Diabetes is a chronic disease that affects how the body processes blood sugar (glucose). There are two main types of diabetes: type 1 and type 2. Both types can lead to high blood sugar levels, which over time can cause serious health complications like heart disease, stroke, kidney disease, vision loss and nerve damage.
In addition to the physical toll, diabetes often takes an emotional toll as well. Dealing with the day-to-day management of diabetes as well as the anxiety about developing complications can negatively impact mental health. Many people with diabetes experience emotional problems like depression, distress, anxiety and disordered eating patterns.
What is diabetes?
Diabetes occurs when the pancreas cannot produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar.
In type 1 diabetes, the immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. People with type 1 diabetes must take insulin injections to survive. This form of diabetes usually develops in childhood or young adulthood, which is why it was previously called juvenile diabetes.
In type 2 diabetes, the body develops insulin resistance, meaning the cells do not properly respond to insulin. The pancreas initially produces more insulin to try to compensate, but over time it cannot keep up with the body’s needs. Type 2 diabetes is the most common form, developing primarily in adults. Major risk factors include being overweight and inactive.
Other less common types of diabetes include gestational diabetes, which occurs during pregnancy, and other forms that result from specific genetic syndromes, pancreatitis, surgery or medication.
Managing diabetes
Managing diabetes requires making lifestyle changes and carefully monitoring blood sugar levels. Treatment plans are tailored to each individual based on the type of diabetes, age and other factors.
– Medications – Such as insulin, metformin and other drugs to control blood sugar.
– Blood sugar testing – Using a glucose meter to frequently check blood sugar levels. Testing may be needed multiple times per day.
– Carbohydrate counting – Tracking carbohydrate intake is key for managing diet and insulin dosing.
– Regular exercise – Exercise helps improve insulin sensitivity and blood sugar control.
– Routine medical care – Seeing healthcare providers regularly for check-ups, screening tests and treatment adjustments.
Following the treatment regimen takes significant time and commitment. Failing to properly manage diabetes can result in hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar), both of which can create serious short-term and long-term problems.
Emotional impact of diabetes diagnosis
Receiving a diagnosis of diabetes, regardless of type, can come as a shock. Many people experience grief, anger, fear, anxiety and denial. The permanence of the disease and likelihood of developing complications can be difficult to accept.
There is often a grieving process for the perceived loss of a life without chronic illness. People may grieve the ability to freely eat foods they enjoy without managing carbohydrates. A diabetes diagnosis represents a major life change.
The initial emotional reaction tends to improve with time and experience managing the condition. However, the emotional burden of diabetes often resurfaces during times of stress or at important milestones like starting school, going to college or getting married.
Common reactions to diagnosis include:
– Shock, disbelief, denial
– Anger, frustration
– Anxiety, fear about the future
– Sadness, depression
– Feeling overwhelmed by the treatment regimen
– Isolation or loneliness
Children and teens with diabetes face additional challenges, as they may feel different from their peers. Parents of children with diabetes also experience emotional distress related to managing their child’s condition.
Diabetes distress
Many people with diabetes experience “diabetes distress,” a term that describes the negative emotional reactions related to living with and managing diabetes.
Diabetes distress is extremely common. Studies show around 1 in 3 people with type 1 diabetes and nearly half of those with type 2 diabetes report moderate to high levels of distress.
Sources of diabetes distress include:
– Daily burden of self-management
– Worries about developing complications
– Interpersonal issues and lack of support
– Feeling overwhelmed or discouraged by unmet treatment goals
– Anxiety about hypoglycemia
– Emotional exhaustion or “burnout” from the constant effort required to manage diabetes
People may feel socially isolated or alone in dealing with their condition, particularly if friends and family are not understanding. Financial concerns related to medical costs and missed work can also contribute to distress.
Diabetes distress differs from clinical depression – while distress refers to common reactions that occur as part of living with diabetes, clinical depression is a mood disorder requiring medical treatment. However, diabetes distress left unaddressed can develop into depression.
Signs of diabetes distress include:
– Feeling burned out by the daily effort to manage diabetes
– Anger, irritation or moodiness related to diabetes and its management
– Feeling discouraged or overwhelmed by the demands of living with diabetes
– Unrelenting worry about diabetes complications
– Feeling alone in dealing with the condition
Clinical depression
People with diabetes have a higher risk of developing major depressive disorder. The prevalence of clinically diagnosed depression in people with diabetes is around 15-20%.
For comparison, the rate in the general population is approximately 5-10%. So diabetes at least doubles the risk of depression.
