight and adjust your caloric intake accordingly. A registered dietitian can help, but the rule of thumb is that regular exercise is key to maintaining weight loss and reducing sugar levels.

I know I have given you a general guide instead of a specific diet, in the hope that you can craft a plan that meets your particular needs, and one that you can maintain over the course of your life. Diabetes risk is a lifelong risk, and the changes you make in your diet and exercise plan should be long-term behavioral adaptations. Remember — an overall healthy diet, good weight maintenance, and regular exercise are key in reducing the odds of developing diabetes.