Stress management can be defined in many ways. For the purposes of this presentation, stress can be defined as “any situation that tends to disturb the balance between a living organism and its environment”. (1) Stress can be perceived as physical stress, emotional stress or mental stress. (1) Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an Original Essay Physical stress consists of anything that puts strain on the physical body. (1) The cause may be, but is not limited to, hot/cold temperatures, physical injury, chronic illness, or pain. (1) Emotional and mental stress can consist of anything that causes individual emotional tension or mental strain of any kind. Causes may include, but are not limited to, apprehension, fear, frustration, sadness, anger and grief/grief. (1) The urge can occur due to anything from psychological disorders, for example, personality disorders or post-traumatic stress disorder to something as simple as not being able to find the right pair of shoes. (1) Historically, diabetes-related stress has been studied for centuries. Dr. Thomas Willis was one of the first to document stress as a contributing factor to the etiology of diabetes and high blood glucose values; Furthermore, to the possibility that a stressful event could be one of the catalysts for the onset of diabetes. (2) As time passed and more research was completed. Stress has been shown to increase blood glucose levels. (2) During a stressful event, regardless of whether the impact is physical, mental, or emotional, the fight-or-flight response occurs. (2) The amygdala receives a stress signal and reacts by sending another signal to the hypothalamus. (2) The hypothalamus then stimulates a sympathetic nervous system response. (2) The physiological response to activation of the sympathetic nervous system is increased heart rate, increased respiratory rate, elevated blood pressure due to vasoconstriction, muscle tension, increased awareness through visual stimuli, and auditory. (2) This signal travels along the vagus nerve and stimulates the adrenal medulla to secrete epinephrine. (2) The presence of epinephrine causes the body to extract lactate, glycerol, amino acids and glucagon from the liver and skeletal muscles to produce glucose through gluconeogenesis. (2) Glucose is secreted by the liver into the bloodstream, thereby increasing blood glucose levels. (2) The second part of the fight-or-flight reaction to stressors occurs because of the initial surge of adrenaline. (2) This epinephrine stimulates the hypothalamus to release corticotropin-releasing hormone (CRH). (2) Corticotropin-releasing hormone triggers the release of adrenocorticotropic hormone (ACTH). (2) Adrenocorticotropic hormone stimulates the release of cortisol from the adrenal medulla which further stimulates the liver to produce glucose and secrete it into the bloodstream; finally, raising blood glucose levels. (2) Chronic stress causes persistent release of epinephrine and activation of the adrenal medulla producing cortisol through the action of the hypothalamic-pituitary axis. (3) This may cause dyslipidemia, immunosuppression, osteoporosis, damage to blood vessels and arteries, high risk of hypertensive stroke or myocardial infarction. (3) Increased energy needs cause an increase in appetite, potentially causing weight gain and increased insulin resistance. (3) Therefore it is important to try to reduce stress to a level deemed acceptable by the client as everyone has different levels of stress. (7)