November is National Diabetes Month, a time when communities across the country bring attention to the impact diabetes has on Americans – including the relationship between diabetes and depression.

A day in the life

Living with diabetes requires daily physical and emotional demands. The idea that diabetes can be managed simply by eating healthier and exercising more is a myth. Yes, eating nutritious foods and enjoying physical movement is good for the heart, soul, and for diabetes management; but there is so much more to living healthy with diabetes.

It’s a daily balancing act between all the things that raise blood sugar and those that lower blood sugar, including food, medication, alcohol, physical activity, and stress. Not to mention hormones, sleep, illness, hydration, altitude, insulin gone bad, and so much more. People with diabetes have to constantly sort through mixed messages around food choices. They have to navigate insurance coverage for frequent healthcare visits and diabetes supplies, which can be time-consuming, frustrating and expensive. The list goes on. It’s no wonder that diabetes increases a person’s risk for depression and other mental health issues.

“People with diabetes are 2 to 3 times more likely to have depression than those without diabetes.” – National Institute of Health

Mental health

There is a close link between diabetes and mental health. The constant need to manage diabetes tasks may lead to feelings of sadness, guilt, fear, anger, and depression. In fact, people with diabetes are 2 to 3 times more likely to have depression than those without diabetes, according to the National Institute of Health.

Since clinical depression is so deeply interconnected with diabetes, researchers now think it is a two-way relationship: People with diabetes are more likely to develop depression, and people with depression are more likely to develop diabetes. Read more at Diabetes Forecast.

If left untreated, poor mental health can worsen diabetes care and vice versa, according to the CDC. Unfortunately, mental health is often overlooked by healthcare providers, so it’s important to advocate for yourself, or enlist a family member to help discuss mental health concerns with your doctor.

Diabetes distress

Everyone who lives with diabetes is at risk for diabetes distress – a term used to describe the unique emotional issues related to the daily stressors and worries of living with diabetes. Diabetes distress is often associated with the thought of “I just can’t do this anymore.”  Symptoms may include feeling overwhelmed by the demands of living with diabetes; often failure in following a prescribed diabetes routine; feeling unsupported by friends and family; feeling angry, scared, and/or depressed about living with diabetes; and feeling that long-term complications of diabetes are inevitable.

Major sources of diabetes distress include:

  • Feeling powerless over one’s diabetes
  • Judgement from others
  • Managing diabetes in social situations
  • Worrying about severe low blood sugars
  • Stress around food and eating
  • Financial burden of diabetes care

Eating disorders

Diabetes also increases the risk of developing an eating disorder, a serious mental health disorder. In fact, individuals with type 1 diabetes have twice the risk of developing an eating disorder compared to those without diabetes, according to the Joslin Diabetes Center.

But it’s not just those with type 1 diabetes. Anyone living with diabetes can be at risk for developing an eating disorder. In diabetes treatment, counting carbohydrates, reading food labels, and weight control can reinforce eating disorder behaviors. Diabetes care will not improve until the mental health issues surrounding the eating disorder are addressed. Unfortunately, eating disorder symptoms are often overlooked or mistaken for “good diabetes” habits; thus taking longer to diagnose and delaying necessary treatment.

Finding hope and support in diabetes

People with diabetes live fulfilling lives every day. If you are feeling discouraged, tired of dealing with diabetes, or not seeing the results you hoped for, you are not alone. There are resources available and things you can do to take steps forward:

  • Focus on one small goal at a time
  • Join a support group in your area or online
  • Meet with a diabetes educator to help with problem-solving together
  • Contact your insurance member services, ask your doctor to refer you to a mental health counselor, reach out to Community Behavioral Health, or visit the Network of Care website.
  • Let people know how they can be supportive

Remember, diabetes can be unpredictable even with careful planning. If diabetes is affecting your mental health, let your healthcare provider know. Be reassured that it can get better with a supportive team to help you along the way.

Trish Lieberman MS, RD, CDE, LDN is a Registered Dietitian and Certified Diabetes Educator specializing in both the treatment of eating disorders and in diabetes care for type 1 and type 2 diabetes. Trish is passionate about helping empower individuals to develop a healthy relationship with food, body, and self.