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In functional medicine, we talk about wellness being on a continuum. Although ideally, we would all be able to achieve "perfect health," we do not live in a vacuum. We can choose to adopt a healthier lifestyle, but life is complicated. Even when we do our best to care for ourselves, we will be exposed to a multitude of challenges in life that impact our health.
A great example is stress! Of course, not all stress is bad, and stress is unavoidable. From a functional medicine perspective, we try to keep in mind that stress can mean MANY things- from stress in our work or personal lives, pesticides in our foods, cleaning and personal products, to lack of sleep or illness- stress can have a nearly silent impact on our health. And as nurses, most of us can definitely relate to this in our professional lives!
I've been thinking about stress this week because I recently embarked on a personal experiment that shed light on the intricate relationship between stress and blood glucose levels. I have been wearing a continuous glucose monitor (CGM) for several months recently to gain a deeper understanding of my body's responses to not just what I eat, but many other factors. What I discovered was eye-opening, particularly during a period when I was battling a viral upper respiratory illness.
Fortunately, I haven't been sick in several years, so this was my first time feeling poorly while wearing a CGM. Prior to getting sick, my glucose levels were well-controlled and stable based on my current lifestyle and eating habits. As I began noticing upper respiratory symptoms, I noticed that my glucose readings were consistently elevated above my norm. Levels were elevated not only after meals but also while I was fasting. Of course, congestion and a cough impacted my ability to sleep soundly at night, which further complicated the stress effect of this brief illness.
This experience served as a catalyst for this blog to underscore the significance of considering the multifaceted contributors to glucose fluctuations beyond diet alone. Stress, whether from acute illness, poor sleep, emotional turmoil, or other sources, can have a profound impact on blood glucose levels, potentially leading to insulin resistance and associated health concerns. Even otherwise enjoyable activities like travel and vigorous exercise have been shown to increase blood glucose levels.
The Physiology of Stress and Blood Glucose
Under stress, our body kicks into a 'fight or flight' response, releasing hormones such as cortisol, norepinephrine, and epinephrine. These hormones prompt the liver to increase glucose production, providing the body with a quick energy source. In isolated instances, this mechanism serves us well; however, chronic activation due to ongoing stress can lead to persistently elevated blood glucose levels.
Illness acts as a physical stressor, triggering inflammatory responses and hormonal shifts that similarly raise blood glucose. This response is not limited to severe illness but can also stem from mild viral infections, as I personally observed.
Poor sleep, another form of stress, disrupts hormonal balance, particularly with insulin and cortisol. Insufficient or poor-quality sleep can lead to higher fasting glucose levels and decreased insulin sensitivity, compounding the risk of developing chronic conditions like type 2 diabetes. This is why I approach sleep issues like sleep apnea, insomnia, night awakenings, and nocturia so seriously with my own patients.
The Broader Implications for Healthcare
For nurses and nurse practitioners, understanding these dynamics is crucial. We encounter patients under various stressors, not just from their immediate health concerns but also from environmental and psychological factors. By acknowledging and addressing these stressors, we can provide more holistic care, guiding our patients towards strategies that mitigate stress's impact on glucose levels and overall health.
This knowledge also underscores the importance of self-care among us as healthcare professionals. We are no strangers to stress, particularly in our fast-paced and emotionally demanding roles. By monitoring our stress and its physiological impacts, we can model healthy behaviors for our patients while safeguarding our well-being.
Practical Steps Forward
Education and Awareness: As healthcare providers, we should educate ourselves and our patients about the non-dietary factors affecting blood glucose, emphasizing the importance of stress management, quality sleep, and mental health.
Holistic Approaches: Incorporate stress-reduction techniques such as mindfulness, meditation, regular physical activity, and adequate rest into care plans.
Support a Healthy Immune System and Optimize Health Outcomes: Functional RNs and NPs can use our holistic approaches to immune health and disease prevention to reduce the frequency and severity of illness for our patients. If you haven't yet, check out my blog post on addressing insulin resistance.
Personal Monitoring: Consider the use of CGMs in patients with unexplained glucose fluctuations or those struggling with stress management, to provide real-time feedback and tailor interventions more effectively.
Advocate for Change: In our roles, we can advocate for workplace policies that reduce nurse and healthcare worker stress, promoting a healthier work environment and better patient care.
My recent experience with elevated glucose levels during illness has reinforced my belief in a holistic approach to health, considering all factors that contribute to our well-being. As nurses and nurse practitioners, let's lead by example, integrating these insights into our practice and personal lives, and empower our patients to take proactive steps towards their health, well beyond the traditional focus on diet alone. And this experience is one more example of why CGM use can be a powerful tool in our practice to increase patient awareness.
Together, we can address the multifaceted nature of health, acknowledging the critical role stress plays in our metabolic processes and advocating for a comprehensive approach to wellness that truly resonates with the principles of functional medicine. Identifying and addressing insulin resistance in your patients is fully within the scope of RNs and NPs, and this important nursing skill can play a major role in improving our patients' health outcomes. For nursing professionals eager to deepen their understanding of these types of intricate health connections that can enhance their clinical practice, I teach the Functional Medicine for Nursesâ„¢ course through the Integrative Nurse Coach Academy in partnership with the Institute for Functional Medicine. This course is designed to blend the functional medicine approach with the nursing perspective. By enrolling, you'll gain comprehensive insights into functional medicine principles, including in-depth explorations of topics like this, and how to apply this knowledge in nursing practice. This training is not just about acquiring information; it's about empowering you to transform patient care and become a leader in the field of holistic nursing and functional medicine. If you're passionate about advancing your career and enhancing your ability to heal, I invite you to join us and take the next step in your professional journey. Learn more here.