Diabetes is a chronic disease that is characterized by elevated blood glucose levels when our body either doesn’t make enough insulin, and/or it doesn’t use insulin well (i.e. insulin resistance). Without insulin, the cell remains locked, and glucose can’t get inside. The glucose remains in our blood and causes the high blood glucose (also known as high blood sugar) that we see in diabetes!

Diabetes is a global health concern.

1 in 10 individuals (537 million adults) were living with diabetes in 2021 and this number is expected to rise to 643 million by 2030 and 783 million by 2045.

But beyond its physical symptoms and complications, implications, diabetes has an impact on mental health. Let’s explore that in this article.

The Impact of Diabetes on Mental Health

Living with diabetes means being at risk of various complications, especially if one’s condition is poorly managed. Diabetes is a leading cause of kidney failure, blindness, lower limb amputation, heart attack and stroke. In Singapore, 1 in 2 people who had a heart attack had coexisting diabetes, and 2 in 3 new cases of kidney failure had diabetes.

That is why for many people, getting diagnosed with diabetes may often come as a shock and can be overwhelming — they can go through a range of emotional challenges such as feelings of sadness, depression, or poor eating habits.

Questions such as “How will this affect how I live my life?”, “Will I always be on medication?” or “How will this affect my loved ones” may be among the questions they ask themselves. 

One of the most significant sources of anxiety for individuals with diabetes is the fear of complications and the long-term consequences associated with the condition. Diabetes increases the risk of cardiovascular diseases, kidney problems, nerve damage, and vision impairment, among other complications. The persistent concern about potential health issues can contribute to a heightened state of fear and anxiety. 

Diabetes Impacting Mental Health

Individuals living with type 1 or type 2 diabetes are at higher risk for depression, anxiety, and eating disorder diagnoses. Unfortunately, these mental health disorders associated with diabetes will compromise adherence to treatment, increasing the risk for serious short- and long-term complications.

Diabetes Depression is Not Just a Bad Mood

Depression is a medical mood disorder that causes persistent feelings of sadness and often a loss of interest in activities you used to enjoy. It is characterized by sadness, emptiness, or an irritable mood, accompanied by somatic and cognitive changes that greatly impact the individual’s capacity to function at work and at home – including how you manage your chronic disease. 

If you are not able to manage your diabetes well, you increase your risk for complications such as cardiovascular diseases, kidney damage and vision impairment.

According to the CDC, people with diabetes are 2 to 3 times more likely to have depression than people without diabetes. But only 25% to 50% of people with diabetes who have depression are diagnosed and treated – without treatment, depression only gets worse.

Symptoms of depression can include:

• Feeling sad or empty

• Losing interest in what used to be your 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

Over the years, studies have shed light on the biological basis for the relationship between depression and diabetes. There is possibly a bidirectional relationship between type 2 diabetes and depression. This means that:

1. Type 2 diabetes increases the risk for onset of major depression, 

2. While, a major depressive disorder signals increased risk for onset of type 2 diabetes.

Stress and Anxiety

Everyday diabetes management – or being diagnosed with diabetes by itself – can be stressful. You can feel stress as an emotion such as anger, fear or panic; or as a physical reaction such as sweating.

If you are experiencing stress, it may be difficult for you to manage your condition as usual. This is because it can affect your immune system and your cardiovascular system, among others. In addition, hormones are released in response to stress which causes your blood sugar levels to rise or fall unpredictably. 

Meanwhile, anxiety is how your mind and body react to stress. People with diabetes are 20% more likely than those without diabetes to have anxiety. Symptoms of anxiety include feeling restless, agitated and irritable; getting tired easily; having trouble concentrating; muscle tension or knots; and difficulty sleeping or staying asleep. 

Diabetes Distress

Diabetes management is not easy and can be overwhelming. For some people, they may feel that diabetes is controlling them instead of the other way around. These overwhelming feelings, referred to as “diabetes distress” first entered the psychosocial research vernacular in 1995. It refers to “the negative emotional or affective experience resulting from the challenge of living with the demands of diabetes”.

Diabetes distress occurs because diabetes care involves self-management behavior, requiring behavioral and lifestyle modifications and monitoring, 24 hours a day and without rest days. 