The reasons for the link between diabetes and depression are not fully understood. Possible factors include:
– Emotional burden of chronic disease
– Biochemical changes related to diabetes
– Stress of managing a complex condition
– Anxiety about developing complications
– Lifestyle limitations imposed by diabetes
– Neuropathy (nerve damage) related to diabetes
Several studies have found depression is most common in women with diabetes, particularly those with type 2. Depression also tends to be more prevalent in people who have diabetes complications or other medical conditions in addition to diabetes.
Having both diabetes and depression together can negatively impact disease management and health outcomes. Depression makes it more difficult for people to maintain their treatment regimen. In turn, higher blood sugars can worsen feelings of depression.
Symptoms of depression include:
– Persistent sad, hopeless or empty mood
– Loss of interest in activities
– Changes in appetite and sleep habits
– Lack of energy, fatigue
– Difficulty concentrating, making decisions
– Feelings of guilt, worthlessness
– Thoughts of suicide, suicide attempts
People with diabetes and depression need treatment for both conditions through medications and/or therapy. Treating depression can help improve adherence to diabetes treatment plans.
Anxiety
It is very common for people with diabetes to have elevated symptoms of anxiety. Estimates indicate around 30% of individuals with diabetes meet the criteria for an anxiety disorder.
Causes of anxiety include:
– Stress of managing a chronic illness
– Worry about short and long-term complications
– Fear of hypoglycemic episodes
– Feeling overwhelmed by the demands of diabetes
Anxiety related to hypoglycemia is particularly common. People may become preoccupied with avoiding low blood sugars. This fear can develop into hypoglycemia phobia, an intense and irrational fear of hypoglycemia leading to maladaptive behaviors.
For example, someone with hypoglycemia phobia may intentionally keep blood sugars high to avoid a hypoglycemic episode at all costs. However, prolonged hyperglycemia also has risks. Finding balance is key in diabetes management.
Generalized anxiety disorder and panic disorder are more prevalent in people with diabetes compared to the general public. Symptoms include excessive worry, restlessness, muscle tension, panic attacks, and avoiding situations that could trigger hypoglycemia.
Obsessive compulsive disorder and post-traumatic stress disorder related to traumatic hypoglycemic events or other aspects of living with diabetes also occur. Effective therapy and medications are available to treat anxiety disorders.
Signs of anxiety include:
– Excessive fear about hypoglycemia
– Avoiding behaviors to reduce hypoglycemia anxiety
– Panic attacks related to low blood sugar
– Generalized persistent worry
– Obsessive thoughts about diabetes management
– Muscle tension, restlessness
– Distress in social situations related to dealing with diabetes
Disordered eating
The need to balance food intake, physical activity and medication when you have diabetes puts people at increased risk for developing eating disorders or disordered patterns of eating.
It is estimated eating disorders impact about 1 in 10 women with type 1 diabetes. Rates in men are lower. For people with type 2 diabetes, rates of eating disorders are similar to the general population.
Examples of disordered eating patterns that may develop include:
– Binge eating – Consuming large amounts of food while feeling loss of control
– Insulin restriction – Limiting insulin doses to promote weight loss
– Dieting – Severe restriction or avoidance of carbohydrates
– Bulimia behaviors – Bingeing and purging
– Orthorexia – Obsessive focus on eating in a healthy manner
Such behaviors can negatively impact blood sugar management and diabetes health outcomes. However, people may engage in these patterns in an attempt to gain control over a disease that imposes rigid dietary structure.
Psychological treatment is needed to promote healthy eating habits and improve blood sugar regulation. People who restrict insulin or binge and purge are at particularly high risk for deadly consequences.
Coping strategies
It is clear diabetes often takes a toll on mental health. However, there are many ways people can try to cope with the emotional challenges:
– Seek support from mental health professionals, support groups and diabetes education programs
– Make self-care a priority through healthy behaviors like exercise, sleep and stress management
– Identify and acknowledge feelings to prevent bottling up emotions
– Set small achievable goals for diabetes management and celebrate successes
– Maintain open communication with healthcare providers about struggles as well as accomplishments
– Connect with supportive friends and family members who listen non-judgementally
– Consider therapy dog or emotional support animal to reduce stress
– Try mindfulness, meditation or breathing exercises to calm anxiety
– Limit negative self-talk and instead practice positive affirmations
– Maintain sense of normalcy in life with valued activities and social connections
While diabetes inevitably causes some emotional distress, developing healthy coping strategies and maintaining open communication with medical providers can help foster positive mental health.
Conclusion
Diabetes frequently takes both a physical and emotional toll. Dealing with the daily management, fear of complications, stress, and other struggles can contribute to emotional problems like distress, depression, anxiety and disordered eating patterns.
However, there are many supportive resources and professionals available to help people cope with the behavioral health aspects of diabetes. Taking steps to foster mental well-being is just as important as managing the physical components of diabetes. Addressing emotional health and embracing diabetes support systems leads to better overall health.