Diabetes: From the Inside - Out: My Little Book on Diabetes

From the Inside - Out My Little Book on Diabetes Silvia I. Almanza, M.S., R.N., C.D.E. Inside—Out Inside—Out My Little Book on Diabetes Silvia I. Almanza.
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You never have to count calories again. I find myself putting down my phone and focusing on the eating. With calorie guilt gone, you can eat what you want and savor it slowly. After years of torturous calorie restriction, eating is really enjoyable again! The above two rules are the only dietary rules you need to maintain ideal weight for the rest of your life, assuming you apply common sense and avoid extremes.

Stress and Diabetes: A Review of the Links | Diabetes Spectrum

The diet works by building in regular periods of insulin relief, keeping your body from becoming resistant to insulin. Following these two rules, you will maintain your weight and health by never entering the vicious cycle of increasing insulin resistance. In order to break out and quickly get down to your ideal weight, you need one more rule, the rule of using special tricks: Use additional tricks to accelerate your escape from diabetes and obesity. Use any combination of the tricks below to accelerate your weight loss and return to good health.

Yes, think about your weight 10, 20, 30 years ago. Another friend of mine started on this journey last year weighing pounds. He got to this point by following the two rules above and just 3 of the 5 tricks below. Take a swig of vinegar before every meal. Most people use apple cider vinegar. Cut down on sweets, and if you can, cut them out entirely for a couple months. I still eat ice cream about once a week, and know people who are losing weight on this diet while eating ice cream almost every day.

Better to severely restrict sweets for the first few months, and then gradually reintroduce. Trick not as important: Regularly giving your muscles a workout has been shown to increase insulin sensitivity.

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Instead of breakfast, increase the fat, protein, and vegetables you eat at lunch and dinner. Go for longer periods of time without eating yes , yes , fasting. Consume water only for days or weeks at a time.

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Your fat will literally dissolve away, and with it your type 2 diabetes and other ailments. The definitive book here is Dr. I and at least 20 of my friends have tried fasts lasting days to weeks. It works, and it is amazing. Your doctor may be skeptical and resist your efforts to cure yourself, but persevere!

Worst case, put your doctor in touch with Dr. Jason Fung , a nephrologist who grew tired of simply controlling pain for his end stage kidney patients at the end of lives ravaged by diabetes, and decided to do something to help them thrive with the energy of a healthy life well-lived. The sympathetic system is involved with the preparation of the body for action. It increases oxygen and nutrient supplies to the muscles by increasing the blood flow to the skeletal muscles and freeing glucose and lipids from its stores.

It also prepares the immune system to deal with possible injury. With regard to the effects of stress on the neuroendocrine system, the HPA axis is of considerable importance. This in turn travels to the adrenal cortex, where it leads to the secretion of glucocorticoid hormones, in particular cortisol. Cortisol exerts considerable influence over bodily functions, both when the body is at rest and during stress. In normal circumstances, it is secreted according to a circadian daily rhythm, with cortisol levels highest in the morning and lowest in the evening.

However, exposures to stress stimulate the HPA axis to release additional amounts of cortisol to maintain homeostasis and reduce the effects of stress. Cortisol influences a wide range of processes, including the breakdown of carbohydrates, lipids, and proteins to provide the body with energy. It also has an effect on bone and cell growth and may modulate salt and water balance. Cortisol has an immunosuppressive effect and therefore plays a role in the regulation of immune and inflammatory processes.

That the central nervous system communicates with and exerts an influence on the immune system is now well established; brain lesions can alter a variety of immune measures, and both the autonomic and the neuroendocrine system have been shown to influence the state of the immune system.

Although there is still much unknown about the effects of acute stress on the immune system and studies have been limited in the number of immune parameters studied, one review 42 revealed that stress influences both circulating cell numbers and the function of immune cells. The final section of this article focuses on the implications of stress research for practice in the care of individuals with diabetes.

In addition to the physiological impact that stress has on glycemia, research has shown that stress interferes with the ability to self-manage diabetes. Doing everyday self-care tasks, such as monitoring glucose frequently, following a meal plan, and correctly preparing or remembering to take insulin or oral medications at the right time, is difficult during times of stress. Moreover, diabetes self-management tasks themselves may become a source of stress.

Learning to prevent and control the negative responses to stress is helpful, particularly if the causes are relatively permanent. For example, if cooking dinner, bathing children, and doing laundry constitute a typical stressful evening, that stress is a relatively permanent part of life for several years and must be dealt with accordingly. Assessment of stress levels in practice is a relatively underdeveloped area. One approach is to identify those life events during the previous year that typically act as stressors.

Using a scale such as the Recent Life Changes Questionnaire 43 or the Revised Social Readjustment Rating Scale, 44 individuals identify events that have occurred in their life from a list that includes births, deaths, marriage, retirement, social issues, financial worries, work-related stress, and so forth. The weighted ratings provide the basis for an overall score that can be compared to norms.

