Diabetes and Reactions to Profound Life Stressors

According to The Holmes-Rache Life Stress Inventory (2008) these are the top ten stresses in life:

10) Death of a spouse (and, in my opinion: death of a child)

9) Divorce

8) Marital separation or separation from a relational partner

7) Jail term

6) Death of a close family member

5) Personal injury or illness

4) Marriage

3) Fired from work

2) Marital reconciliation

1) Retirement

In today's climate, it is clear that all 10 stressors have plagued the world's population. Our current financial troubles have led directly to at least six of these top 10 stressors (death of a spouse-suicide, divorce, marital separations, jail term, fired from work, and in some cases, retirement). Coping with profound stress (whether good or bad) has a major impact on bodily function and hormone interaction. Our physiology is based on the "fight or flight" response that enabled our survival as a species. As such, when confronted with a modern stressful situation, "action" hormones are released to enable as to fight or run away (figuratively, of course). These hormones include primarily cortisol, glucagon, epinephrine (adrenalin), and norepinephrine (noradrenalin). ALL of these hormones function to allow some form of action to occur, and thus, increase the concentration of blood glucose for energy. These same hormones are released in children, teens, and adults with diabetes and are responsible for hyperglycemia that may occur in times of stress.

Over the last few months, I have had the sad experience of seeing families and patients who have endured many of these profound life stressors. The majority of families are just trying to cope with altered life circumstances, let alone manage diabetes "highs and lows." Therefore, I thought it wise to discuss the importance of damage control in association with reflective listening and emphasize the importance of mental stability, of which sometimes initially, at least, might be at the expense of meticulous diabetes self-care skills.

In situations involving the loss of a spouse (parent) or a child (sibling), our first goal is overall support. Usually in these circumstances, our diabetes team is not always notified and we may be seeing the family several weeks or month after the tragedy. Generally, diabetes control is not a major priority in these situations resulting in somewhat higher hemoglobin A1c and more variability of blood sugars. Families often feel guilty about neglecting their usual roles as supportive caregivers and the child or teen may be checking blood sugars less frequently or forgetting insulin boluses etc. This is NOT the time to be insistent on meticulous diabetes related behavior. This is the time to promote "damage control." Naturally, given an ideal situation, I would suggest more vigilance in diabetes care to decrease the significant highs and lows associated with profoundly stressful situations. However, this is clearly not always possible in bereaved and highly stressed families.