Diabetes and Mental Health

Living with and managing diabetes is often very stressful. People with type 1 and type 2 diabetes are at higher risk of developing mental health issues, including depression, anxiety, eating disorders, and more. Additionally, the physical changes experienced by diabetics—such as hypoglycemic episodes—can affect a person's mental well-being.

In this article, learn how you can manage or prevent the mental health issues associated with diabetes.

Connection Between Diabetes and Mental Health

Mental health issues are more common among people who have diabetes than in the general public. Likewise, diabetes is more commonly diagnosed among people with psychiatric disorders than among the general public. In short, the relationship between diabetes and mental health disorders is bi-directional (one affects the other).

It can be hard to manage the injections, appointments, diet, and other lifestyle changes that a diabetes diagnosis requires. Fear of a low blood sugar event, medication access, and blood sugar changes can affect mental health.

Additionally, having diabetes and a mental health diagnosis can negatively affect your outcomes with both conditions. It makes sense that having mental health issues may affect your ability to cope with and manage your diabetes and vice versa.

Depression

According to the Centers for Disease Control and Prevention (CDC), people with diabetes are two to three times more likely to have depression than people who do not have diabetes. Unfortunately, only 25–50% of these cases get diagnosed and treated.

Symptoms of depression include:

• Ongoing sadness, apathy, or depressed mood
• Low energy and fatigue
• Loss of interest in previously enjoyed activities
• Changes in sleeping, eating, appetite, and weight
• Difficulty concentrating or making decisions
• Thoughts of suicide

In general, you may be at increased risk for developing depression if you have a family history of depression, are going through a significant life change, or are enduring trauma or stress. Diabetes requires substantial lifestyle changes, and management can be stressful, which may contribute to depression.

Among people with diabetes, other risk factors for depression include:

• Taking insulin
• Diabetes complications
• Poor glycemic (blood sugar) control
• Having recurrent hypoglycemic episodes

Anxiety Disorders

People with both type 1 and type 2 diabetes have higher rates of anxiety. However, research has also found that anxiety disorders may increase a person's risk of developing diabetes.

Additionally, low blood sugar episodes can feel a lot like anxiety. Even when someone with diabetes has normal blood sugar levels, they may be worried about their blood sugar spiking or dipping.

Symptoms of anxiety include:

• Feelings of nervousness, restlessness, worry, and panic
• Nausea
• Headaches, stomachaches, and muscle aches
• Rapid, irregular heartbeat
• Sweating, dizziness, or tingling extremities
• Trouble concentrating or sleeping

Diabetes and anxiety are each risk factors for developing the other. One study also found that people with diabetes who had anxiety were more likely to be women, and incidence of this decreased with age. Another study found that those with diabetes and anxiety were more likely also to have depression, higher hemoglobin A1c (HbA1c/blood sugar levels) and body mass index (BMI), and macrovascular complications (complications of the large blood vessels).

Eating Disorders

Certain eating disorders are also more common among people with diabetes than those without it.

One recent study found that 21% of people with binge eating disorder (BED) also have type 2 diabetes.

Symptoms of binge eating disorder include:

• Recurrent binge eating episodes
• Feelings of disgust, shame, or loss of control during the episode
• Weight fluctuations
• Difficulty concentrating

People with type 1 diabetes are also at higher risk of developing eating disorders. About 7% of teenagers with type 1 diabetes may have an eating disorder. This combination is sometimes called diabulimia, which refers to when a person with type 1 diabetes purposefully does not take their insulin in an effort to lose weight.

Other Mental Health Disorders

Most diabetes and mental health research have historically focused on anxiety and depression. However, a recent 2022 study on type 2 diabetes among people with psychiatric disorders shed light on the prevalence of other mental health conditions.

The research found that the prevalence of diabetes among certain psychiatric disorders was significantly higher compared to 6–9% among the general population. Diabetes prevalence with other conditions included:

• Sleep disorders: 40%
• Binge eating disorder: 21%
• Substance use disorder: 16%
• Anxiety disorder: 14%
• Bipolar disorder: 11%
• Psychosis: 11%
• Schizophrenia: 10%
• Mixed groups of psychiatric disorders: 10%
• Depression: 9%
• Intellectual disability: 8%
  

Diagnosis

In the case of some mental health conditions, including depression, there is an issue with underdiagnosis. Nearly half of mental health conditions among those with diabetes may go undiagnosed. It is essential to receive a correct and timely diagnosis if you are struggling with your mental health and have diabetes.

Have an open and honest conversation with a trusted healthcare provider at your next appointment. Your provider may ask you questions about your thoughts, appetite, or sleeping patterns, administer simple screening tests in which you answer a series of questions, or refer you to a mental health specialist.

Treatments

Improving your mental health could help you better manage your diabetes and vice versa. For example, if you feel less apathetic, depressed, and exhausted, you may have more energy to spare for managing doctor's appointments, medication schedules, and your diet. On the other hand, if your diabetes is better controlled, you may feel better physically, which can carry over to your mental well-being.

Treatments vary between different psychiatric conditions and may also depend on your specific symptoms, values and preferences, and existing medications.

Some treatments may include:

• Cognitive behavioral therapy (CBT)
• Family therapy
• Medications
• Stress management techniques

Summary

Living with diabetes can be stressful and is even associated with higher rates of some mental health conditions, including anxiety, depression, and certain eating disorders. However, the relationship between diabetes and mental health conditions is bi-directional. People with certain psychiatric conditions are also at a higher risk of developing diabetes.

A Word From Verywell

Managing diabetes involves massive lifestyle changes and can be quite stressful. If you find yourself struggling with your mental health and have diabetes, it's possible you could have a diagnosable mental health condition. Receiving treatment may help you feel better mentally and emotionally, as well as help you better manage your diabetes and feel better physically.