Diabetes Type 2 and Mental Health

Finding out that you have diabetes can completely change your life. Since diabetes management requires adjusting one's regular routine, getting a diagnosis of diabetes can feel like more than just a threat to someone's health; it can also feel like a threat to one's way of life. These sudden changes may affect your mental health, and if left untreated or neglected, can develop into depression or anxiety.

What is diabetes type 2?

Diabetes is a chronic condition that develops when either the pancreas does not generate sufficient insulin or when the body is unable to properly utilise the insulin that is produced. An inefficient response to insulin is the primary reason for type 2 diabetes, also known as non-insulin-dependent diabetes.¹ Type 2 diabetes accounts for about 95% of all cases of diabetes. Hyperglycemia, also known as high blood glucose or high blood sugar, is a typical complication of untreated diabetes that, over time, causes significant harm to many of the body's systems, particularly the neurons and blood vessels.^1,2 

Management of diabetes and mental health

Diabetes self-care involves 

• Careful monitoring of blood glucose levels 
• Taking medication on time 
• Maintaining weight 
• Taking a healthy diet 
• Exercising
• Decreasing alcohol consumption and tobacco (smoking)

Changes in blood sugar can lead to shifts in mood and other mental symptoms like tiredness, confused thinking, and stress. Experiencing these adjustments can be unpleasant, and you may begin to feel less energetic and emotionally drained to perform the necessary procedures involved in effectively managing your condition.

Patients with diabetes are more likely to be diagnosed with mood and anxiety disorders, as well as eating disorders. The poor rates of detection are one of the greatest obstacles in the management of mental problems in diabetic patients.³ 

This may lead to⁴

• Decreased quality of life, 
• Higher medical care costs, 
• Poor treatment tolerance, 
• Inadequate glycemic control (as demonstrated by raised HbA1c levels), 
• Higher rate of hospitalisation due to diabetic ketoacidosis, 
• An increase in absenteeism 

Young people with diabetes are particularly susceptible to mental health comorbidities as they undergo various transitions  (geographic, social, and between paediatric and adult treatment) which increase their risk of poor health outcomes.³ 

Depression

Depression is one of the most serious mental health complications that can occur alongside diabetes. It has recently been recognised as a distinct illness called diabetes distress.³ 

The risk of developing depression is two to three times higher in people with diabetes. Some diabetic patients may feel burdened by the self-care demands of the disease, including the fear of complications, diet maintenance, and regular physical exercise. Having doubts about their level of care and accountability in managing their diabetes can be distressing, which may lead to depression.

Health Anxiety

For some people, the stress of dealing with a chronic illness like diabetes can cause anxiety. Anxiety problems add difficulty to manage diabetes in daily life.  Hence, patients might experience the following:^3,4

1. Hypoglycemia- The symptoms of hypoglycemia sometimes coincide with those of major anxiety disorders, making it hard for a person with diabetes to tell the difference between anxiety and signs of low blood glucose that need immediate treatment.

2. Existing phobia- The development of severe anxiety or panic disorders is a potential complication of a diabetes diagnosis if the individual has a history of phobias or other anxieties such as needles or blood draws. Patients with diabetes often neglect their glucose monitoring and insulin dosing because of their anxiety and fear of needles. In extreme circumstances, hypoglycemia episodes can cause sweating, anxiety, tremor, tachycardia, and confusion.

3. Fear of hypoglycaemia- Some people with diabetes may keep their blood glucose levels over the recommended range out of fear of hypoglycemia.

4. Denial and uncertainty- may have trouble accepting a long-term diagnosis that requires constant self-management. This may result in a number of different emotional reactions, including depression, grief, denial, and avoidance.

Social anxiety

Modifying one's way of life and making necessary psychological and social adjustments are difficult but are essential components of managing type II diabetes. Patients may develop anxiety as a result of social embarrassment due to the difficulty of controlling their blood sugar levels and the need for sufficient care. Fatigue due to low blood sugar levels may also lead to lower productivity which may cause anxiety about job security.

Having diabetes has a profound effect on many people's social lives, especially when it comes to consuming alcoholic beverages. People experience anxiety when trying to cut back or abstain from alcohol, especially in social circumstances when they feel pressured to drink. In order to avoid the stress and anxiety associated with social situations (such as going to a bar or a wedding), many people avoid such events altogether.⁵

This further leads to a feeling of loneliness and depression in people with type 2 diabetes which could increase the prevalence of diabetic symptoms, frequent complications, severe pain, poor blood glucose control, lower quality of life, depressive mood, higher BMI, and more disability.⁶  

Dysregulated eating

Self-management can be hard to fit into a busy schedule. The patient may feel depressed, anxious, frustrated, or worn out from dealing with daily diabetes care, which may lead to the development of binge eating and poor eating habits.^3,7 This contributes to complications such as obesity, poorer glycemic control, higher hospitalisation and retinopathy rates, neuropathy, and premature death.^3,7

Delirium

Diabetic delirium may be the result of hypoglycemia episodes or diabetic ketoacidosis. Patients with diabetes may display either hypoactive or hyperactive delirium, characterised by a state of relative calm and low psychomotor activity or by excitement, rambling speech, and aimless wandering. Furthermore, delirium also causes disorientation, confusion, impaired sensorium, hallucinations, sleep/wake cycle disorders, and cognitive disturbance.⁴

The prognosis of delirium can be greatly improved if it is diagnosed soon. Managing the underlying cause while providing supportive care is the mainstay of treatment. 

If you’re worried about your or your loved one’s mental health

• Encourage them to schedule an appointment with their physician to discuss any issues they're experiencing with their condition. 
• Create a secure environment where your loved one can ask questions and receive answers without feeling judged.
• Learn more about how their personal experiences may be affecting their ability to self-manage their diabetes and its outcomes.
• Instead of trying to tackle everything at once, try focusing on just one or two small goals related to diabetes management.
• Sign up for a diabetes support group and meet up with others who are going through the same things as you are (and learn from them too).
• Consult a mental health specialist if you need counselling for your condition. 

Conclusion

Patients with type 2 diabetes have significantly higher rates of developing mental health problems. Accepting that type 2 diabetes is a chronic condition can bring on a wave of emotional distress for people with the disease. Diabetic distress symptoms, such as mood shifts or behaviour changes, may go unrecognised or misidentified. Self-management of the condition can be tiring and unpleasant, contributing to the development of diabetic distress. Therefore, it is essential for individuals to be aware of the mental health conditions for which they may be at risk and to receive all the support they require from their loving friends and family.