Diabetes & Mental Health: How Depression and Anxiety Can Impact Your Management

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Mental health can impact so many aspects of your life from how you think, feel, handle stress, and for people living with a chronic illness like diabetes- even how they manage their blood sugars. Whether you have depression, anxiety or another mental health condition, they can make it more difficult when it comes to taking care of your diabetes. Diabetes is a big burden for someone to carry as it requires constant, around the clock management. Aside from taking insulin and monitoring blood sugar levels, diabetes requires you to take care of yourself mentally and emotionally as well. This blog post is going to look at common mental health conditions, how they can impact your management, and what you can do to get support.


Depression and Diabetes Distress

The presence of depression disorders can be up to three times more common for people with type 1 diabetes than the general population. Depressive episodes can cause:

  • Feelings of hopelessness

  • Tiredness and lack of energy

  • Trouble thinking or making decisions

  • Loss of appetite or binge eating

  • High levels of self-blame and guilt

  • Not taking medications

  • Less frequent monitoring of blood sugar levels

  • Reduced physical activity

These symptoms can impact how someone manages their diabetes because they find themselves lacking energy to keep up with the daily demands of diabetes.


Difference Between Depression and Diabetes Distress

Diabetes distress is also common amongst people with diabetes and is used to describe the emotional response to living with diabetes and the relentless pressure from daily self-management activities.


Diabetes distress can cause a lot of the same thoughts and feelings as depression, however, diabetes distress is not thought of as a mental illness. It is an expected reaction from the burden of living with diabetes and if left untreated can lead to diabetes burnout. Diabetes burnout can leave you feeling defeated or powerless against diabetes no matter how much effort you put into your management.


Managing Depression and Diabetes Distress

When it comes to managing depression, diabetes distress, or diabetes burnout, it is important to regularly check in with yourself about your level of worry, distress, or burnout and work with your healthcare team to find effective coping strategies. As someone who has depression and type 1 diabetes, here are a few things I have found helpful:

  • Community: the type 1 diabetes community is like no other- surrounding yourself with people who really “get it” and can relate to what you are going through can make you feel less alone or isolated.

  • Give yourself space: it is unrealistic to be hyper-vigilant about your management 24/7. Giving yourself permission to take a safe, short step-back can help you regroup sooner rather than later.

  • Get additional support: you don’t have to do it all on your own– you can use the American Diabetes Association directory here to find a mental health provider near you.

Anxiety and Diabetes

The concerns about the carbohydrate content in meals, monitoring blood sugar levels, or constant reminders of long-term health complications can put a lot of stress and pressure on someone living with diabetes and eventually manifest into anxiety. Anxiety disorders that are common with diabetes include:

  • Generalized anxiety disorder

  • Post-traumatic stress disorder (PTSD)

  • Panic disorder

  • Obsessive-compulsive disorder (OCD)

  • Agoraphobia (fear of certain places/situations)

The constant pressure of managing a chronic condition may lead to people with diabetes feeling anxious in various areas of their management.


Disordered Eating and Eating Disorders

Mealtimes can be highly stressful for people with diabetes as it requires you to be aware of the carbohydrate count and macronutrient breakdown for every meal and snack you consume in order to take your insulin appropriately. Oftentimes what starts out as well-intentioned can soon become a fixation that causes high levels of anxiety around food and can lead to developing disordered eating or an eating disorder.


People with diabetes are twice as likely than the general public to develop disordered eating or an eating disorder and can be crippling and dangerous. Disordered eating and eating disorders often begin when someone is looking for a sense of control in their lives. With diabetes, there are many things that are outside of your control and manipulating your food intake can be a very gray area as it may give you a false sense of control and temporary relief in anxiety.


What does disordered eating look like with diabetes

  • Compulsively eating only a certain number of carbohydrates per meal

  • Obsession with measuring or weighing food

  • Removing certain foods or food groups

I struggled with disordered eating for the first few years of my diagnosis. I refused to eat more than 30g of carbs at a given time and would show up to restaurants with my own meal prepped (and precisely measured) food. I missed out on so many life experiences because I was constantly preoccupied by thinking about food. If this sounds like you, there is a way to break the cycle and not live in a constant state of anxiety.

  • In my Eating Essentials for T1D course, you will deepen your understanding of the nuances with nutrition, establish your own food philosophy, and challenge your food rules so you can learn to manage your blood sugars without giving up the foods that you love.

Hypo-Anxiety

You may have heard a horror story about someone being “dead in the bed” or experienced first-hand the seriousness of a severe hypoglycemic episode. No matter the source, hypo-anxiety is a state of fear or constant worry that your blood sugars will go too low.


Symptoms of Anxiety & Low Blood Sugar

The symptoms of anxiety and low blood sugars can mirror one another. Both can cause shakiness, fast heart rate, irritability, nausea, difficulty concentrating, and panic. The overlap in symptoms isn’t just coincidental, there is a physiological reason behind it. When blood sugars are low, the body will try to raise blood sugar levels by signaling the liver to release glucose into the bloodstream by increasing adrenaline levels. This phenomenon will trigger the “fight or flight” response which is the same pathway that is triggered with anxiety.


How does hypo-anxiety impact blood sugars

The sensations that are felt during a low blood sugar are uncomfortable and scary. In effort to avoid it, some people purposely run their blood sugar levels higher in order to prevent a low blood sugar or find themselves constantly over treating during a low blood sugar episode. As a result, they may find themselves on a mentally and physically exhausting cycle of elevated blood sugars and constant panic.


Persistently elevated blood sugar levels can increase someone’s risk for other diabetes complications so it is important that you can get to the root of your anxiety and steps you can take to offset some of the worry. Here are some ideas on how to manage hypo-anxiety:

  • Always be prepared and carry low blood sugar treatments with you

  • Share your blood sugar levels with a friend or family member

  • Try different mindfulness techniques when experiencing a low blood sugar and are in a heightened state of distress

  • Set your low blood sugar alerts to be higher so you are alerted sooner

  • Try talking to your care team, healthcare provider, or other people with diabetes

If you take one thing away from this blog post, it is that your mental and emotional health is an important aspect of your diabetes management that shouldn’t be overlooked. Living with a chronic condition is no easy fret- I mean, you are mimicking the partial function of a human organ for crying out loud! If you currently feel stuck in your management, know that there is hope in finding a management style that doesn’t sacrifice your mental health in the process. This journey will look so different for everyone, but you are never alone in what you may be experiencing.