4.  Reducing the impact of stress

Someone with diabetes usually has some control over how he reacts to stress. If he's aware he's feeling tense, he may be able to learn to relax and reverse the body's hormonal response to distress. Help him recognize when he's stressed and what's upsetting him by asking him to keep a stress journal. By jotting down a few notes when the going gets tense and rating his level of stress before testing his blood sugar, he should be able to figure out what's likely to cause a rise in his numbers.

• Encourage the person you're caring for to alleviate stress whenever possible. Once he has identified the cause of his distress, ask him to write down his feelings about this stressor, and help him identify potential solutions or options. Then help him come up with an action plan about how he can eliminate this stressor from his life so he feels less frazzled. If, for instance, he knows that his numbers go up whenever the neighbor's son cranks up his stereo after 10 p.m., maybe he can convince the neighbors to keep it down at night. If he bickers constantly with someone in his life and realizes that this makes his blood sugar go wild, perhaps the two of them can consciously work to reduce the squabbling or see a counselor.
• Consider his personality. Different personality types have different ways of coping with stress. If, for example, the person you're caring for has a problem-solving mindset, he may be able to reduce stress by asking himself: "How can I handle this predicament?" and taking action. If he finds it easier to let things go, he might try telling himself, "This problem really isn't so important after all," meditate, or play cards for an hour or so. Neither approach is right or wrong: The goal is to encourage him to handle stress in constructive ways without making his blood sugar levels swing out of control.
• Set small, healthy goals. During stressful times, help your friend or relative set small, achievable goals for keeping his blood sugar on track so he won't feel overwhelmed -- and tempted to blow his treatment plan altogether. Maybe he's willing to take a short walk around the neighborhood with you. Or perhaps he'll agree to eat three veggies today or have two cookies instead of five. Maybe he'll agree to check his blood glucose at least once -- or let you do it for him. Little steps like these can help keep him motivated and prevent him from throwing in the towel under pressure.

Helping someone with diabetes relax

Many simple relaxation strategies can help the person you're caring for prevent or lessen the impact of stress. These include:

• Breathing exercises, yoga, meditation, massage, and other similar activities that can calm the mind.
• Progressive relaxation therapy that includes learning to tense and relax major muscles in a sequence.
• Exercise, which raises levels of endorphins and serotonin, two brain chemicals that influence mood and sense of well-being. Exercise is an invaluable stress reliever with loads of other health-related benefits as well.
• Behavior modification, a fancy term that can simply mean replacing unhelpful thoughts with helpful ones and emptying distracting thoughts from the mind. He can learn techniques for doing this from a therapist.
• Time spent outside -- don't underestimate the soothing effects of fresh air, sunlight, and nature.
• Sleep: Inadequate rest can make stress worse and lower his ability to cope with it. Conversely, healthy slumber habits can increase energy and improve attitude. If he struggles to get enough shut-eye at night, suggest a restorative short nap during the day.

Whichever strategies the person you're caring for tries, encourage him to practice for a few weeks or months before discarding them. Like learning a new sport or hobby, it takes time and practice to discover how to truly chill out.