How Diabetes Impacts Mental Health

Diabetes is a condition where the body’s blood sugar levels are higher than normal because the body either doesn’t produce enough insulin or can’t effectively use the insulin it does produce. When people think about diabetes, they often focus on physical symptoms like frequent urination and the daily challenge of monitoring blood glucose levels. But diabetes profoundly impacts the mind as well as the body. Physiological changes in the brain and the emotional strain of living with a chronic illness can impact the mental health of people living with diabetes. Understanding the relationship between diabetes and mental health is key to providing more comprehensive care and improving quality of life.

The Brain and Blood Sugar

The brain is the most energy-demanding organ in the body, using roughly 20% of our daily glucose supply to function ^[1]. Glucose is its primary fuel source, and stable blood sugar levels are essential for maintaining normal cognitive functions like memory, learning, attention, and emotional regulation.

People living with diabetes are at risk for having blood sugar levels that are too high (hyperglycemia) or too low (hypoglycemia), sometimes fluctuating unpredictably. These shifts can cause temporary confusion, dizziness, fatigue, and irritability. Eventually, persistent hyperglycemia can damage blood vessels, including those supplying blood to the brain. Reduced oxygen delivery and impaired neurological function often follow, which can lead to long-term cognitive issues.

Even short-term changes in glucose levels can make a big difference in brain functioning. For example, hypoglycemia can cause symptoms that resemble anxiety or panic, while hyperglycemia may lead to difficulty concentrating or sluggish thinking. These subtle yet disruptive effects are a daily reality for many people living with diabetes and show the ongoing relationship between blood sugar and brain health.

Diabetes and Depression

“Depression is the elephant in the room that we need to acknowledge in people with diabetes.”

— Dr. Betul Hatipoglu, Medical Director of the Diabetes and Metabolic Care Center at University Hospitals Cleveland Medical Center ^[2]

Depression, or major depressive disorder, is one of the most common mental health challenges faced by people with diabetes. Research shows that people living with diabetes are nearly twice as likely to experience depression compared to the general population ^[3]. Moreover, depression can increase the risk of developing diabetes, and diabetes can increase the likelihood of experiencing depression.

There are both biological and emotional reasons for this relationship. Fluctuating blood sugar levels may affect neurotransmitters that regulate mood. One of these is serotonin, which helps regulate mood and process emotions. Another is dopamine, which deals more with pleasure and motivation. Additionally, chronic inflammation and insulin resistance, which are common in diabetes, are linked to increased rates of depression ^[4].

The emotional burden of living with diabetes also plays a significant role. Living with a chronic illness involves daily decision-making, planning, and a constant awareness of long-term risks. Over time, this can lead to emotional exhaustion and symptoms of depression.

Fortunately, effective treatments exist. Counseling, medication, and lifestyle changes have been shown to improve both mood and metabolic control. Healthcare providers should regularly screen for depression in people living with diabetes and provide resources to address both physical and emotional needs ^[5].

Cognitive Decline and Dementia

Diabetes is linked to an increased risk of cognitive decline and dementia ^[6]. Several factors are thought to underlie this connection. High blood sugar levels over time can damage the brain’s blood vessels, increasing the risk of stroke and impairing cognitive function. Also, insulin resistance may interfere with brain signaling pathways. This contributes to the buildup of beta-amyloid plaques, which are a key feature of Alzheimer’s disease ^[4]. In fact, Alzheimer’s is sometimes called “type 3 diabetes” because of the way insulin problems affect the brain.

Cognitive changes in people living with diabetes are often subtle at first. People may misplace items, forget appointments, or have trouble concentrating. But as these changes progress, people are more likely to experience memory problems, slower processing speeds, and difficulties with problem-solving. Recognizing and addressing these changes early is key to preserving brain health ^[7].

Diabetes and Delirium

Delirium is an acute, sudden change in mental status marked by confusion, disorientation, and changes in alertness and behavior. It is more common among older adults and people living with chronic health conditions like diabetes. Delirium is usually thought of as an emergency that follows a hospitalization, infection, or surgery. While these are all real scenarios, delirium can result from poorly managed blood sugar too ^[8].

