People with diabetes can experience mental-health issues like depression, anxiety and eating disorders. Here’s what you need to know about the emotional and mental impact of diabetes. 

Diabetes is a disease that can be a challenge physically and emotionally, both for those who have it and for family members. And people living with it have to manage the disease on a continuous basis.

In terms of physical health, having diabetes can lead to other health problems and complications. For example, the Centers for Disease Control and Prevention (CDC) says that adults with type 1 and type 2 diabetes may be at an increased risk for severe illness from the virus that causes COVID-19.

• COVID-19 and flu season: How to stay healthy and protect yourself

In terms of mental health, people with the disease may also live in a state of insecurity. This means they may:

• check their blood glucose excessively,
• always watch for possible complications and
• worry about the impact of diabetes on their personal and work lives.

Valérie S. Legendre is a clinical psychologist and Senior Mental Health Consultant in Group Life and Disability and Integrated Health Solution, Eastern Canada at Sun Life. Legendre notes that diabetes can play a huge factor in a person’s emotional and mental well-being.

Here, she looks at the psychological effects of diabetes and how they’re treated.

How does diabetes affect your mood?

Diabetes-related psychological issues need to be distinguished from mental-health disorders. Most diabetes-related psychological problems stem directly from the disease itself.

To understand these issues, researchers carried out a study across 17 countries looking at diabetes and its relation to depression.¹ What came out of the study was the concept of “diabetes distress.”

The study found three main emotional problems caused by living with diabetes – dysphoria, anxiety and irritability.

• Dysphoria refers to feelings of dissatisfaction, listlessness, loss of interest, unease and sadness. These feelings can be mild and temporary or more severe and long lasting. When dysphoria is intense and lasts long enough, it can lead to clinical depression.
• Anxiety, on the other hand, often revolves around fear of hypoglycemia and fear of complications. Hypoglycemia happens when blood sugar levels drop to dangerously low levels. It’s a distressing experience and can leave people with significant worry and anxiety, especially over the possibility of nocturnal hypoglycemia.
• Finally, the demands of diabetes management and care can make a person feel irritable. 

What is it diabetes burnout?

People who live with diabetes often have to make major lifestyle changes. Studies have shown that most people living with diabetes experience fear and negative feelings at some point.² This emotional burden can lead to “diabetes burnout,” which is one of the most serious psychological complications of diabetes.

Diabetes burnout can make people feel profoundly powerless and hopeless. Here are some warning signs to watch for:

• lapses in blood glucose monitoring,
• reducing or stopping insulin injections,
• not caring about nutrition,
• no longer exercising and
• ignoring or trying to forget about the diabetes.

On top of diabetes distress, current research shows that people with diabetes run a higher risk of mental illness than people without a chronic disease. There are several reasons for the increased risk, but here are a few to note:

• First, some studies show that treating mental illness with medication may help increase the risk of diabetes.
• Biochemical changes caused by mental illness itself may be another factor.
• Finally, like people suffering from mental illness, people with diabetes need to make significant lifestyle changes. This can have a negative impact on their general health.

What’s the link between diabetes and depression?

People with diabetes have a nearly 30% risk of suffering symptoms of depression. About 10% will experience severe depression, known as major depressive disorder.

Having to administer insulin is the most significant risk factor for developing depression, for all types of diabetes.

Other factors that increase the risk of depression in people with diabetes include:

• poor control of blood glucose,
• long-standing diabetes,
• poverty,
• lack of social supports and
• long-term complications.

In people whose main diagnosis is depression, there’s still a link with diabetes.

When a person is depressed, their risk of developing type 2 diabetes goes up by nearly 60%. People suffering from depression may be more inactive, overweight or experiencing stress – these are all risk factors for diabetes.

Can diabetes cause anxiety?

Having to make lifestyle changes due to diabetes can also increase a person’s anxiety and worry. For some people, this anxiety can become severe and invasive.

Anxiety disorders are a mental-health problem that occurs often in people with diabetes. According to one study, an estimated 14% of people with diabetes also have a generalized anxiety disorder.³ This percentage rises to 42% when a person has clinically significant symptoms of anxiety.

Can diabetes lead to an eating disorder?

Eating disorders are also more common in people with diabetes than the general population.

There are multiple factors that trigger, sustain and increase the risk of disturbed eating behaviour. These factors include:

• dietary changes,
• blood glucose monitoring,
• tight control over meals and
• weight gain caused by taking insulin.

In adolescents, type 1 diabetes appears to be a risk factor for diabulimia. It’s an eating disorder that is unique to people with type 1 diabetes. They may deliberately omit or reduce their dose of insulin in order to lose weight.

Night eating syndrome tends to occur in people with type 2 diabetes and symptoms of depression. Night eating syndrome can result in weight gain, poor control of blood glucose and increased diabetes complications.

• Is there a diet that can help prevent and manage diabetes?

Diabetes and mental health: Treatment options

People who are suffering from diabetes distress or from a psychiatric illness can talk to a health-care professional about their symptoms.

A qualified health-care professional can help treat mental-health problems. There’s also data that supports the use of cognitive behavioural therapies (psychotherapy) and antidepressants (pharmacotherapy), alone or in combination.

Medication only reduces psychological symptoms. So, for adults, psychotherapy is more likely to improve both psychological symptoms and blood glucose control than medication alone.

• What does a psychotherapist do? Here’s what you need to know before you see one.

For people with moderate depression, combining cognitive behavioural therapy with 20 minutes of daily cardiovascular activity can have a very positive impact on depression.

• Get moving to manage diabetes

The key to treating either diabetes distress or a psychiatric illness is making sure diabetes management is part of the treatment program for a positive impact on both conditions.

Do you have employee benefits at work? You can contact your Employee Assistance Program for support. Qualified professionals are there to help. You can also use your Health Spending Account if you need specialized medical equipment.

Remember, government health insurance doesn’t cover all health-care costs. That’s why it’s important to understand and take advantage of employer-sponsored health plans that you may receive at work.