The Psychological Impact of Diabetes

Diabetes is a long term health condition that affects around 4.4 million people in the UK, with new diagnoses happening all the time. There are two types of diabetes, type one and type two and according to NHS data, around 9 in 10 people living with diabetes have type two. Both type one and type two diabetes can result in life changing complications.

If you have type one diabetes your pancreas is unable to produce the hormone insulin that is needed to break down glucose in the blood. This can lead to dangerously high blood sugar levels that have to be treated with insulin injections. Although type one diabetes can be managed with insulin it cannot be cured.

The vast majority of people who have diabetes in the UK will have type two diabetes. Type two diabetes is linked to being overweight, having a poor diet and living a sedentary lifestyle. If you have type two diabetes, your pancreas is not making enough insulin or the insulin your body produces is not working as it should be. Some cases of type two diabetes can be put into remission by losing weight and making positive lifestyle changes.

Diabetes is a leading cause of many serious, preventable health conditions including strokes, heart problems and kidney disease. Although the physical issues associated with diabetes are widely understood, the psychological and emotional stress of having diabetes is not talked about enough.

Having diabetes requires daily checks and management and can significantly interfere with a person’s routine, often leading to increased stress levels. There is a growing amount of evidence that suggests a strong correlation between diabetes and poor mental health, including depression, anxiety and burnout. In this article we will look further into the psychological impact of diabetes and suggest some strategies for coping.

Common Psychological Impacts of Diabetes

Our mental and physical health are inherently interconnected. Untreated mental health problems can make diabetes symptoms worse and having diabetes can exacerbate existing mental health issues, leaving us stuck in a vicious cycle.

According to charity Diabetes UK, as many as 40% of people diagnosed with diabetes report struggling with their psychological wellbeing post-diagnosis.

Some of the common psychological impacts of diabetes include:

• Stress and anxiety
• Diabetes burnout
• Depression
• Guilt and self-blame

Stress and anxiety

To manage the condition, you may have to regularly monitor your blood sugar levels using pinprick tests, administer insulin or other medications and take special care with your diet including reading nutrition labels and controlling your sugar, fat, salt and calorie intake. This can lead to significant feelings of panic, stress and anxiety about the condition.

Diabetics often begin to worry about having complications such as hypers (spikes in blood sugar levels) and hypos (sudden drops in blood sugar levels) or feel that they are not managing the condition adequately. Stress hormones can cause fluctuations in blood sugar levels that can worsen symptoms. Additionally, long-term stress can impact your immune system which may lead to future health problems.

A diabetes diagnosis may sometimes make people feel like they have lost control over their day to day living. Sometimes people may overcompensate for the changes that diabetes has made to their lives by trying to control every aspect of their life, which may lead to symptoms of obsessive compulsive disorder (OCD) or complete burnout.

Diabetes burnout

Some people with diabetes may experience emotional fatigue and burnout due to the daily demands of diabetes management. Burnout is a term used to describe feeling completely overwhelmed, exhausted and worn out, which is not uncommon amongst diabetics.

People with diabetes who are struggling to stay on top of their condition, or their weight, may become despondent or frustrated. When you have a chronic condition, it is important that you stick to your treatment plan and if it feels like it is not working, you should see your GP as soon as possible before making any big changes.

Depression

The relationship between depression and diabetes is a complex one. Some research suggests that people with diabetes may be up to three times more likely to experience depression than those without.

According to the Centre for Disease Control (CDC) only 25% to 50% of diabetics with depression seek help to have their depression diagnosed and treated.

Common symptoms of depression include:

• A persistent low mood
• Feelings of sadness and hopelessness
• Loss of interest in daily life or hobbies
• Problems sleeping

Depression can also cause tiredness and a general lack of motivation which may cause people to neglect their self-care, which may mean they are less likely to engage in proactive behaviours to manage their diabetes such as checking their blood sugar, eating healthily or staying active.

Like diabetes, depression can usually be treated using a combination of medication and lifestyle changes. Some people find attending therapy sessions or counselling can also help them to deal with their mental health.

Guilt and self-blame

Some individuals, especially those with type two diabetes, may blame themselves for developing the condition. This can lead to feelings of guilt and shame for their diagnosis and they may fail to acknowledge that a range of factors may be responsible for them developing diabetes.

