Editor’s note: This is the 10th article in AFMC’s diabetes series. It focuses on understanding the emotional side of diabetes.

Diabetes is a long-term, complicated and demanding disease. A normal and expected part of having diabetes is feeling stress, frustration, anxiety or even depression. Getting a diagnosis of diabetes challenges you to face new limits on what you can do. It takes time to adjust to this new reality. Some people are in denial about their diagnosis. Feeling anxious about treatments and outcomes is normal. Many people who are newly diagnosed with diabetes say they experience a roller coaster of emotions.

Researchers have found that treating diabetic patients’ emotional health is as important as treating their physical needs. By including mental status as a part of your general diabetes care, you can learn to talk about emotional issues and adopt coping techniques. Recognizing diabetes’ emotional stressors can help keep the disease under control and lessen your chance of complications.

Diabetes increases emotional response

In the United States, people with diabetes are twice as likely as the average person to have depression. When a person is depressed, it changes the way the body functions and has a negative impact on physical health. Symptoms of depression can increase your risk of getting diabetes or worsen diabetes symptoms. For example, overeating due to stress or depression may cause weight gain, a major risk factor for diabetes. Being overweight can cause fatigue or feelings of worthlessness. This, in turn, may cause you to ignore your diet and the diabetes-control medications you need.

The National Institutes of Health say that having diabetes increases your risk for depression, and can worsen depression symptoms. The stress of managing diabetes every day and the effects of diabetes on the brain can contribute to depression. Extremely high blood sugar (glucose) levels also have an impact on the brain’s ability to function, called cognition.

Mental health affects diabetes risk

At normal levels, cortisol – the primary stress hormone – supports health. But at higher levels it increases blood glucose that’s associated with diabetes. Stress alone can change blood glucose levels and your body’s ability to control blood glucose, thus increasing your chance of getting type 2 diabetes. In a 13-year study of 5,300 workers, ages 29 to 66 years, who were under a lot of pressure on the job and felt they had little control over their work, researchers reported their risk of developing type 2 diabetes was 45 percent higher.

A 2016 study from Rice University explains a link between emotional stress and type 2 diabetes. Researchers believe the connection is caused by how the brain controls anxiety. Anxiety is controlled by the brain’s “executive function,” which includes working memory, attention, reasoning, inhibition, planning and problem solving. Stress and anxiety can cause inflammation in the body, thus increasing the risk of getting diabetes.

If you already have diabetes, then depression, anxiety and poor stress management skills generally mean poorer control over diabetes. These emotional issues can make it more likely that you will be overweight, get less exercise, and have poorer control of your blood glucose.

People with diabetes and depression have more severe symptoms of both diabetes and depression than people who have diabetes but are not depressed. They also have higher rates of work disability and use more medical services than those who have diabetes alone, according the National Institute of Mental Health.

What is depression?

Many of the symptoms of clinical depression and diabetes are the same, making it difficult to determine exactly what is going on – diabetes, depression or both.

Major or clinical depression is defined as having five or more of these symptoms for more than two weeks:

  • Feeling sad, irritable or anxious
  • Feeling empty, hopeless, guilty or worthless
  • No interest in doing things you used to enjoy, such as hobbies, activities, even intimate relations
  • Fatigue and decreased energy, feeling listless, slowed down or restless
  • Trouble concentrating, or staying focused, remembering details and making decisions
  • Not being able to sleep or sleeping too much; waking up too early
  • Eating too much or not wanting to eat at all, possibly with unplanned weight gain or loss
  • Thoughts of death, suicide or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause, and/or that do not ease even with treatment

Sources of diabetic distress

Most people with diabetes are not clinically depressed. However, they are more likely to have emotional issues that are directly related to having diabetes or worrying about it. This is called diabetes distress. More than 40 percent of people with diabetes have a high-to-moderate level of distress; at lower levels of distress it increases to 65 percent.

Diabetes distress can come from three sources:

  • Diabetes itself – managing the disease takes time and commitment; frustration with the results is common
  • Other life stressors influence how you manage your diabetes
  • Spikes in distress can be caused by having to start a new medication or getting a new complication

Treatment options can help

When you visit your doctor, always tell someone on your health care team how you are feeling emotionally. Are you unhappy? Do you feel angry? Are you frustrated because your blood glucose level is too high? How you feel drives what you do. If you’re depressed, it’s unlikely that you will be doing diabetes self-management tasks (such as taking your medications, eating right and getting regular exercise) as well as you should. Depression affects your ability to carry on with daily life and enjoy work, leisure, friends and family.

Do not ignore depression or other emotional issues as something you cannot change. Effective treatments are available. Rice University researchers list several effective ways to help combat anxiety, depression or stress that often accompany diabetes:

  • Mindfulness therapy helps you learn to focus on the present, rather than worry about past problems
  • Cognitive behavioral therapy, or talk therapy, helps you change negative thinking and behaviors, such as excessive worry about your illness
  • Interpersonal and other types of time-limited psychotherapy
  • Antidepressant medications include SSRIs and SNRIs
  • Anti-inflammatory medications
  • Support groups
  • Electroconvulsive therapy (ECT) is generally reserved for the most severe cases of depression. However, newer brain stimulation approaches, including transcranial magnetic stimulation (TMS), can help some people. General anesthesia is not needed and it has few side effects.
  • Exercise, in addition to lowering stress levels, can also help normalize blood glucose levels

Anyone with diabetes knows that, on some days, managing diabetes can be frustrating and stressful. Feeling sad or depressed may make it harder to take care of yourself and harder to keep your blood sugar under control. Sometimes it’s too much to handle. Feeling down once in a while is normal. However, if you feel sad most of the time, don’t want to do things you once enjoyed, or feel tired on most days, then you may be depressed. Get help for your emotional issues along with your diabetes.