What influence does diabetes have on mental health?

Diabetes is an emotionally and physically demanding condition because patients must continually think about their disease management. 

Psychologically, patients affected by diabetes may tend to live with insecurity and in fact may: 

• Check their blood sugar too often
• Always be on the lookout for new diabetes-related complications
• Worry about the impact diabetes can have on their professional or personal lives

Diabetes can thus have significant impact on patients' emotional and mental well-being. 

How can diabetes influence a patient's mood?

Mental health problems are to be distinguished from psychological problems associated with diabetes. In most cases, these psychological issues are a direct result of the disease itself. 

To understand these psychological issues linked to diabetes, researchers conducted a study in 17 countries, in which they examined diabetes and its relationship with depression. The concept of "diabetes distress" emerged from this study. 

The research identified three main emotional problems caused by daily life with diabetes:

• Anxiety: This is often related to the fear of hypoglycemia and diabetes-related complications. Hypoglycemia is a phenomenon that occurs when blood sugar levels drop dangerously low. This unsettling experience usually leads to a lot of worry and anxiety. 
• Dysphoria: This is manifested by feelings of apathy, dissatisfaction, discomfort, loss of interest or sadness. These feelings may be mild and temporary, but they can also be more severe and longer term. When dysphoria lasts, it can lead to major depressive disorder. 
• Irritability: This may be caused by the demands of diabetes management and care, which can sometimes feel onerous. 

In addition, people affected by diabetes often have to make significant changes to their lifestyle. To do so, the patient has to come to terms with the disease and its related treatment constraints and mourn the loss of their former life. 

According to many studies, a majority of patients affected by diabetes experience, at one time or another, fears and negative feelings about the changes brought about by the disease. These negative feelings can lead to "diabetes burnout", one of the most serious psychological complications of the disease. 

What is diabetes burnout?

Living with diabetes is a daily challenge which can cause stress and lead to mental and physical exhaustion (burnout). This can lead to a vicious circle of loss of motivation and poor blood sugar management, which increases risk of diabetes-related complications and reduced quality of life. Diabetes requires constant involvement and mental and physical energy due to its daily self-management. 

To guard against diabetes burnout, here are some signs to watch out for: 

• Poor blood sugar monitoring
• Reduction or stopping of insulin injections
• Decreased attention to food
• Stopping physical activity
• A desire or even an attempt to ignore or forget diabetes.

There are many ways to prevent or treat diabetes burnout. It is important to accept and put a name to these negative feelings. Acceptance eventually leads to better well-being and renewed motivation. Likewise, it is important to do something every day that is not related to diabetes, such as seeing a friend or doing an activity just for yourself. 

What mental health conditions are linked to diabetes?

Unfortunately, the impact of diabetes on mental health is significant.  

The risk of developing depression is almost three times higher in patients with diabetes. Approximately 10% will experience severe depression, known as major depressive disorder. 

Similarly, generalized anxiety disorder is very common in people with diabetes. Indeed, the need to change one's lifestyle generally increases anxiety and worry. According to one study, about 14% of people with diabetes also have a generalized anxiety disorder.  

Finally, eating disorders are also more common in people with diabetes than in the general population. 

Several factors are involved in disordered eating behaviors: 

• Imposed dietary changes
• Blood sugar monitoring
• Strict control of meals
• Insulin-induced weight gain 

Mental health: How to maintain it when you have diabetes?

Overall, the recommendations for maintaining physical and mental well-being are the same for people with diabetes as for people without diabetes.  

Here are some recommendations: 

• Know and apply the principles of a healthy diet, but don't be afraid to indulge from time to time
• Maintain a regular sleep schedule, and get 7 to 9 hours of sleep per night, 
• Exercise regularly
• Do relaxation exercises such as meditation, yoga or deep breathing
• Seek social and medical support: It's important to talk about what is going wrong.
• Assert your needs and make time for diabetes management

Finally, do not hesitate to talk to your health care team about your psychological state. If necessary, psychological or psychiatric help can also be arranged to support you. 

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