Understanding PTSD and Type 2 Diabetes

Post-traumatic stress disorder (PTSD) is a mental disorder that is a result of exposure to certain terrifying or life-threatening (actual or perceived) events. It can cause emotional and physical dysregulation in a variety of ways.

Type 2 diabetes is a form of diabetes where the cells don’t respond properly to insulin (a hormone that regulates blood sugar), resulting in elevated blood glucose (blood sugar).

While the two conditions may seem unrelated, there is an association between them. PTSD has been linked to poor diet, inflammation, and reduced physical activity, which are also risk factors for type 2 diabetes.

In this article, we review the connection between PTSD and type 2 diabetes and how one condition may impact the diagnosis and treatment of the other condition.

Group counseling session for PTSD

Courtney Hale / Getty Images

The Connection Between PTSD and Type 2 Diabetes

PTSD has been associated with an increased risk of type 2 diabetes. This is partially because of the higher prevalence of inflammation, obesity, metabolic syndrome, and depression among those with PTSD compared to those without PTSD.

Lack of physical activity due to psychiatric factors such as depression or anxiety associated with PTSD can also lead to becoming overweight or obese, increasing the risk of type 2 diabetes.

Certain medications for PTSD, like some antidepressants and antipsychotics, can also cause weight gain or problems with glucose regulation, which can increase the risk of developing type 2 diabetes.

Latest Research

Improvements in PTSD symptoms have been associated with reduced type 2 diabetes risk. Decreased depression, as well as adherence to taking selective serotonin reuptake inhibitors (SSRIs), has been associated with improvements in insulin resistance, blood glucose control, and reduced inflammation.

This may be to some degree because once someone is not experiencing a depressed mood, they are more likely to be physically active, eat a healthier diet, and connect with others for social support and activities.

A 2019 study found that after controlling for confounding variables, obesity was still a major factor in whether someone with PTSD would develop type 2 diabetes. In those living with PTSD, ensuring that they are eating healthy diets and staying physically active is important for their mental and physical health.

Complications of PTSD and Diabetes

PTSD, when not treated or managed, can increase unhealthy lifestyle behaviors like self-medicating with food, substances, or smoking. This can increase the risk of obesity, high blood pressure, and cardiovascular diseases.

When to See a Healthcare Provider

Go to the emergency room or call 911 if you have:

  • Chest pain
  • Fainting, confusion, unconsciousness
  • Seizure
  • Shortness of breath or trouble breathing
  • Red or painful skin lesions that seems to be spreading

Call a healthcare provider if you have:

  • Numbness or tingling in your feet
  • Sores or infections that don't seem to be healing
  • Vision problems
  • Increase urination

Diagnosis of PTSD and Diabetes

PTSD and type 2 diabetes have very different symptoms and are diagnosed by two different kinds of healthcare professionals. Mental health disorders are diagnosed according to criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A psychologist or psychiatrist typically diagnoses PTSD.

Criteria for PTSD can include:

  • Recurrent and intrusive memories
  • Distressing dreams and/or nightmares
  • Significant physical reactions to triggers associated with the trauma
  • Avoidance of things or places that remind one of the traumatic event
  • Distorted negative beliefs about oneself or the world

Type 2 diabetes can be diagnosed by your primary healthcare provider or an endocrinologist (a physician specializing in hormonal health conditions).

Healthcare professionals should be aware of the link between PTSD and type 2 diabetes, particularly symptoms like physical inactivity, obesity, and side effects of certain psychiatric medications (like weight gain).

Self-Test for PTSD

If you think you might have PTSD, there are some online screening tools like:

It’s important to remember that these are merely screening tools for oneself, and a clinical diagnosis needs to be made by a mental healthcare professional.

If You Are Having Suicidal Thoughts

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 and connect with a trained counselor. If you or a loved one are in immediate danger, call 911.

Treatment of PTSD and Diabetes

Type 2 diabetes is generally treated by healthy eating, exercise, and medications, which may sometimes include insulin. Stress can also affect blood sugar levels, so stress management is often encouraged in managing diabetes.

PTSD is often treated with psychotherapy and sometimes medications if need be. PTSD may affect the treatment of type 2 diabetes by impacting stress levels and mental health.

Medications

PTSD can be treated with several medications, including selective serotonin reuptake inhibitors (SSRIs) like Zoloft (sertraline) or serotonin-norepinephrine reuptake inhibitors (SNRIs) like Effexor (venlafaxine) and other categories of psychiatric medications.

One study found that SSRIs improved blood sugar levels, but more research is necessary. Talk with your healthcare provider about the medications you are on for PTSD and how they may affect your blood sugar. This can also include side effects like weight gain and what that might mean for your blood sugar.

Medication may be given for type 2 diabetes if blood sugar levels are not controlled by lifestyle modifications such as diet and exercise. These may be oral or injectable medications.

Glucophage (metformin) is a first-line medication for the treatment of type 2 diabetes. A study of veterans with PTSD and diabetes who were given metformin after their PTSD diagnosis showed they were more likely to have a clinically meaningful reduction in PTSD symptoms than a control group not given metformin.

