Diabetes and Mental Health

Is mental health pretty low on your list of priorities for managing diabetes? This may change your mind. Mental health affects so many aspects of daily life—how you think and feel, handle stress, relate to others, and make choices. You can see how having a mental health problem could make it harder to stick to your diabetes care plan.

The Mind-Body Connection

Thoughts, feelings, beliefs, and attitudes can affect how healthy your body is. Untreated mental health issues can make diabetes worse, and problems with diabetes can make mental health issues worse. Fortunately, if one gets better, the other tends to get better, too.

Depression: More Than Just a Bad Mood

Depression is a medical illness that causes feelings of sadness and often a loss of interest in activities you used to enjoy. It can get in the way of how well you function at work and home, including taking care of your diabetes. When you aren't able to manage your diabetes well, your risk goes up for diabetes complications like heart disease and nerve damage.

People with diabetes are two to three times more likely to have depression than people without diabetes. Only 25 to 50 percent of people with diabetes who have depression get diagnosed and treated. However, treatment—therapy, medicine, or both—is usually very effective. Without treatment, depression often gets worse, not better.

Symptoms of depression can be mild to severe and include

• Feeling sad or empty
• Losing interest in favorite activities
• Overeating or not wanting to eat at all
• Not being able to sleep or sleeping too much
• Having trouble concentrating or making decisions
• Feeling very tired
• Feeling hopeless, irritable, anxious, or guilty
• Having aches or pains, headaches, cramps, or digestive problems
• Having thoughts of suicide or death

If you think you might have depression, get in touch with your doctor right away for help getting treatment. The earlier depression is treated, the better for you, your quality of life, and your diabetes.

Stress and Anxiety

Stress is part of life, from traffic jams to family demands to everyday diabetes care. You can feel stress as an emotion, such as fear or anger; as a physical reaction, like sweating or a racing heart; or both.

If you're stressed, you may not take as good care of yourself as usual. Your blood sugar levels can be affected too—stress hormones make blood sugar rise or fall unpredictably, and stress from being sick or injured can make your blood sugar go up. Being stressed for a long time can lead to other health problems or make them worse.

Anxiety—feelings of worry, fear, or being on edge—is how your mind and body react to stress. People with diabetes are 20 percent more likely than those without diabetes to have anxiety at some point in their life. Managing a long-term condition like diabetes is a major source of anxiety for some.

Studies show that therapy for anxiety usually works better than medicine, but sometimes both together works best. You can also help lower your stress and anxiety by

• Getting active (Even a quick walk can be calming, and the effect can last for hours.)
• Doing some relaxation exercises, like meditation or yoga
• Calling or texting a friend who understands you (not someone who is causing you stress!)
• Grabbing some "you" time (Take a break from whatever you're doing. Go outside, read something fun—whatever helps you recharge.)
• Limiting alcohol and caffeine, eating healthy food, and getting enough sleep

Anxiety can feel like low blood sugar and vice versa. It may be hard for you to recognize which it is and treat it effectively. If you're feeling anxious, try checking your blood sugar and treat it if it's low.

There will always be some stress in life. If you feel overwhelmed, talking to a mental health counselor can help. Ask your doctor for a referral.

Diabetes Distress

You may sometimes feel discouraged, worried, frustrated, or tired of dealing with daily diabetes care, like diabetes is controlling you instead of the other way around. Maybe you've been trying hard but not seeing results, or you've developed a health problem related to diabetes in spite of your best efforts.

Those overwhelming feelings, known as diabetes distress, may cause you to slip into unhealthy habits, stop checking your blood sugar, even skip doctor's appointments. It happens to many—if not most—people with diabetes, often after years of good management. In any 18-month period, 33 to 50 percent of people with diabetes have diabetes distress.

Diabetes distress can look like depression or anxiety, but it can't be treated effectively with medicine. Instead, these approaches have been shown to help:

• Make sure you're seeing an endocrinologist for your diabetes care. They are likely to have a deeper understanding of diabetes challenges than your regular doctor.
• Ask your doctor to refer you to a mental health counselor who specializes in chronic health conditions.
• Get some one-on-one time with a diabetes educator so you can problem-solve together.
• Focus on one or two small diabetes-management goals instead of thinking you have to work on everything all at once.
• Join a diabetes support group so you can share your thoughts and feelings with people who have the same concerns (and learn from them too).

Talk to your health care team.

Your health care team knows diabetes is challenging but may not understand how challenging. You may not be used to talking about feeling sad or down. However, if you're concerned about your mental health, let your doctor know right away. You're not alone—help is available!