Endo visit: BSL's and stress

[sparkle9]

Yesterday I went for my second visit with my new endo. The results of recent tests for TSH, microalbumin, and gastroparesis were all normal. Cholesterol and triglycerides are great. Yay! Blood pressure was elevated again at the time of the visit, but is under control (thanks to lisinopril) when I take it at home. Last A1c a month ago was not good - 8.4.

After looking at the detailed records (bsl's, lantus and humalog doses, food, and exercise) I had kept for a month, he told me that my fluctuating sugar levels are due to stress. By fluctuating I mean varying from the high 200's to the 70's without any other logical explanation. These fluctuations occur mostly during the late afternoons and overnight, but not consistently. According to him, when you are under stress, your bs can rise significantly, and then when you are able to relax, such as after work or at night when you are sleeping, your bs will drop. I believe he used the term "stress responder" to describe me.

I have been under more stress than usual during the past year and have had severe anxiety symptoms. I have tried both Lexapro and Zoloft but cannot tolerate either one. Both of them make me feel so disoriented and fatigued that I can barely function. When I told him this, he recommended that I see a psychiatrist to find out what else I could take. He said in no uncertain terms that it was extremely important to get my anxiety under control in order to preserve my health. I already have coronary artery disease, so he was especially concerned about that.

I'm going to take his advice and see a psychiatrist. I've also been been getting regular exercise and am taking steps to resolve some personal problems. In the meantime, I'd be very interested to know if anyone else has had a similar experience with stress affecting bsl's. Also, has anyone taken anything other than SSRI's (Zoloft, Prozac, Lexapro) that has helped with anxiety?

Thanks,
Sparkle

[docta-docta]

Hi Sparkle,

Congrats on your doctor's visit. The lab results sound great (except for the A1c).

I'm not so sure I'm one to suggest otherwise at listening to your doctor's advice, but I just want to make sure your doctor has considered some other things before giving you another pill to swallow. (Some anti-depressants can help lead to insulin resistance). Also, some of these drugs can impair the sympathetic system in your body from responding to a low. This means if you have a hypoglycemic event, your body may not be able to fight it off as well.

Claiming "Stress" as the reason to health problems can actually raise my own stress, ironically.

Therefore, consider the following things:

1. When you go low, your body can respond with stress factors, resulting in a high after adrenline and cortisone play their evolutionary roles in bringing you back up with some energy.

2. Have you looked at diet? High fat/protein meals can have effects as far as 12-24 hours later. Low carb isn't good for everyone. Fasting can also result in unexpected highs.

3. Diabetes is NEVER predictable. Just because you have some random highs doesn't mean it's just by stress.

4. Try eating half an apple before going to bed. The slow release of carbs will help to prevent the body from going into a "starvation mode--time to dump glucose!!"

5. Your A1c should come down below 6%. Therefore, I'm not really thinking you should be attacking these random highs yet, until you can get your general overall A1c down. I don't know what your insulin types are, but I highly suggest a non-peaking basal insulin with a rapid-acting insulin for meals. If you're a Type 2, then that's a whole different thing that I would address in a separate commentary. :)

6. Once your overall A1c's drop, you will find peaks occurring less often. Sudden peaks are normal and can happen in even the most controlled diabetic.

It's 3:30 AM so I should probably sum this up....

Everyone has anxiety. Some have it more than others. I'm not saying you might need medication to help control it, but I think you'll feel much better when you maintain a <6.0% A1c. Your brain will be less clogged, and you'll energy return that you didn't know you had.

Diabetes is like a roommate that leaves their dirty socks on the floor. You have to live with that roommate, and should pick your battles wisely. Approach the general A1c value first, and then work on the random peaks!

-DoctaDocta (quack, quack)
P.S. Good work on the exercise.

[sparkle9]

Docta-Docta,

Thanks so much for your suggestions. Here are my feelings on the things you asked me to consider:

1. I know that I've had a few highs that resulted after bad lows. This seems to happen to me even if I don't overtreat the lows. The last one happened on the day I took Zoloft, so I'm wondering if that was a factor. I didn't feel the low until it was REALLY low.

2. I eat a balanced diet with a moderate amount of carbs and fairly low fat. I never fast unless I have a fasting blood test!

3. Diabetes certainly isn't predictable, at least not in my case! The highs, even though random, are frequent. I may not have made that clear in my first post. This is what is driving up the A1c, according to the endo.

4. I will try eating half an apple before bed.

5. I know my A1c needs to come down. I think the doctor's point was that it won't come down until I get rid of the highs, which he thinks are stress-related. BTW, I'm on lantus and humalog and have been Type 1 for 34 long yrs.!

I would love to have an A1c below 6%! I just don't know how to get there. I did increase my lantus by 2 units a few days ago, and things are much better in the mornings. I'm continuing to keep my detailed insulin, food, exercise log in hopes of improving things further. I will also go to the psychiatrist and see what he has to say, although I really don't want to take another pill.

Again, thanks so much for your suggestions.

Sparkle

[Mark C]

In the meantime, I'd be very interested to know if anyone else has had a similar experience with stress affecting bsl's.

Without a doubt, if the mortgage is late, and they call every freakin' hour to remind me, my BGL rises by about 100 points. Stress definitely is the cause of some of my high levels.

[Clint]

I would have to agree that when I am stressed or exhausted, my BS tends to rise quite a bit...

[buzzborne]

I would have to agree that when I am stressed or exhausted, my BS tends to rise quite a bit...

I'm usually the same... but then at times when I'm stressed I can go low.