Keywords: Stress, anger, diabetes mellitus, Type 2 diabetes, insulin resistance, diabetic distress, cortisol, adrenaline, Nigeria.
Introduction.
Stress, Anger and Diabetes Linked – Nigeria. What is diabetes mellitus? Is there a link between stress and diabetes? What is the rate of stress coexisting with diabetes in Nigeria? What is the biology between stress and diabetes? Do those suffering from diabetes have anger and rage issues? Which way forward for those suffering from diabetes and stress?
The first Director-General of World Health Organization (WHO), Dr. Brock Chisholm believed that mental and physical health are linked. And many research works have proved beyond doubt that physical and mental health are intrinsically linked. Stress, anger and diabetes are linked even in Nigeria
What is diabetes mellitus?
Glucose comes from the food eaten and it is the body’s main source of energy. So after one eats food containing carbohydrate, the digestive system breaks the carbohydrate into glucose. From the intestines, this glucose is absorbed into the blood stream. This makes the level of blood sugar to rise.
Now the body cells absorb this glucose from the blood for energy use. Some glucose gets stored in the liver as well to be used when it is necessary. All these require insulin. Insulin is a hormone produced by an organ in the abdomen called the pancreas. As the glucose continue to enter the body cells, the blood glucose or sugar level decreases.
People suffering from diabetes mellitus have a problem with the insulin from the pancreas. So their body cells are unable to get this important glucose for energy. And the blood glucose remains high.
There are two types of diabetes mellitus. In the type 1 diabetes mellitus, which usually starts at birth or young age, the pancreas doesn’t make insulin. For the type 2 diabetes, adult onset, the pancreas makes insulin, but the body cells are unable to use it. This is called insulin resistance. The topic stress, anger and diabetes linked – Nigeria will be concerned with the type 2 diabetes mellitus, which starts in adulthood.
Is there a link between stress and diabetes?
The simple answer is yes, there is link between stress and diabetes. In our everyday life stress is a normal occurrence. Stress can come from work deadlines, family obligations, relationship issues, academic issues, poor sleep, etc.
Effects of stress can lead to developing the type 2 diabetes if the person is already predisposed to the disease. Stress is usually the last straw that breaks the camel’s back. And this stress can affect people who are already suffering from diabetes in so many ways.
Stress and the development of type 2 diabetes:
High level of stress can reduce the insulin and lead to the development of type 2 diabetes.
Stress can also predispose one to overeating. This is because some people react to stress or depression by overeating. By doing this, they gain weight, which is a risk factor for developing type 2 diabetes.
Some people have abnormal coping mechanism for stress, whereby they abuse substances. These substances can include alcohol, cannabis, etc. which can increase the blood sugar level.
First time diagnoses of diabetes:
At the early stage when the person is diagnosed with diabetes, the person feels worried. This is a form of stress. The person gets worried about adjusting the diet, taking medications, checking blood sugar and learning new ways of life. He/she will also worry about the long term complications of the disease.
These lead them to feel grief, disappointments and more worrying. And emotional issues can make it difficult to care adequately for oneself, eat right and exercise. These can raise the blood sugar more.
The issue of frustration:
These normal worrying can get out of hand and lead to frustration with those newly diagnosed and old timers. This will cause what is called diabetes distress and burnout. These occur when one feels frustrated and overwhelmed by the diabetes.
The symptoms of diabetes distress include feeling angry about the illness, not motivated to comply with drugs and instructions. The person will avoid going for checkups and checking the blood sugar and will engage in eating unhealthy foods.
There will be a feeling of loneliness and isolation. And anxiety and depression will set in.
The effect of stress to compliance with medications and instructions:
Stress can predispose someone suffering from diabetes to forget to take their medications. This occurs especially when one suffers from work stress or stress from family issues.
Stress and depression:
Depression and stress have a direct link to each other. So that when the stress level is high, depression sets in. And of course, there is also a direct link between depression and the development of type 2 diabetes. Depression can also worsen already existing diabetes because it does not allow the person adhere life style modifications. So complications and death can arise.
Stress and anxiety:
Anxiety in people who do not have diabetes can predispose them to weight gain, increase in cholesterol and increase in blood sugar.
Stress from lack of sleep:
When someone is under stress, it can affect sleep. Poor sleep can adversely affect the blood sugar.
The rate of stress coexisting with diabetes in Nigeria.
