Diabetes and Mental Health: Depression and Anxiety
Living with diabetes affects more than the body. Managing blood glucose every day, worrying about complications, and coping with changes in routine can take an emotional toll. Depression and anxiety are more common in people with diabetes than in the general population, and they can make diabetes harder to manage. The good news is that mental health conditions are treatable, and getting help can improve both how you feel and your diabetes. This guide explains the connections between diabetes and mental health, warning signs, and where to get support.
If you are thinking about harming yourself, call or text 988 to reach the 988 Suicide and Crisis Lifeline, or call 911.
How diabetes and mental health are connected
The American Diabetes Association notes that people with diabetes are more likely to experience depression and anxiety. The connection works in both directions:
- Diabetes can affect mood. The daily demands of diabetes care, fears about complications, financial stress, and physical symptoms can lead to emotional distress.
- Mood can affect diabetes. Depression can make it harder to eat well, be active, take medicines, and check glucose. It is also associated with higher blood glucose and a higher risk of complications.
- Biology may play a role. Researchers are studying how inflammation, stress hormones, and changes in the brain may link diabetes and depression.
- Blood glucose affects how you feel. Both high and low glucose can cause irritability, fatigue, anxiety, and trouble concentrating.
Depression
Depression is more than feeling sad for a day or two. According to the National Institute of Mental Health (NIMH), depression is a common but serious mood disorder that affects how you feel, think, and handle daily activities, with symptoms lasting at least two weeks. Signs include:
- Persistent sad, anxious, or "empty" mood
- Loss of interest or pleasure in hobbies and activities
- Feelings of hopelessness, guilt, or worthlessness
- Fatigue or decreased energy
- Difficulty concentrating, remembering, or making decisions
- Changes in sleep, such as insomnia or oversleeping
- Changes in appetite or weight
- Restlessness or slowed movement or speech
- Thoughts of death or suicide
Some symptoms of depression, such as fatigue and changes in appetite, overlap with symptoms of high blood glucose. That's one reason it's important to discuss how you feel with your care team.
Anxiety
Anxiety disorders involve excessive worry or fear that is hard to control. People with diabetes may feel anxious about complications, needles, or the future. Some develop a specific fear of low blood glucose, which can lead them to keep glucose higher than recommended. Symptoms of anxiety include restlessness, racing thoughts, muscle tension, trouble sleeping, and physical symptoms such as a fast heartbeat. Note that some symptoms of anxiety, like shakiness and sweating, can also be symptoms of low blood glucose. If you're unsure, check your glucose. See hypoglycemia.
Diabetes distress and burnout
Diabetes distress refers to the frustration, worry, and emotional burden specifically tied to living with diabetes. It is common and is different from clinical depression, though the two can overlap. When distress builds up over time, some people experience diabetes burnout and pull back from self-care. See diabetes burnout and stress and blood sugar.
Eating disorders
People with diabetes, particularly those with type 1 diabetes, have a higher risk of disordered eating. Some people intentionally restrict insulin to lose weight, which is very dangerous and can lead to DKA. Warning signs include unexplained high A1C, weight loss, repeated DKA, preoccupation with weight, and secretive eating. If you are concerned about yourself or a loved one, talk with a health care provider. See diabetes in children and teens.
Screening
The American Diabetes Association's Standards of Care recommend that diabetes care teams regularly screen for depression, anxiety, diabetes distress, and disordered eating. Screening often uses short questionnaires. If your provider doesn't ask, you can bring it up. Saying "I've been feeling down" or "managing my diabetes has been overwhelming" is a good start. See preparing for a doctor visit.
Treatment works
Depression and anxiety are treatable. Effective options include:
- Talk therapy (psychotherapy): Approaches such as cognitive behavioral therapy (CBT) help people change unhelpful thought patterns and build coping skills. Therapists familiar with diabetes can be especially helpful.
- Medicines: Antidepressants and other medicines can help. Some can affect weight or blood glucose, so your providers should coordinate. Tell every provider about all medicines you take.
- Collaborative care: Some clinics combine diabetes and mental health care in one team, which can improve both mood and glucose.
- Diabetes education and support: Learning skills and simplifying routines can reduce distress.
- Peer support: Talking with others who live with diabetes can reduce isolation.
MedlinePlus offers more information on depression and its treatment.
Self-care strategies
These steps can support mental health alongside professional care:
- Stay active. Physical activity can improve mood and blood glucose. See exercise and diabetes.
- Prioritize sleep. See sleep and diabetes.
- Connect with others. Reach out to friends, family, or support groups.
- Set small goals. Focus on one or two manageable changes at a time.
- Limit alcohol. Alcohol can worsen depression and affect glucose. See alcohol and diabetes.
- Practice relaxation. Deep breathing, mindfulness, and enjoyable activities can help.
- Be kind to yourself. Out-of-range glucose readings are information, not failures.
Supporting a loved one
If someone you care about has diabetes and seems depressed or overwhelmed, listen without judgment, offer practical help, encourage them to talk with a professional, and avoid "policing" their food or glucose. Learn the warning signs of suicide and know how to reach 988.
When to get help right away
Get help immediately if you or someone else:
- Has thoughts of suicide or self-harm
- Talks about wanting to die or being a burden
- Is skipping insulin on purpose or has signs of DKA
Call or text 988, or call 911.
Frequently asked questions
Does having diabetes mean I will get depression?
No. Many people with diabetes never experience depression. But the risk is higher, so it's worth paying attention to your mood.
Can treating depression improve my blood sugar?
Treating depression can make it easier to take care of diabetes, and some studies have found improvements in glucose when depression is treated together with diabetes.
Will antidepressants affect my diabetes?
Some can affect weight, appetite, or glucose. Your providers can choose medicines with your diabetes in mind and monitor you.
Who should I talk to first?
Your primary care provider or diabetes care team is a good place to start. They can screen you and refer you to a mental health professional.
Can low blood sugar feel like anxiety or a panic attack?
Yes. Low blood glucose can cause shakiness, sweating, a racing heart, and nervousness, which can feel a lot like anxiety. If you notice these symptoms, check your glucose first and treat a low if needed. If your glucose is in range and the feelings keep coming back, talk with your care team about anxiety.
Where can I find more reliable information?
Trusted sources include the CDC, NIDDK, MedlinePlus, and the American Diabetes Association. Be cautious with social media posts or products that promise quick fixes, and check new information with your care team before making changes.
Key takeaways
- Depression and anxiety are more common in people with diabetes, and they can make diabetes harder to manage.
- Symptoms lasting two weeks or more, such as low mood, loss of interest, and fatigue, deserve attention.
- Diabetes distress and disordered eating are also important to recognize.
- Therapy, medicines, and support are effective; tell your care team how you're feeling.
- In a crisis, call or text 988 or call 911.
Sources
Links to the sources cited above appear in the text. We rely on the Centers for Disease Control and Prevention (CDC), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the American Diabetes Association (ADA).
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- Diabetes in Older Adults: Goals, Safety, and Care
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