However, these scales are rather long and take some time to complete, which may not always be appropriate in a practice setting. Polonsky 45 describes a diabetes-specific exercise to help people with diabetes develop an understanding of the relationship between stress and blood glucose levels. In this exercise, individuals rate their perceived stress each evening on a 0—10 Likert scale and record their glucose levels before breakfast and dinner and at bedtime. The individual then looks for blood glucose level patterns for days when perceived stress is high, medium, and low.

The premise behind this exercise is that those individuals whose blood glucose levels are sensitive to stress may be more sensitive to stress management strategies. Although validation data are not available, individuals may find this approach helpful in understanding and managing stress-related aberrant glucose readings. Finally, surveys tools, such as the individual items on the PAID scale that measure diabetes-related distress, may also reflect accumulated stress resulting from living with diabetes. Clinicians must take care to differentiate stress response from depression and anxiety.

Depression is more common in diabetes than in the general population. Three approaches to stress management go hand in hand, albeit with some overlap: Some interventions directly target people with diabetes in order to prevent diabetes-related stress and improve quality of life or glycemia. Time management and organizational techniques may reduce small stressors that often compound until a crescendo is reached.

Self-help books 53 , 54 may be useful for patients to find successful ways to put structure in their lives and manage their time and life stressors. Minimizing the source of stress is helpful. For example, if repetitive noise at work is causing stress, one solution could be substituting white noise for the repetitive noise by softly playing relaxing classical music. Setting up a meeting with the employer or coworkers to get help with one's workload may also alleviate stress. Often, the most difficult challenge is actually identifying the source of stress and separating that source from the responses to stress.

Effective problem-solving strategies are important for minimizing the source of stress. Diabetes-specific approaches that may help individuals cope better with diabetes include setting specific, realistic self-management goals. Many individuals set global vague goals that may serve to exacerbate stress.

Diabetes Storybook

Realistic, measurable, and achievable goals specifically stating the measurement criteria that indicate success are more helpful as motivators. Most stress management techniques emphasize changing the response to stress. When the response to chronic or acute stress results in rage and reactive behavior, a thought-stopping and reflective technique can be helpful in preventing negative consequences of the impulsive behaviors associated with anxiety and rage Table 1.

Other approaches involve learning how to induce a more relaxed feeling. Benson's relaxation response, 55 first reported as a means to lower blood pressure, can be useful in inducing relaxation quickly in times of stress, for example, while driving in traffic, or before taking an exam. Practicing the relaxation response is extremely important because the technique is difficult to learn. However, once learned, the relaxation response quickly brings about the physiological responses associated with relaxation. Other approaches to stress that may be useful for individuals with diabetes include using distraction and involvement in pleasurable activities that help to minimize the influence of stress-producing activities.


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For other examples, see Table 2. For example, active participation in a hobby even a sedentary one or exercise program can help combat stress. Typically passive activities, such as watching television, may not help alleviate stress, although attending a concert, theater performance, or movie with friends can have beneficial effects as a distraction. If one is not able to put aside worries from work, then distraction may be effective. If a person with diabetes is experiencing severe stress, referral to a mental health professional may be the most effective approach. Reports from research investigating the effect of stress management on glycemic control have been inconsistent.

However, recent reports have shown that stress management may affect diabetes and its treatment. They found that those using stress management had a small improvement in A1C 0. Although Boardway et al. For adolescents enrolled in an intensive diabetes management clinic, Grey et al. In summary, research has indicated that stressful experiences have an impact on diabetes.

Stress may play a role in the onset of diabetes, it can have a deleterious effect on glycemic control and can affect lifestyle. Emerging evidence strongly suggests, however, that interventions that help individuals prevent or cope with stress can have an important positive effect on quality of life and glycemic control. The clinical implications of this research illustrate the need for greater understanding of the effects of stress, as well as a serious acceptance of the need for psychosocial support for people in this predicament.

We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Skip to main content. Diabetes Spectrum Apr; 18 2: Abstract Evidence suggests that stressful experiences might affect diabetes, in terms of both its onset and its exacerbation.

The Genetic Landscape of Diabetes [Internet].

Role of Stress in the Onset of Diabetes Stressful experiences have been implicated in the onset of diabetes in individuals already predisposed to developing the disease. Stress and Diabetes Control In recent years, some researchers have turned their attention to the possibilities of stressful experiences influencing diabetes control. Behavior The behavioral mechanisms through which stressful experiences might affect diabetes control are varied and often complex. Physiological Mechanisms Behind Stressful Experiences Any stressful event might be judged by people in different ways, based on factors such as previous experience, psychological factors, and social influences.

Stress Management In addition to the physiological impact that stress has on glycemia, research has shown that stress interferes with the ability to self-manage diabetes. Remove or minimize the source of stress. Change the response to stress. View inline View popup Download powerpoint.

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Diabetes Storybook

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