woman holding temples next to a Christmas tree

Ho, Ho… Humbug: Texas A&M health educators help South Texans avoid the holiday blues to control their diabetes

December 8, 2014
woman holding temples next to a Christmas tree

Holiday stress can negatively affect all of us, but for people with diabetes, too much stress could lead to serious health complications.

Stress is as much a part of American culture as a hamburger with fries, and too much of either is detrimental to our health. In fact, stress can impact just about every part of the human body, from our hair to our blood cells. If left untreated, consistently high stress can lead to serious health problems such as insomnia, anxiety, a weakened immune system, even heart disease, obesity and depression. What’s more, chronic stress can exacerbate existing illnesses, which is why health educators with the Texas A&M Health Science Center Diabetes Education Program provide their clients with education and resources about identifying and managing stress and depression to help control their diabetes.

Diabetes, stress and depression are clinically linked. Americans with diabetes are twice as likely as the average person to have depression, although experts don’t yet know whether diabetes increases the risk for stress or depression, or if stress or depression increases the risk for diabetes (research suggests both cases are possible).

“People with diabetes experience more stress than the average person year-round because of many possible factors,” said Maggie Scheerer, RN, certified diabetes educator with the program. “But we see a much higher prevalence of stress and depression this time of year due to the added pressures of the holidays.”

According to the American Psychological Association’s “Stress in America” survey, the top sources of stress include money, work, family responsibilities, relationships and personal health concerns, in that order. During the holidays, when we’re purchasing gifts, food, decorations, plane tickets, and gathering with more family members, our general stress level is certainly heightened. Add a major health concern, and there’s no wonder the holidays can be such an immense source of stress for people with diabetes.

The Texas A&M Diabetes Education Program, which is based in Corpus Christi, Texas, serves a broad spectrum of clients from different socioeconomic backgrounds. One of their locations deals almost exclusively with the Hispanic population in an impoverished area where few graduated from high school and even fewer have received education on managing their stress and metabolic disorders. For these individuals, holiday stress goes beyond just buying gifts or the difficulty of hosting relatives.

“One of our clients recently lost her full time job and hasn’t had any success yet in securing another,” said Hermelinda Basurto, RN, health educator with the program. “She has a son who is in a juvenile detention center in the Texas Valley – about three hours from Corpus Christi – and she doesn’t have enough money to go visit him for Christmas, which is causing her a lot of stress right now. Plus, she is a single parent who has other children at home. For her, managing diabetes has been put on the back burner.”

Managing stress and depression is especially critical for people with diabetes. Not doing so can lead to a slew of additional complications, such as renal failure, amputation, stroke or heart attack caused by out of control blood sugar. This is because stress can cause blood sugar to rise, and increased blood sugar can cause stress – a cycle that perpetuates itself. Furthermore, depression has impacts to our behavior which can exacerbate diabetes by making it more difficult to prepare and eat healthy meals, get regular physical activity, take diabetes medicines and check blood sugar levels. People with depression are also more likely to overeat or skip meals, which can cause both spikes and drops in blood sugar.

The first step Texas A&M health educators take in helping their clients manage stress and depression is to go over some general information about it in class. Then, during individual follow-up visits, they sit down and talk with each client one-on-one. Once they are able to understand the client and help the client identify what they are experiencing, they ask them to share their techniques for relaxing or coping with stress.

“We often get a lot of blank stares,” Scheerer said. “It’s surprising how few of our clients can identify what they do to relax or cope with stress. We tell them it doesn’t have to be a complicated routine, like meditation or yoga. It could be as simple as listening to music they enjoy or playing with their dogs. Then we start getting responses. It’s very eye opening for a lot of them.”

Some strategies Scheerer and Basurto suggest are performing simple breathing exercises, doing some light physical activity, strategically tensing and relaxing muscles, and working on replacing negative thoughts with positive ones. If the client is experiencing more than just day-to-day stress, they take more time with them to find out just how often they’re feeling blue. Feeling sad or down in the dumps for weeks or months could be an indicator of depression, which often requires expert help, such as counseling from a licensed professional.

“We also teach clients to seek comforting activities and avoid painful ones,” Scheerer said. “The holidays can present many of these situations, so this technique is especially important this time of year. For instance, if baking cookies reminds you of all the holidays spent doing this activity with your late mother, and that causes you pain, then it’s best to avoid that activity. But if decorating the Christmas tree brings you comfort, then do that.”

If stress or depression becomes too difficult for you to handle, health educators from the program recommend contacting your diabetes care team. They can provide some informal counseling and connect you with resources to ease your struggle. If you begin thinking about harming yourself or others, dial 911 or contact the National Suicide Prevention Lifeline (1-800-273-8255).

“It seems that ‘stressed out’ is the new norm in our society,” Basurto said. “Educators and the medical profession need to acknowledge and address this issue or negative emotional and physical effects will continue. Stress may add to people with diabetes neglecting their self-care, and serious consequences can arise.”

— Lindsey Hendrix

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