Hypoglycemia, in particular, can quickly lead to altered mental states, especially in older people or those taking insulin or certain oral medications. Hyperglycemia can also spur on delirium, especially in cases of diabetic ketoacidosis. This condition involves a surplus of ketones, which are chemical by-products made when the body breaks down fat for energy. More ketones are produced when insulin is low and glucose can’t be used. When ketones build up in the blood, it becomes acidic and disrupts normal brain function.

Delirium is not only frightening but potentially life-threatening. Higher mortality rates, longer hospital stays, and an increased risk of long-term cognitive impairment are all tied to delirium. Unfortunately, delirium is often misdiagnosed as conditions such as dementia or simply “old age.”

Prevention and early treatment of delirium are critical. Proper blood sugar control, careful management of medications, and awareness of early symptoms like sudden confusion can help lower the risk of delirium.

Diabetes and Anxiety

Anxiety and emotional exhaustion are common yet often hidden aspects of living with diabetes. These psychological burdens can interfere with diabetes management and overall well-being. Some factors that contribute to diabetes-related anxiety include:

• Worries about Blood Sugar: Constant monitoring of blood glucose levels can create ongoing anxiety, especially when levels are unpredictable. Fear of sudden highs or lows can lead to obsessive checking or avoidance behaviors.
  
• Fear of Complications: Many people living with diabetes worry about long-term complications such as neuropathy, kidney disease, or vision loss. These concerns can lead to feelings of dread, especially when tied to past experiences or stories of others’ struggles.
  
• Burnout: The daily tasks of diabetes care, such as measuring blood sugar, planning meals, and taking medications, can become overwhelming. The accumulation of these responsibilities can lead to emotional fatigue and isolation.
  
• Social Stigma: Some people feel embarrassed or judged for having diabetes, especially when they have to use insulin in public or explain dietary restrictions. This can contribute to social anxiety disorder and avoidance of social activities.
  
• Information Overload: Conflicting information about diabetes can overwhelm people trying to make informed choices. Fear of doing something “wrong” may increase stress about the ability to manage diabetes.
  
• Lack of Support: Feeling unsupported by healthcare providers, family, or friends can worsen anxiety. People living with diabetes experience a significant emotional toll when they feel alone in managing their condition.

Addressing these emotional challenges through counseling, support groups, and stress-reduction strategies can make a meaningful difference in reducing anxiety and restoring a sense of balance.

Mental Health Support and Diabetes Care

Given the psychological impact of diabetes, mental health care should be an essential part of diabetes management. Unfortunately, mental health care is often overlooked in diabetes treatment plans, which tend to focus more on physical symptoms and lab results ^[5].

Healthcare providers should routinely screen for mental health concerns, including depression, anxiety, and cognitive decline. This is especially important for people with a new diagnosis of diabetes, those with poor blood sugar control, or people experiencing complications.

Evidence-based therapies like cognitive behavioral therapy (CBT) can be effective in helping people living with diabetes manage depression and anxiety. Mindfulness practices, stress-reduction techniques, and peer support groups can also provide valuable tools for managing emotional health.

Recognizing the mental health challenges of living with diabetes is critical. By providing comprehensive care that addresses both mind and body, healthcare teams can empower people living with diabetes to lead healthier, more fulfilling lives.

A Holistic Approach to Diabetes

Diabetes is about more than blood sugar. Diabetes affects the whole body, including the brain and its cognitive and emotional processes. From depression and anxiety to cognitive decline and delirium, the mental health effects of diabetes vary widely and can significantly affect day-to-day life.

Recognizing the connection between mental health and diabetes allows a more holistic, compassionate approach to care. Mental health support should be seen as a core part of diabetes management along with healthy eating, exercise, regular checkups, and medication when necessary.

People living with diabetes can seek out resources to help them advocate for comprehensive care that addresses both the visible and invisible challenges they face. The American Diabetes Association offers local chapters across the country where people living with diabetes and their caregivers can find support and information. And those who feel they need professional support to address mental health challenges are encouraged to find a therapist knowledgeable about the connection between mental health and chronic disease.

While the challenges of diabetes are significant, they are not insurmountable. With growing awareness of how diabetes impacts mental health, people are better equipped to address the full scope of this condition. By embracing mental health alongside physical health, people living with diabetes can find strength and hope in their journey toward a more balanced, empowered life.