Diabetes and Depression: How Mental Health Affects Disease Management

By Ashley Hattle

A diabetes diagnosis can upend your quality of life. You may find yourself having to track your blood sugar levels multiple times a day, dose out insulin, or pay attention to your meals in new ways.

There are several types of diabetes, including type 1, type 2, gestational, and latent autoimmune diabetes in adults, and each of these require daily management. Diabetes management doesn’t necessarily get easier the longer you have the condition. New and seasoned patients alike have a higher risk for depression, anxiety, diabetes distress, and diabetes burnout.

“A lot of people think that diabetes should get easier over time, but the truth is that for most people, there will be times during adult life when managing T1D [type 1 diabetes] becomes especially difficult,” says Caitlin Kelly, PhD, director of Outcomes Research at T1D Exchange, a nonprofit that promotes research and improved care and outcomes for those living with type 1 diabetes. “T1D management isn’t a straightforward path for many people. Instead, it’s filled with twists and turns.”

The role of stress

People with diabetes have higher rates of depression and anxiety. When they experience these conditions concurrently, managing either one can be more challenging—or even interrelated, with poor mental health increasing blood sugar levels and high blood sugar inducing emotional stress.

Diabetes management can be stressful. “Stress impacts diabetes significantly: it can be one of the biggest influences on blood sugars outside of food,” says Amanda Comstock, PsyD, a clinical psychologist who specializes in the treatment of people with diabetes and has type 1 diabetes herself.

Some patients find themselves obsessively tracking their carbohydrates, while others swing the opposite way and ignore every data point because they are overwhelmed, says Comstock. Both responses are a way of dealing with the extra stress.

It’s not about perfect numbers

People with diabetes are up to three times more likely to experience depression, yet only 25–50% of individuals living with both conditions have their depression diagnosed and treated, according to the Centers for Disease Control and Prevention (CDC). Individuals with diabetes also have a 20% higher risk of anxiety. Studies indicate therapy with or without medication can help improve mental health and, in turn, diabetes management.

This process may start with letting go of the idea of perfect blood sugar levels.

“If I can assist patients in recognizing that the information we receive [blood sugar numbers, A1Cs] are data points that simply provide us with information on how to proceed next in this disease, we can reduce the emotional distress and feelings of failure,” Comstock says. “Normalizing that there is no such thing as perfection in diabetes management is extremely important.”

Diabetes distress and burnout

Diabetes distress is a term commonly used in diabetes treatment—it involves experiencing negative emotions related to a diabetes diagnosis and the difficulty of self-management, according to the National Institutes of Health (NIH). The CDC estimates that 33–50% of patients experience diabetes distress in any given 18-month period.

“It may be related to a ‘mismatch’ in what a person feels they need to manage their diabetes well and the skills they currently have,” Kelly says.

People with diabetes may also experience “diabetes burnout,” which the NIH defines as feeling mentally and physically tired from the work needed to manage diabetes, sometimes resulting in caring less about self-management of the disease.

“It can often be associated with poor glycemic control and nonadherence to treatment,” says Comstock. “If one is experiencing mental health distress, it is likely that they may also be experiencing diabetes burnout.”

Finding and building a strong support system

It’s normal and healthy to feel angry or sad and ask, “Why me?” after a diabetes diagnosis. Dealing with these emotions is crucial for your long-term physical and mental well-being. It’s important to build a network of support you can trust by working with medical providers, including a mental health specialist, and educating your loved ones about your disease.

A clinical health psychologist or rehabilitation psychologist can be especially helpful for individuals with diabetes, says Melissa Geraghty, PsyD, a clinical health psychologist, Director of Mental Health and Support with the U.S. Pain Foundation, and CEO of Phoenix Rising with Dr. G. She also recommends looking for ways to “receive support and community from people who get it,” such as participation in the free peer-led support groups offered online through the U.S. Pain Foundation. To learn more, visit painconnection.org.

Comstock often hears patients, frustrated with the challenges of diabetes management, say they “don’t want to do this” anymore. They feel like they are failing because they are struggling to manage the condition, even years or decades after their diagnosis. A support system that allows you to talk about and process these concerns can lead to better mental health and diabetes management.

Living with diabetes can be overwhelming, whether you’re brand new to the diagnosis or have lived with the disease for 50 years. But “you are not alone, and you do not have to be alone in this journey,” says Comstock.

She adds, “While we want individuals to live a healthy life and meet their individualized treatment goals of diabetes, truly living a full and happy life is the goal.”