Diabetes and mental health

If you have a long-term condition like diabetes, looking after both your physical health and your mental health is important [1].

Mental health problems can be common among people with diabetes [2]. This article will look at why that might be, some of the issues that can occur and the help that is available.

How are diabetes and mental health connected?

About a third of people with diabetes have psychological or social problems that make managing their diabetes more difficult [2]. 

There are a number of conditions that have been found to be associated with diabetes, including depression, anxiety, sleeping problems and eating disorders [2, 3].

If you have problems with mental health, you may be less likely to stick to treatment plans and diabetes self-care [1, 2, 3]. Mental health issues can also increase your chances of experiencing more complications of diabetes [1, 2, 3].

Diabetes distress

‘Diabetes distress’ refers to the negative emotions and the burden of self-management of living with diabetes [3, 4]. The term is used to describe the emotional turmoil and despondency specifically related to living with diabetes and its treatment [3, 4].

Four things make up diabetes distress [3]:

• The emotional burden of living with diabetes
• Distress about self-managing diabetes
• Stress associated with relationships with a partner, friends and family
• Stress associated with the relationship between you and your healthcare providers

Diabetes distress can have a significant effect on your diabetes [4], as it has been shown to be associated with less effective blood glucose management [3, 4].

It has also been shown to be related to higher blood pressure, an increased risk of heart problems and, perhaps obviously, a lower quality of life [3].

If you are finding that managing your diabetes is becoming too much to handle or that it is affecting your relationships, speak to your diabetes team. They will be able to point you in the right direction to get help.

Depression and diabetes

If you have diabetes, you are more at risk of developing depression [2, 3, 5]. Regarding the prevalence of depression among adults with diabetes, results from studies are inconsistent and varied. Some studies found rates of depression two to three times greater in adults with diabetes than in the general population, while others suggest that it is only about 60% more common [2, 3, 5].

Living with diabetes can be a lot to handle, and while this burden may be part of the reason why depression is more common, there may also be changes in your body due to your diabetes that can affect your mood [2]. Some studies suggest that diabetes may affect your chance of getting depression by activating certain parts of the immune system, and by increasing the activity of specific areas of the brain [2].

Having depression can have a big effect — both on you and on your diabetes. Symptoms of depression are associated with reduced self-care and less effective blood glucose [2, 5]. Both depressive symptoms and diagnosed depression also make it more likely that you will get complications from your diabetes [2, 5]. Depression and developing diabetes are also linked — people with depression have an approximately 40% to 60% increased risk of developing type 2 diabetes [3].

If your mood is low, whether your diabetes is a factor or not, there are many ways you can get help. Talk to your diabetes team or your doctor, and they will be able to direct you to support that works for you.

Stress, anxiety and diabetes

Living with diabetes can be stressful and anxiety-provoking [3]. 

Anxiety has been shown to be more common for people who have diabetes [3]. One study found that up to 14% of people with diabetes have generalized anxiety disorder (GAD), with three times as many having anxiety symptoms [3].

Stress and anxiety can affect diabetes too, causing problems with self-care and diabetes management [3]. A meta-analytic review has shown that having a diagnosed anxiety disorder is significantly associated with poorer blood glucose management. However, there is no consensus [2, 4]. 

Long-term anxiety may also lead to an increased risk of developing type 2 diabetes [3]. Regarding stress, it has been found that some types of stress may increase the chance of having type 2 diabetes by up to 20%, with severe stress (such as post-traumatic stress disorder — PTSD) leading to a 40% higher risk of developing the condition [3].

There may be any number of reasons why you might feel anxious or stressed, some related to your diabetes and some not. For example, some people feel anxious about having to self-administer injections [3]. 

Regardless of the underlying cause, your healthcare team can help you to learn effective coping skills and direct you to support services that can make a difference for you [3].

Eating disorders and diabetes

Several different types of eating disorders are associated with diabetes [2, 3].

Bulimia is an eating disorder and a mental health condition [6]. Symptoms include binge eating (eating a lot of food in a very short amount of time) followed by purging (making yourself vomit, using laxatives, or doing an extreme amount of exercise after a binge to avoid putting on weight) [6].

Anorexia is another eating disorder associated with diabetes [3]. People who have anorexia try to keep their weight as low as possible by reducing the amount of food they eat and by exercising more [7]. Anorexia is a serious condition that can put your life at risk, and is one of the leading causes of death due to mental health problems [7].

Eating disorders are more common in people with diabetes than the general population, notably in women with type 1 diabetes. It has been found that bulimia is more common in women with type 1 diabetes than in those without [2, 3].

Anorexia and other eating disorders can make you very ill and have a significant effect on your diabetes [2, 3, 6, 7]. People with anorexia or bulimia and diabetes are at a much greater risk of complications if they use insulin omission (not taking their insulin as they should) to lose weight [2].

Getting help and support as soon as possible gives you the best chance of recovering from eating disorders such as anorexia and bulimia [6, 7].

Getting help

If you have diabetes and have trouble with your mental health, or are worried about someone else, it is important to know that there is lots of help out there.

The first people you talk to might be your diabetic team if you are starting to have mental health issues [3]. Your team may be able to help you themselves, suggest coping strategies, or signpost you to support services that will meet your needs [2, 3].

One form of help that might be offered are therapies such as cognitive behavioral therapy (CBT) [2]. Treatments like these have been shown to improve blood glucose management too [2].

If your team thinks it might help you, they may refer you for specialized psychological or psychiatric care [2]. 

There are lots of people that you could talk to, including friends, family and members of your healthcare team [3].

Mental health problems are very common for people with diabetes, and can manifest as diabetes distress, depression, anxiety, eating disorders or in other ways [2, 3, 4, 5].

If you are struggling with your mental health, don’t feel like you are alone. Friends and family can form an important support network for you, and your diabetes team will be able to signpost you to services that can help you.