STRESS AND DIABETES

In a new book, Stress-Free Diabetes: Your Guide to Health and Happiness, published by the American Diabetes Association, Napora shows how for people with diabetes, worries about blood glucose control, healthy eating, and the risk of complications can compound the typical pressures of work, school, and family.                                                                                       Not all stress is bad, of course, Napora notes. "The fear of failing or not being accepted can be a positive stress because it pushes you to work harder," he says. But too much stress over time does more harm than good. Napora has taught stress management at the Johns Hopkins  Comprehensive Diabetes Center since 1984 and at the Suburban Hospital Diabetes Center in Bethesda, Md., since 1999. He also has a private practice in Baltimore, specializing in the treatment of diabetes, chronic pain, and other chronic illnesses.                                                                           In Stress-Free Diabetes, he offers tips for effective management of stress and diabetes. For example, Napora recommends writing a "contract" of your goals and committing to them. It might limit you to eating something sweet only every other day or call for you to walk instead of drive when possible. Writing things down is important, he says, because it allows you to review and revise your thoughts.                         Minding your health when you have diabetes can itself create stress, Napora says, and people with diabetes may have a hard time distinguishing the effects of stress as something separate from the effects of the disease itself. "People with diabetes are not as stress-sensitive as they should be," he says.                                                                  To become more aware of how stress can affect your health and to help you make good choices, Napora advises asking yourself what he calls "mindful questions," like "Is this working for me?" and "If not, why?" The answers can lead you to ways of overcoming or getting rid of stressors, perhaps by exercising, meditating, writing things down, or seeing the humor in your situation.                                                                                         The questions may also help you spot behavior that undermines good diabetes control, like emotional eating or excessive alcohol consumption. "You need to be stress-smart," Napora says, "if you're going to manage your diabetes well."