In the recent times, the rate of stress in Nigeria has increased tremendously. Stressors include economic issues, family issues, security issues, etc. The stress level among bankers in Enugu gave a rate of is as high as 85.9%.
The prevalence of those suffering from diabetes in Nigeria as at a 2018 research study was 5.8%. This means that 11.2 million of Nigerians or 1: 17 adults are living with diabetes. The most prevalent type of diabetes in Nigeria is the type 2.
In southeastern Nigeria, 52% had diabetic distress in one study in 2020. And in Kano one study gave a prevalence of 22% for depression among patients suffering from diabetes in 3 hospitals.
What is the physiology between stress and diabetes?
Insulin resistance:
Stress causes the adrenal glands in the body to produce cortisol and adrenaline. These hormones make the liver to release sugar it stored. So with chronic stress, the liver keeps releasing sugar. Also the hormones make the person eat a lot so that the liver sugar stores can be replenished.
With the repeated increase in blood sugar, the gateways on the body cells, through which glucose passes, get worn out. The gateways are called insulin receptors which get worn out. So the insulin being produced doesn’t work anymore. This is what is called insulin resistance.
Obesity:
Stress hormones make one eat a lot and fat accumulates and is stored. High level of cortisol makes one crave for sweet and fatty foods. The accumulated fats also affect the insulin receptors leading to more insulin resistance.
Effect of stress on the pancreas:
In chronic stress, the pancreas is negatively affected and does not produce enough insulin. This is due to the effects of chronic high levels of cortisol and adrenalin. So blood sugar rises.
Poor sleep:
Sleep deprivation is a risk factor for the increase in cortisol level in the body. Adrenaline level also increases when the person has been having poor sleep. All these predispose to insulin resistance. Poor sleep also increases appetite and the risk of obesity.
The effect of stress on the brain:
Chronic stress can alter the brain’s response to the way one perceives food. It negatively affects the frontal lobe of the brain, affecting its function. Thus the person is unable to think properly, make good judgment and planning.
So that when one sees food he/she will not be able to discern which food is good or bad. Rather such people will make use of their amygdale which is involved with emotions. Thus on seeing a delicious food their emotions come into play and they will prefer the harmful food.
Does diabetes make someone have anger and rage issues?
Those who suffer from diabetes mellitus are at risk of having mood swings. Diabetes can predispose one to having anger issues. These anger issues can present as physical and psychological abuse. This results from the fact that many people who suffer from diabetes get easily frustrated. Also the fluctuating blood sugar levels in poorly controlled diabetes can predispose to mood swings and aggressive benaviours.
A rise or a fall in the blood sugar level can produce anger, anxiety or depression in the individual. The anger issue seen in people suffering from diabetes is called diabetic rage. And this diabetic rage can occur without the individual being aware of it. The frustration from being diabetic, being overwhelmed by treatment regimen and the feeling of resentment contributes to diabetic rage.
The signs of diabetic rage include easily lashing out at people via slapping, hitting, threatening and cursing. The individual can also engage in property destruction, temper tantrums, etc.
The fluctuating blood glucose level can predispose to dementia, e.g. Alzheimer disease. Such individual may hallucinate believing that someone is against him/her and thus will lash out on the perceived enemy.
Diabetes can predispose one to delirium which is an acute confussional state. And this can cause the individual to attack someone or destroy properties. Those who have blood sugar lower than 70mg/dl are at risk of this.
How to reduce stress when there is existing diabetes.
In our everyday living, we may not be able to avoid stress altogether, but they can be reduced. We can also change our attitude towards stress and that can go a long way in reducing the effects of stress. Reducing stress will reduce its effects on the diabetes and make compliance to medication and other life changes possible.
The tips on how to manage stress can be read from the post on coping with stress in Nigeria.
And there is need to be compliant to professional instructions. So there is need to consult health professionals. These include a physician and a dietician or a nutritionist. It is important to also consult a clinical psychologist and a psychiatrist when stress cannot be managed by self help.
Sticking to the food prescriptions from the dietician will go a long way to reducing the blood sugar. And it will also reduce the effects of stress. This is because stress and depression can predispose one to taking sweet foods high in carbohydrates and fat. So keep away from pastries, organ meat, etc.
Being compliant to the medications for diabetes as prescribed by a doctor, will also reduce the blood sugar. There is also need to be compliant with medications prescribed for mental health issues. Doing regular blood sugar test is also important. But never describe the sugar level as good or bad. Rather see it as being high or low.
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