The Progressive Nurse

Progressive, adj: making progress toward better conditions

Category: Stress Management

Diabetic Management During Stress or Illness



The Cleveland Clinic offers excellent advice for managing diabetes during times of physical or emotional distress.  Experts offer the following five tips to help maintain blood sugar and  minimize the dangerous complications of uncontrolled diabetes.

1. Stay hydrated

Dehydration occurs quickly when you have fever, vomiting or diarrhea. The main risk from dehydration is hyperglycemia (high blood sugar).  Cold medications, skipping diabetes medications and eating food erratically may also lead to high blood sugar.

According to diabetes specialist Bartolome Burguera, MD, “when you’re ill, it’s very important to check your blood sugar regularly, continue to take medications on a schedule and drink fluids regularly.”  He also suggests that when your blood sugar goes over 250, check your urine for keytones (produced when your body has difficulty processing blood sugar) and call your clinician with the results.

2. Change up your diet

When you are ill or stressed, your diet may change.  If you are unable to eat normally or have a decreased appetite, meal replacement drinks are often helpful.  “Nutritional shakes formulated for people with diabetes have a moderate amount of carbohydrate, which is appropriate” (Burguera).  Homemade meal-replacement shakes are also helpful by using:

  • Frozen fruit
  • A protein source (e.g., protein powder, Greek yogurt, peanut butter, tofu)
  • Milk, soy milk or almond milk

Alternatively, “noodle soups are typically well tolerated and the noodles offer carbohydrates, which may help prevent low blood sugars” (Burguera).

3. Create a sick-day tool kit

Dr. Burguera recommends putting together a “sick-day diabetes tool kit” that includes items to be eaten or drank when feeling unwell.  “Some non-food items to include in your tool kit are extra blood-sugar monitoring supplies and a thermometer to check for a fever”  (Burguera).  Your kit may include:

  • Regular soda pop or juice (to prevent low blood sugars)
  • Broth-based soups
  • Gelatin (regular, not sugar-free)
  • Water
  • Electrolyte-supplemented beverages

4. Make sure you’re monitoring

Monitoring your diabetes is essential during times of stress.  “In general, if you’re taking insulin at meals and long-acting insulin once a day, you should monitor your blood sugar four times per day — before each meal and before bed”  (Burguera).

5. Talk to your clinician

Individualized care is important with diabetic management and your clinician will adjust your diabetes medications as necessary and dependent on:

  • The type of medications you’re taking
  • The extent to which your food intake has decreased

Dietician Dawn Noe states that “if you’re taking long-acting insulin, which is typically given at bedtime, we usually recommend you continue with the same dose, as long-acting insulin is mainly responsible for insulin needs not related to food intake.”

When insulin is taken before meals (also called rapid-acting insulin, fast-acting insulin, or mealtime insulin) your clinician may need to reduce your dose, depending upon your daily meals for breakfast, lunch and dinner. “If you skip a meal, skip the mealtime insulin” (Noe).

Oral medications may need to be adjusted by your clinician.  Diabetes medications, such as metformin, SGLT-2 inhibitors or DPP4- inhibitors, rarely cause low blood sugars and may not need adjusting.  “These medications usually bring down blood sugar from high to normal, but very rarely drop blood sugar too low” (Burguera).  However, sulfonylureas or acarbose may cause your blood sugars to drop if you are eating less. “These medications should be adjusted based on blood-sugar readings” (Burguera).

Whether during stress or illness, blood sugar management is imperative to control diabetes and maintain a healthy lifestyle and quality of life.

Read the Article Here:   5 Best Tips to Manage Diabetes When You’re Sick

Fighting Disease and Illness with the Mind-Body Connection


“If you’ve been there in the mind you’ll go there in the body.” -Dr. Denis Waitely

“Whether you think you can or think you can’t, you are right.” -Henry Ford

Mind-Body Connection and Improved Immunity

Can you imagine fighting disease and illness just by changing your mental game?  The way we think and feel can have a profound effect on our health. It is said that everything begins in the mind, “between the ears.”

