PHYSIOLOGY OF THE STRESS RESPONSE Stress inducing agents

Stress may be defined as a state of threatened homeostasis. Stress has been shown to have a role in the cause of diabetes and certainly in the management of the disease. There may be cortisol mediated intra abdominal fat deposition, modulated by chronic stress, leading to metabolic syndrome or Syndrome X. Hypothalamic-pituitary-axis (HPA) activity has also been postulated to have a significant role in intrauterine programming. The Hoorn study has shown that stressful l i fe events may be associated with visceral adiposity and type 2 diabetes mellitus. In the management of type 2 diabetes mellitus, compliance depends on personality traits and healthcultural beliefs. In childhood diabetes, emotional pain of coping may be taken as a paradigm in planning management for the child as well as the family. Diabetes specific psychological instruments for qual i ty of l i fe, wel l being and treatment satisfaction, could prove useful in clinical practice and in clinical audit.