Increased stress plays a role in developing many conditions, including diabetes, and it makes it significantly harder to manage. Photo: RNZ / Rebekah Parsons-King
You may have noticed that I took a month or two off writing about my Type 2 diabetes. There's a reason for that.
Every time I go to the doctor, I am asked about stress - how are my stress levels, how am I coping? And much of the time, I can honestly say "OK." But I had a period there for a bit where I knew I was going to be pretty stressed, and rather than what I would have done in my pre-diabetes life - power through - I tried to manage it.
Pausing this column for a while was one strategy. I also deleted the Twitter app off my phone and added an extra gym session to each week; I tried to sleep a reasonable amount.
I did all this because I knew it would help. But I didn't quite understand why until I spoke to Rosemary Hall.
Dr Hall is an endocrinologist and the president of the New Zealand Society for the Study of Diabetes. We were on a podcast together, talking about diabetes, and in it, she said "and of course, being stressed will push up your blood sugars".
It felt like a light bulb going on in my head. Like "white sugar and white flour are the same thing to your body", I knew it, but it took someone saying it out loud to make it make sense to my brain. All this time I thought stress was bad for my brain, but it's also pretty bad for my body.
(This is a lesson I've learned before, it just needs repeating.)
Our body's response to stress is based on needing to run or hide, Hall says.
"If you're being chased, then you run and [stress] sets up your sympathetic nervous system to activate all of the things that are required for getting away: puts your heart rate up, shuts down your gut, you know, means that you don't need to stop and have a toilet stop."
We think about this, often, as "fight, flight, or freeze". And the thing is, even with freeze - hiding away - similar things happen in the body.
Because diabetes is such a complicated condition, with multiple factors, it's impossible to say that stress causes it. But increased stress plays a role in developing many conditions, including diabetes, and it makes it significantly harder to manage.
"People with diabetes in stressful situations will always know instinctively that their blood sugars are going to be more difficult to get right," Hall says.
"That's [due to] a multitude of things. It's the physiological stress, it's the eating behaviours - like not eating, or eating at funny times, or eating funny things that are going to make it worse.
"It's the sleep issues that make everything worse. Sleep is an absolutely critical part of developing diabetes, and for managing diabetes, as well."
Hall gave me the best explanation of Type 2 diabetes I've heard in the past year. She believes it mainly comes down to two things: genetics and insulin resistance.
To take glucose from the blood to muscles and fat cells, insulin "opens up a little gate" on a cell, and the glucose runs through. Insulin resistance makes that gate rusty. Glucose can't get into the cell as easily, so it hangs out in the blood where it causes problems. Drugs like metformin are like a lubricant for those gates.
Cortisol - often called the stress hormone - drives up glucose in the blood, because if you're running from a wild animal, you need it for energy.
But, among other things, long-term stress can create increased central fat cells (the fat cells around your middle which are in, around and between your organs). Those central fat cells then produce proteins and hormones that increase insulin resistance in a bunch of different ways, including changing the way glucose is produced and increasing the way fatty acids are broken down.
Over time, those gates get more and more squeaky.
As well as helping us run from stressful situations, cortisol gets us up in the morning. About half an hour before you wake, your body releases cortisol to get you up and moving. This is why jet lag feels so awful, Hall says - because you don't get that boost in the morning. But with long-term stress, cortisol doesn't dip during the day as it should, so blood sugars stay high.
Taking on extra responsibilities at work was stressful, but so is ... well, the world around us at the moment. One of the things I have learned in the past year is that managing my diabetes - and my health generally - is a balance.
Freaking myself out that I have eaten 10 grams too many carbs in a day, probably isn't worth the long-term impact that lying in bed worrying about it has. I work out at the gym not just because having more muscles means my cells' insulin gates open a bit more easily, but because it helps me to stay a little bit more chill.
I try not to waste too much time looking back nowadays - but imagine if that was a lesson I'd been taught a little earlier.