To better manage and reduce stress, everyone, particularly those with long term medical conditions such as diabetes, needs to better understand stress, how it can affect you, and what you can do to combat it.

The term stress is often used very loosely and it refers to a lot of different things. Things that stress one person (a "stressor") may not stress another person. Similarly, the way one person responds to a stressor may be completely different to the way another person responds.

For example, Bob is stressed by constant deadlines, pressure to perform in front of groups of peers, and peak hour traffic. When his body responds to these stressors, Bob feels "worked up and tense", starts to sweat, notices his fingers shaking, and breathes a lot more quickly and shallowly than he usually does.

Tina, on the other hand, finds that constantly taking care or her children's needs, thinking about her blood-sugar levels, talking to "needy" friends on the phone and doing work around the house is very stressful. She responds by feeling "anxious and panicky", experiencing butterflies in her stomach and nausea, and a sensation like her head is spinning.

Stressors are things that you perceive to be threatening, challenging or potentially harmful. At some level, you perceive that the stressor may be extremely difficult for you to deal with, or that it may in fact exceed your ability to cope.

While some things would be stress to anyone, it is not necessarily objective characteristics of things or situations that make them stressors, but the way you think about them.

Although our bodies and minds all work differently, most people's bodies and minds respond similarly during periods of stress.

Our brains are hardwired to protect us from dangerous stressors through a stress response, also referred to as the "fight or flight" response. So, when we are faced with a stressor, such as a wild animal during the early days of human kind, we automatically prepare ourselves to either fight the danger or run away.

The fight or flight response is triggered when our mind identifies an impending stressor. Our sympathetic nervous system releases adrenaline, which circulates through our bloodstream to change the activity of many bodily organs.

During fight or flight, some of the following changes may occur:

• Decrease in sex hormones.
• Decreased blood flow to the digestive tract.
• Increased respiration (breathing) rate.
• Increased sweating.
• Increased muscular tension.
• Increased heart rate, blood pressure and blood clotting ability.
• Increased glucose release from the liver and increased insulin release.

Our body's intention is to a) increase functions that will help us respond quickly and survive attacks, and b) decrease everyday "maintenance functions" that would otherwise use valuable energy.

This fight or flight response has good intentions - it is designed to help us respond quickly and efficiently. No doubt it was very handy keeping our ancestors alive when they came across a dinosaur or a crocodile.

Of course, these days our stressors are quite different - they tend to be longer term problems of a less physically-threatening nature, such as paying bills, raising children, facing retirement, and so on. Although our fight or flight response is still useful, it can have a negative impact if it occurs for prolonged periods of time, or in very intense "bursts".

The additional danger of stress for people who have diabetes is the raised blood-sugar levels that occur with the stress response.

In addition, a period of stress can deplete glucose stores, and can also increase the likelihood of "hypos". Some people notice their diabetic symptoms fluctuating rapidly during times of stress because of the up-and-downs in blood sugar level.

Stress can also have indirect effects on diabetes. If you react to a stressor by feeling depressed, then you may feel lethargic, depleted and unmotivated. When you feel like this, you may be less likely to take care of yourself, maintain exercise, or look after what you eat.

This is especially the case for the "emotional eaters" among us, who cope with feelings of stress by eating foods that are usually fatty or high in sugar content.

The daily hassles of managing diabetes can produce ample stressors, especially when you have to schedule them around everything else that is going on in your life.

But the biochemical effects of high or low blood sugar can also either mimic or induce the stress response. That is, when your blood-sugar levels are chaotic, it is normal for you to feel a bit on-edge, stressed, depressed, or anxious.

Awareness and understanding of stress and how it affects you are the first steps in managing it.

However, by adopting some simple strategies, people, particularly those with diabetes, are able to reduce the impact that stress has on their lives.

Lifestyle maintenance

Exercise and recreation are important in managing diabetes and also are effective ways to manage stress. They activate people into doing things they enjoy, as well as improve their health and fitness. Things to keep in mind when planning an exercise and recreation program include:

1. A small amount of exercise on a regular basis is better than over-exercising infrequently.
2. Choose a type of exercise that is enjoyable. Punishing exercise can be stressful itself.
3. Choose exercise that allows you to participate in the local/work community.
4. Get a friend, workmate or a group of people involved.
5. Exercise needs to be a regular, high priority part of your lifestyle.
6. Schedule pleasant events into your life, like fun times with friends, intimate moments with your partner or times when you have an opportunity to be alone.

A nutritious diet is vital in reducing stress. Develop a balanced diet together with a dietitian and take it in moderation. A number of important things need to be considered.

1. Changes to eating habits are more likely to last if they are made slowly.
2. Try alternative food products.
3. Increase intake of unprocessed, fresh foods.
4. Experiment with new ways of preparing and serving food.
5. Limit intake of fast food and take-away.
6. Decrease intake of caffeine, sugar, fats and salt.
7. Increase intake of foods with greater nutritional value.
8. Food intake should be kept at a moderate level.
9. Minimise your alcohol and nicotine use.

Sleep is a fundamental requirement for life. Poor sleeping is associated with stress. It is a problem when it is insufficient and causes fatigue during the day. A vicious cycle develops when worry over problems disturbs sleep, and then fatigue the next day interferes with coping ability. Some suggestions for improved sleeping follow:

1. Learn to relax physically and use relaxation skills at bedtime.
2. Aim for a regular bedtime to establish regular body rhythms.
3. Do not worry about not getting to sleep easily.
4. If you are still awake half an hour after going to bed, get up. Do something quiet and relaxing until feeling drowsy.
5. Again, cut down on alcohol, smoking, chocolate, coffee or tea. These can damage sleep.
6. Keep fit with regular exercise.
7. Do not eat heavy meals just before bedtime.
8. Reserve your bed for sleep. Don't use it for watching TV, solving problems, or worrying.
9. Keep a notebook beside your bed. If a problem comes into your head, write it in the book for attention the next day.
10. Get up the same time each day. Don't sleep in or nap during the day.

Cognitive strategies

Stressful thinking can be tackled by working out which thoughts cause you stress and then disputing the irrational thoughts and substituting more realistic ways of thinking.

1. Write down the activating event or situation that is causing stress. Make sure these are the objective facts.
2. Write down your self-talk about the situation. Do some of the irrational thoughts apply to you in this situation?
3. Focus on your consequential feeling and write down a clear one or two word label for the feeling, such as angry, sad, afraid, worthless, etc.
4. Dispute and change your irrational self-talk by asking yourself whether there is any evidence for your belief or is your interpretation of the situation the only thing you are going on.
5. Substitute a less stressful, more realistic, alternative self-talk.

Action plan

Equipped with a better understanding of stress and how it affects you physically and emotionally, and armed with some effective stress management strategies, you are well on your way to stress free success. The final step is to ensure these ideas are captured in an effective action plan. Working with a counsellor or psychologist can help you develop an action plan that will put you on this right path and keep you there in the long term. Good luck.

Try this short stress test

Are you:

• Getting upset over trivial things?
• Tending to over react to situations?
• Getting upset easily?
• Using up a lot of nervous energy?
• Feeling impatient often?
• Finding it hard to wind down?
• Feeling irritable too often lately?
• Being intolerant with others and their interruptions?
• Getting agitated?

If you ticked three or more, you probably suffer from stress.