Wil Dubois

Happy Saturday, and welcome back to our weekly advice column, Ask D’Mine, hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil is talking stress and all the crazy effects it can have on those of with lazy pancreases. Read on... you might just find a "cure" for what's stressing you out.

Note that this is the first of a two-part column, as well, so be sure to check back next week!

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

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Sharon, type 3 from Texas, writes: My grandson is 9 and is in his fourth year of T1D. Until recently he has split his week half with his dad and half with his mother and me (Grammy). A recent court case gave his dad managing custody. He changed my grandson’s school and living arrangements. My grandson now lives with his dad with vistation for my daughter and me on Thursday evenings and first, third, and fifth weekends. In part because he was on my health insurance, and in part because no one stepped up, I was managing his doctor visits and supplies through the pharmacy. I was often the only one at the doctor appointments.

I state this to establish that I was deeply involved and concerned for my grandson’s care and control of the diabetes. With the recent changes every time my grandson has been with us he has ended up with extreme high BG readings in the 300s. I feel this due to anxiety from the changes in his life. I’ve read several articles indicating that stress, anxiety, emotion, has the effect of elevating blood glucose. Fight or flight response. I haven’t seen any information on suggested increases in insulin to prevent these. This has become a major problem with interactions with his dad. Any suggestions you have would be greatly appreciated. 

 

Wil@Ask D’Mine answers: Yikes. Let me first say that I’m so sorry to hear about the family chaos surrounding you and your grandson. Poor kiddo. As if diabetes weren’t enough. Sounds like the courts should have given your grandson to you, not his mother or his father. Or at least they should have given you custody of his diabetes as his parents weren’t “stepping up.”

Sheesh.

Of course, that’s not the way things work. And it wouldn’t really be fair to you anyway, to have only the diabetes, and not the fun part of the boy.

Now, to your question. Yes, you are 100% correct that blood sugar can be elevated—even to very high levels—by stress, anxiety, and emotions. And you are also correct that these elevations are related to the fight or flight response. For those readers who may not have read up on this, let me quickly review flight or fight before we talk about what to do about it, and whether stress can actually be treated with insulin.

Fight or flight is an evolutionary biological response to danger. To understand it, just jump into my literary time machine. Back, back, back, back we go. To the dawn of history. Oh. Wait. That’s not far enough. I think we might need to go back to the twilight of history when our first ancestor climbed down out of the trees, stood up on his hind legs, and on teetering feet went off looking for a 7-11 Store so he could buy a burrito. (I know it was a male ancestor who did this, as the females were sensible enough to know we were better off in the trees.)

So imagine this naked ape on the plains in the wilds of ancient Africa. He has no sharp teeth, no claws to defend himself with. As animals go, his hearing and eyesight are worse than most. His muscles are weak. He’s off to find a burrito, but I suspect he’s much more likely to end up as an afternoon snack for a lion, a tiger, a pack of hyenas, or a hungry snake.

In short, he’s at a distinct disadvantage. But nature came to his rescue by giving our ancestors super-human… uh… super pre-human powers. At least for short periods of time. When the lions, tigers, hyenas, and snakes come calling, the tiny glands atop our kidneys open up and fill us with adrenaline hormones that amp us up. Think Australopithecines on crack. It’s form of sugar high. This gave them, and still gives us, extra energy either to stand our ground and fight, or to make tracks and run away fast. I suspect that in the twilight of history our ancestors did more running than fighting, but I could be wrong. But this adaption to a lack of fangs, claws, and muscle kept the breed alive and allowed us to evolve.

Back in the day, this sugar high was quickly burned off fighting or flighting. But here’s the problem. Today’s lions and tigers and hyenas and snakes are divorce court judges, fighting parents, new schools, and a scary, uncertain future. How do you, as a kid, fight that? Or run from that?

You don’t. And unlike a lion attack, modern stresses aren’t short-lived. They go on and on and on. But the body is stupid. It doesn’t know the difference between a hungry lion and an ice cold judge. Stress, to the body, is stress. And when we get stressed, our bodies dump sugar into our blood. Because it’s biological, we are pretty much helpless to stop it. The main cures are to fix or avoid the stress (good luck with that) or burn off the excess sugar by exercise. Like kick-boxing.

But what about a stress bolus? Can you just inject your way out of stress? The answer is: Yes. No. Maybe. Sometimes. StressAnd it depends.

Which is probably why you couldn’t find any advice about how to do it.

OK. Here’s the deal. If you were 100% uniformly stressed-out all the time, you could just take more basal insulin and be done with it. The problem is that stress isn’t really as uniform as it seems. It ebbs and flows. As do the stress hormones that drive up the blood sugar. Plus, while we’re not burning them off quickly by fighting or flighting as designed, we do burn them off, albeit more slowly than Mother Nature intended. 

For a stressed-out, but motived adult (if such a person exists—stress tends to dissolve resolve) frequent correction boli to “treat” the stress hormones is the best solution. But for an anguished 9-year-old child? Yeah. I’m not so optimistic about that.

If the child is so totally stressed-out that there are never any normal blood sugar readings, increasing the basal insulin is absolutely the best solution. If the child is on shots, the best way to do this is to identify the child’s natural “low tide” point—the time during the day when his blood sugar is the lowest—and then increase the basal insulin a half-unit a day until the low tide is hovering around the endo’s chosen fasting target (generally around 150 for little people). If the kid is on a pump, it’s a bit more complicated, of course.

But where it gets trickier is when the background stress is highly variable and you’re seeing 300s and 100s. Or, God forbid, 300s and lows. If the number set is widely varied, it’s impossible to fix highs using basal insulin without making the lows much worse. In this case, the best solution is a Continuous Glucose Monitor (CGM) and a parent (or a Grammy) with a lot of time to give. You’ll need to fight each high separately by taking a blizzard of small boluses. Perhaps a dozen a day. You’ll also need to use a more aggressive correction factor to deal with stress highs because the hormone driving the high is less responsive to insulin than “garden variety” blood sugar is.

So there you are. When attacked by your own nature, you can choose to stand and fight -- with insulin as your weapon.

Well, crap, I’ve run out of time and space (and coffee, damnit) today. But I have some thoughts about how you might be able to deal with the very last thing that you mentioned: The problem of diabetes and medical interactions in divided families. So tune in next week, same time, same channel, and we’ll talk about that.

{Tune in next week for the continuation on a related topic}


Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

 

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.