Psychotherapy

Four types of therapy are most strongly recommended for the treatment of PTSD, according to the American Psychological Association (APA):

  • Cognitive behavioral therapy (CBT): This type of therapy looks at the connections between thoughts, behaviors, and feelings.
  • Cognitive processing therapy (CPT): This is a specific kind of CBT that helps people learn how to change and challenge unhelpful beliefs related to the trauma.
  • Cognitive therapy: Adapted from CBT, this form of therapy involves changing the negative memories of a traumatic event with the purpose of disrupting unhelpful behaviors and thought patterns.
  • Prolonged exposure (PE): This therapy teaches people to approach traumatic memories, feelings, and situations slowly. By facing previously avoided memories or thoughts, the trauma-related memories can be reframed to feel not as dangerous or powerful.

Coping With PTSD and Diabetes

Living with chronic health conditions, both mental and physical ones, can be challenging. It’s important to have coping tools to effectively manage these conditions and stay as healthy as possible.

Lifestyle Changes

Changing your lifestyle can help make symptoms of both PTSD and type 2 diabetes more manageable and improve your health, but getting treatment from healthcare providers and mental healthcare professionals is still necessary for the best outcome.

Lifestyle changes that can be beneficial include:

  • Regular physical activity: Check with your healthcare provider first to make sure it’s safe. Regular physical activity helps relieve stress and maintain a healthy weight and can help with blood sugar levels.
  • Stress management practices: Things like yoga, mindfulness, and meditation can all help you manage stress; stress can increase blood sugar levels and anxiety, so reducing it can benefit the body and mind.
  • Healthy diet: A healthy diet with plenty of fiber, fruits, vegetables, and minimal amounts of processed and starchy foods, can help you feel better and control your glucose levels. If you need assistance with meal planning, talk with your healthcare provider.

Support Groups

Ask your healthcare provider about support groups in your area. There may be support groups for either PTSD or diabetes at hospitals, outpatient treatment centers, therapy practices, or medical offices. Your healthcare provider may know of these and be able to put you in contact with them.

For PTSD, support groups can be helpful, including:

  • NAMI Connection: Run by the National Alliance on Mental Illness (this is not PTSD-specific but can still provide coping skills and support)
  • CPTSD Safe Support Group: An online support group for survivors of trauma

Diabetes support groups include:

Summary

PTSD and type 2 diabetes may seem like two unrelated conditions, but research shows there are associations between the two.

Living with PTSD increases the risk of developing type 2 diabetes, likely because of factors like lack of physical activity, obesity, inflammatory processes in the body, and certain medications that may be used to treat PTSD (although others can help glucose levels).

While there are ways to manage both with lifestyle changes, seeing healthcare providers for both conditions is necessary.

A Word From Verywell

If you have PTSD and type 2 diabetes, talk with both the healthcare provider and mental healthcare professional treating your conditions about how the two affect each other. If need be, have the two healthcare providers connect and discuss a joint plan of care to help you stay as healthy as possible.

Frequently Asked Questions

  • What is the link between PTSD and type 2 diabetes?

    The association between the two conditions appears to be related to the high prevalence of obesity, problems with glucose regulation, inflammation, metabolic syndrome, and the impact of associated conditions like depression in those with PTSD.

  • Does treating PTSD improve diabetes?

    Yes, multiple studies have shown this. Improvements in PTSD symptoms have also been associated with decreased risks of developing type 2 diabetes. Treating PTSD can also reduce inflammation in the body, high blood pressure, and other associated physical symptoms.

  • How else does PTSD affect physical health?

    PTSD can also cause physical symptoms like joint pain, nausea, muscle tension, increased heart rate, headaches, back pain, fatigue, and other kinds of pain. Some people with PTSD and chronic pain may also misuse substances like alcohol or prescription medications to self-medicate.

 

 

 

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Scherrer JF, Salas J, Norman SB, et al. Association between clinically meaningful posttraumatic stress disorder improvement and risk of type 2 diabetes. JAMA Psychiatry. 2019;76(11):1159-1166. doi:10.1001/jamapsychiatry.2019.2096

  2. Scherrer JF, Lustman PJ. Posttraumatic stress disorder and incident type 2 diabetes: is obesity to blame? Chronic Stress. 2019;3:1-3. doi:10.1177/2470547019863415

  3. Department of Veterans Affairs. Medications for PTSD.

  4. Tharmaraja T, Stahl D, Hopkins CWP, et al. The association between selective serotonin reuptake inhibitors and glycemia: a systematic review and meta-analysis of randomized controlled trials. Psychosomatic Medicine. 2019;81(7):570-583. doi:10.1097/PSY.0000000000000707

  5. Liu S, Raines AM, Yoshida Y, et al. 174-lb: association between metformin treatment and improved symptoms of post-traumatic stress disorderDiabetes. 2020;69(Supplement_1):174-LB. doi:10.2337/db20-174-LB

  6. American Psychological Association. PTSD treatments.

  7. American Diabetes Association. 5. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes—2022Diabetes Care. 2022;45(Supplement 1):S60–S82. doi:10.2337/dc22-S005

  8. Harp JB, Yancopoulos GD, Gromada J. Glucagon orchestrates stress‐induced hyperglycaemiaDiabetes Obes Metab. 2016;18(7):648-653. doi:10.1111/dom.12668

  9. Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus reportDiabetes Care. 2019;42(5):731–754. doi:10.2337/dci19-0014

  10. American Psychiatric Association. Expert Q&A: posttraumatic stress disorder (PTSD).