Diabetes and Mental Health

A diabetes diagnosis can be a life altering event. Whether it be type 1 diabetes where the body does not make any insulin at all or type 2 diabetes when the pancreas makes some insulin but not enough, it can mean changes to your lifestyle that you may not be ready for and can also be hard on relationships with friends or family. As you establish a new routine it is important to establish good habits in managing your mental health. Proper diabetes management requires awareness of your symptoms. Just as you take insulin to ensure your blood glucose levels are where they should be, it’s important to take measures to prevent mental health crises by being aware of how you are feeling mentally and emotionally.

Just like taking care of your body, taking care of your mind is equally as important to living a healthy life. When left untreated, mental health conditions like depression and anxiety can make diabetes worse. Likewise, existing diabetes can make mental health conditions worse.

How are diabetes and mental health connected?

A diabetes diagnosis can feel like not just a threat to health, it can also seem like a threat to a person’s way of life, because managing diabetes means making changes to your day-to-day routine. Your doctor might instruct you to change your diet by eating certain kinds of foods, avoiding sugary beverages, or restricting alcohol intake which can be difficult for anyone regardless of a diabetes diagnosis. Added responsibilities like tracking blood glucose and insulin can be hard to remember at first, doctors’ appointments can cause time away from work, and the costs of appropriate care may be burdensome. These changes can be emotionally draining, and you might start to notice that you are feeling a bit off or have very little energy left to carry out important tasks to managing your condition. 

• People living with type 1 or type 2 diabetes are at increased risk for depression, anxiety and eating disorders. [1]
• Rates of depression across the lifespan are 2 times greater for people with diabetes than in the general population.
• People with type 1 diabetes are twice as likely to live with disordered eating. [2]
• In women with type 1 diabetes, bulimia is most common eating disorder while women with type 2 diabetes are more likely to deal with binge eating. [2]

The fear of blood sugar fluctuations can be very stressful. Changes in blood sugar can cause rapid changes in mood and other mental symptoms such as fatigue, trouble thinking clearly, and anxiety.

Having diabetes can cause a condition called diabetes distress which shares some traits of stress, depression and anxiety. Unlike depression, diabetes distress can be linked back to causal factors related to diabetes. For example - fear of hypoglycemia or a very low level of blood sugar, may cause significant worry. Diabetes distress can also be affected by external factors like family and societal support and health care services. It is estimated that 33 to 50 percent of people with diabetes will experience diabetes distress at some point. [3] While diabetes distress cannot typically be treated with medication, experts say that improving diabetes management to reduce stress, talk therapy and support groups can be helpful.

Identification

One of the biggest challenges to treatment of mental health conditions for people with diabetes is low rates of detection. Up to 45 percent of mental health conditions and cases of severe psychological distress go undetected among patients being treated for diabetes. [4]

Diabetes treatment teams need to be aware of the mind-body connection and ensure whole person care. One way of doing this is by conducting regular screenings for mental health conditions during office visits.

It is estimated that only around 1/3 of people with diabetes and mental health conditions receive a diagnosis and proper treatment. [5] This may be because the signs and symptoms that people experience when their blood sugar is too high or too low can be confused for depression or anxiety. People with diabetes also may face stigma in talking about their feelings of depression and tend not to talk about them at appointments.

The American Diabetes Association standards of care recommend that treatment teams be complete with a mental health professional with expertise with the disease, and for people to be regularly screened. However, the reality is that few diabetes clinics provide mental health screening or integrate behavioral health services. That’s where online screening can help. Mental health screens are a quick, easy way to figure out if what you are feeling could be a mental health condition.

Feel like something’s not quite right? Take a screen here.

Treatment and Therapies

Mental health conditions - just like diabetes - are treatable. Having both at the same time doesn’t make either one less treatable, they just require different treatments. Ask your diabetes care team about a referral to a mental health care provider like a psychiatrist, psychologist or therapist. Together, your doctors can help you find a treatment plan that works for your mind and body to be as healthy as possible.

Therapy

Therapy is an extremely helpful treatment option and people with and without mental health conditions can benefit from it. Talk therapy is not only for discussing your problems, it is also for finding solutions. Professionals can help you work through the many things that may be causing you stress, understand your mental health condition and identify triggers that may make things worse and learn coping skills. Common types of therapy include:

• Cognitive-behavioral therapy (CBT). CBT has two main aspects. The cognitive part works to develop helpful beliefs about your life. The behavioral side helps you learn to take healthier actions. CBT often works well for depression, anxiety and bipolar disorder, but it can also be used for other various conditions.
• Family therapy helps family members communicate, handle conflicts and solve problems better. Forms of family therapy often are used for treating eating disorders and bipolar disorder.
• Dialectical- behavioral therapy (DBT) focuses on teaching skills in four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Learn more about different kinds of therapy here.

Medication

In addition to therapy, there a number of different medications that can help. When deciding on a mental health treatment plan involving medication, talk to your mental health care provider about your family history of mental health and your own diabetic condition.

Some evidence suggests that antidepressants like SSRI’s may help control blood sugar for people who already have type 2 diabetes. In fact, one study found that taking antidepressants is linked to 95 percent higher odds that a person with diabetes’ blood pressure will be controlled. [6] Other research suggests that taking tricyclics and SSRI’s may increase your chances of developing diabetes due to side effects of weight gain.

Stress Management

A diabetes diagnosis can cause prolonged stress which may possibly cause a rise in blood sugar. Stress can also make following your diabetes maintenance routine more difficult. Experts suggest looking for patterns; be aware of your stress level each time you log your blood sugar and see if a pattern emerges. If you notice a pattern, you can learn to spot your stress warning signs and take action to prevent stress and keep your blood sugar low. This may mean working with a professional to learn relaxation and coping techniques.

Just as diabetes therapy must be reviewed and adjusted frequently in order to find a long-term solution to care, finding the right mental health treatment can take time and be a process of trial and error. Like with many other chronic conditions, the sooner you get help, the better. 

Sources

1 Ducat, L., Philipson, L. H., & Anderson, B. J. (2014). The mental health comorbidities of diabetes. JAMA, 312(7), 691–692. doi:10.1001/jama.2014.8040 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439400/ 

2 Eating Disorders. (n.d.). Retrieved from http://www.diabetes.org/living-with-diabetes/treatment-and-care/women/eating-disorders.html

3 Fisher, L., Polonsky, W. H., Hessler, D. M., Masharani, U., Blumer, I., Peters, A. L.,. Bowyer, V. (2015). Understanding the sources of diabetes distress in adults with type 1 diabetes. Journal of Diabetes and Its Complications,29(4), 572-577.doi:10.1016/j.jdiacomp.2015.01.012 https://www.sciencedirect.com/science/article/abs/pii/S1056872

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4 Li, C., Ford, E. S., Zhao, G., Balluz, L. S., Berry, J. T., & Mokdad, A. H. (2010). Undertreatment of mental health problems in adults with diagnosed diabetes and serious psychological distress: the behavioral risk factor surveillance system, 2007. Diabetes care, 33(5), 1061–1064. doi:10.2337/dc09-1515 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2858175/

5 Ducat, L., Philipson, L. H., & Anderson, B. J. (2014). The mental health comorbidities of diabetes. JAMA, 312(7), 691–692. doi:10.1001/jama.2014.8040 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439400/

6 A, J., Lustman, J, P., Scherrer, F, J., Salas, . . . David. (2016, January 07). Antidepressant medication use and glycaemic control in co-morbid type 2 diabetes and depression. Retrieved from https://academic.oup.com/fampra/article/33/1/30/2450462