Psychoneuroimmunology (PNI) is the study of the mind, nervous and immune systems. It is the scientific study of how emotions and behavior affect the brain and immune system function. PNI focuses on the “integrated information circuit” between these systems, and relationships between psychosocial factors (behavior, emotion, environment), the central nervous system, and how alterations in the brain and spinal cord affect the immune system response.  Simply, the state of the mind directly affects illness or wellness.

The literature is stacked with evidence-based research supporting the mind-body connection to immunity, well-being and how the mind affects the body.  It is known that highly stressed individuals are at greater risk for cardiovascular disease (CVD), impaired immunity, diabetes and obesity. Recognizing stressors, controlling our reactions and practicing stress management techniques can reduce risk factors and improve health. The mind has the power to heal or destroy.

Mind-body interventions like the relaxation response can reduce stress and enhance wellness in healthy individuals, and counteract the adverse effects of stress in conditions like hypertension, anxiety, diabetes and aging. The relaxation response is a breakthrough technique that reverses the detrimental effects of stress on our body.

Developed by the father of modern mind body medicine, Dr. Herbert Benson found through his research, that by eliciting the relaxation response, which is a physiologic state of deep rest induced by methods such as meditation, yoga, deep breathing and prayer, immediate changes are produced in the expression of genes involved in energy metabolism, insulin secretion and immune functionality. His research identified biological pathways that regulate and assume specific roles in stress, inflammation and human disease.

The mind-body connection is a vital concept to understand and integrate into a healthy lifestyle to prevent disease and illness, and assist in the development of positive coping skills such as self-control, self-esteem, self-efficacy, and stress management. Learning and implementing positive coping skills now, will provide life long health benefits that will transcend all aspects of the human experience.

Many methods exist that employ techniques to train the brain and reduce the effects of stress induced illness and disease.  In general, these techniques encompass the same basic principals to strengthen new behaviors through reinforcement, motivation and practice.

Key Factors for Stress Management:

  • Assess your perceived and real stressors
  • Change your response, pause and breath
  • Prepare ahead of time for potential stressors
  • Downshift – Consciously attempt to simplify life, determine your ultimate goal and make short and long-term plans
  • Change the way you think
    • Examine your self-talk and emotional responses
    • Practice optimistic and positive thinking techniques
  • Learn to laugh, cry and control your anger
  • Manage your time, prioritize and learn to say no
  • Practice mindfulness and living in the present moment
  • Eat a balanced healthful diet to improve stamina
  • Exercise to raise endorphins, eliminate excess stress hormones and improve mental alertness
  • Relax to restore and preserve energy stores
  • Practice deep breathing and meditation techniques

The mind is the master organ that has a powerful influence over our body, thoughts, emotions and immune system. It controls our daily functions, and constantly interprets and processes information. It is the cognitive (thinking) center of the body where emotions are experienced, ideas are created, and memory is stored. However, you are the master of your mind. Whatever you tell yourself is true, as the mind cannot differentiate between what is real and what is imagined.

The mind leads the body and has the power to heal.  Where your mind leads, the body will follow.

Click here for the Relaxation Response Technique Guidelines



  • Donatelle, Rebecca J. Access to Health. San Francisco: Benjamin Cummings, 2004. Print.
  • Karren, Keith J. Mind/body Health: The Effects of Attitudes, Emotions And, Relationships. Boston: Pearson, 2014. Print.
  • Herbert Benson, MD – The Connection.” The Connection Herbert Benson MD Comments. N.p., 07 Apr. 2014. Web. 03 Feb. 2016.
  • Mack, Gary, and David Casstevens. Mind Gym: An Athlete’s Guide to Inner Excellence. New York: Contemporary, 2001. Print.
  • Seligman, Martin E. P. Learned Optimism: How to Change Your Mind and Your Life. New York: Vintage, 2006. Print.
  • Steps to Elicit the Relaxation Response.” Steps to Elicit the Relaxation Response. N.p., n.d. Web. 03 Feb. 2016.
  • “Through the Wormhole S03E08 Mysteries of the Subconscious Stress, Oh Well, Peach Herbert Benson.” YouTube. YouTube, n.d. Web. 19 Nov. 2014.