Diabetes distress is a barrier to self-care and management among diabetes patients. It may cause patients to slip into unhealthy habits such as not regularly checking their blood sugar, skipping doctor’s appointments, or not caring about the food they eat. In the long term, it may lead to poor quality of life, or even unemployment. 

Understanding the mental health implications of diabetes is essential for providing comprehensive care – this may also include mood swings and fatigue. That is why it is important to have a holistic care model when it comes to diabetes management. By addressing both the physical and psychological aspects of diabetes, healthcare professionals can enhance the overall well-being of diabetes patients.

NOVI Magnum is our personalized, holistic diabetes management program. Get professional support and guidance from NOVI’s specialist doctors, dietitians and fitness coaches. The treatment plan will be personalized to you – from eating and exercise, to remote emotional support and guidance, to medication and supplements. Finally, you get ongoing remote support from our health team via our mobile app, to make it easier for you to keep on track, tweak your program as you progress, and help you stay motivated.

Mental Health Impacting Diabetes

On the other hand, some studies found that certain mental health conditions increase the risk of developing type 2 diabetes.

Depression Increases the Risk of Developing Type 2 Diabetes

Research revealed that young adults with newly diagnosed diabetes were 30% more likely to have had a previous history of depression compared with those without diabetes. The same study revealed that depression appears to increase the risk of developing diabetes by ∼23% in younger adults. 

A 2023 study funded by Diabetes UK, also demonstrated that people with depression have a higher risk of type 2 diabetes compared to people without depression. The study used a statistical method called Mendelian randomisation, a way of using the natural genetic variation which exists in a population to test whether there is a causal relationship between two factors. It also helps to separate out the effects of other factors that could influence any link between the two. The authors discovered that depression may directly increase the risk of developing type 2 diabetes and also identified seven genetic variants linked to both conditions – including variants near genes involved in insulin production and inflammation levels in the brain, pancreas and fat tissues. 

Stress Can Induce Diabetes

Don’t worry, stress by itself does not cause diabetes. However, there is some evidence that there may be a relationship between stress and the risk of type 2 diabetes.

Stress, whether acute or chronic, has a significant impact on the body’s metabolic function. When the body is stressed, the body prepares itself by ensuring that enough sugar or energy is readily available. This is the “fight-or-flight” response wherein  the levels of stress hormones such as glucagon, adrenaline (epinephrine), growth hormone, and cortisol levels rise. The resulting greater release of glucose from the liver, paired with reduced glucose uptake into body tissues such as muscle and fat, increases glucose levels in the bloodstream.   

For those without diabetes, the stress-induced blood sugar rise is followed by an increase in insulin secretion. The blood sugar rise here may be modest and temporary, but in the long-term, it may cause insulin resistance and lead to diabetes. 

However, for those with diabetes, stress can cause a significant and prolonged increase in the blood sugar level (hyperglycemia) as their bodies are either incapable of producing sufficient insulin or are insulin-resistant. 

How to Manage Your Mental Health with Diabetes

When you are feeling overwhelmed, or stressed, remember to look after yourself. We know it is not as easy as that, but it is those little things that matter. For example, if you are too busy at work, you may forget to eat on time or take your medication.

Getting enough sleep, building a healthy exercise routine, and allocating enough time for rest and relaxation helps some people cope better with stress and anxiety. 

Also be on the lookout for signs of depression and seek help early. Speak to your doctor so that your specialist can rule out medical causes of depression such as thyroid problems or side effects from some medications. 

Unfortunately, current diabetes care mostly focuses on the medical aspects of diabetes management. It is also important to address the nutrition, fitness and support needs of the patient. Addressing the psychosocial needs of diabetes patients, among other aspects, results in better glycemic control and improvement on diabetes outcomes.

Learn about Brandem’s journey, and how he overcame diabetes with medication, and lifestyle modifications.

With the NOVI Magnum program, you will have your own care team. Your doctor and health coach will take the time to understand your goals, health status and current lifestyle during your first meeting so they can personalize the care you receive. Further, you will get continuous messaging support and reviews by your coach and doctor remotely and build healthier habits with the right support team before you know it.