If you have diabetes and find yourself feeling guilty or shameful, it is better to focus on becoming healthier and losing excess weight, rather than focusing on past mistakes. To do this you should try to set small manageable goals for yourself.

Stigma

As with many chronic health conditions, some people with diabetes may worry about stigma and judgement from others. This may lead them to become lonely and isolated as they feel that people do not understand or care about their struggles and may incorrectly label them as fussy, awkward or lazy.

Strategies for Coping with the Psychological Impact of Diabetes

If you have diabetes, it is important that you look after your mental wellbeing and mental health, in addition to your physical health. This includes making use of tools, strategies and interventions that can help to build resilience and help you to feel more in control and more positive.

Strategies to build emotional resilience include:

Accepting the condition – learning to accept the condition and adjust to your ‘new normal’ can reduce feelings of stress and unfairness and may improve your mental health.

Focus on what is in your control – by focusing on what you can control rather than panicking about what you cannot, you can start to reduce feelings of anxiety. The factors that you can control to manage your diabetes include your diet, medication adherence (taking the correct medicine as prescribed), engaging with medical professionals and following your treatment plan.

Encourage a growth mindset – people with a growth mindset may enjoy better mental health and increased resilience than those with a fixed mindset. A comprehensive study of 6,500 university students found that those with a fixed mindset were 58% more likely to show symptoms of anxiety, depression and aggression than their peers.

People with a growth mindset think I can and they strive to do better; people with a fixed mindset assume that they can’t change their current situation because everything, including their abilities, skills and behaviours, are already pre-determined.

A growth mindset can help people to improve their self-esteem, feel more confident and feel more able to cope with their struggles, which is especially helpful to people who have a chronic health condition.

Support networks are also vital in improving outcomes for people who struggle with their mental and physical health.

Tips to help connect with others and build a support system include:

Connecting with loved ones – it is important to speak openly with loved ones about how your diabetes makes you feel and what support you need. Your loved ones may be able to offer you help and support, a reassuring, listening ear or encourage you to make positive lifestyle changes such as joining you for an exercise class.

Joining support groups – joining a diabetic support group can help people to connect with others who understand and share similar struggles. Support groups are available both in person and online.

In addition to using self help techniques and seeking support from others, some people find they need to seek professional mental health support to help them make sense of their emotions and behaviours and find ways to cope. This may be in the form of therapy, counselling or taking medication, such as antidepressants:

Psychotherapy – talking therapy, such as cognitive behavioural therapy (CBT) can help us to identify unhelpful thoughts and learn to reframe them. With a condition like diabetes, it is easy to lapse into negative thought patterns of blame, overwhelm or anger about the condition. CBT can empower people with diabetes by teaching long-term techniques and strategies that can make them feel more in control and more positive. In turn this can improve emotional resilience and self-esteem.

Diabetes educators and counsellors – specialist diabetes educators are healthcare professionals who are specially trained to provide a mix of education, information, practical advice and emotional support to people with diabetes. They can suggest tips and strategies for coping, encourage self-care behaviours such as staying active and help with goal setting.

Diabetes educators can also work with at risk individuals to help them to make plans and employ strategies to improve their health that may reduce the chance of developing type two diabetes.

Medication for mental health – some people find that taking medication such as antidepressants helps to alleviate some of the symptoms of depression for them. Antidepressants can be used in conjunction with therapy or as a short term solution whilst waiting to access talking therapy. Antidepressants can cause side effects, including weight gain, which is important to take into consideration if you have diabetes.

Having diabetes can place people under significant stress and strain. Stress-busting techniques such as mindfulness, meditation and finding ways to relax can help us to feel calmer and more in control of our emotions.

Mindfulness and meditation – mindfulness is a technique that uses a special type of mental focus, allowing us to focus on the present and be aware of the moment without feeling overwhelmed. Mindfulness can be incorporated into other activities such as taking a mindful walk or doing some mindful colouring. Mindfulness can also be incorporated into meditation.

A very simple guide to meditation:

• Find a calm and quiet spot, indoors or outdoors – some people even meditate in the shower!
• Sit, kneel or stand in a comfortable position that you can maintain for a few minutes
• You may want to close your eyes or soften your gaze
• Start to focus on your body and how it feels and think about your breath and feel the sensation of your diaphragm as it rises and falls. Concentrate mainly on your breathing
• Pay attention to your thoughts and notice when your mind has wandered
• Don’t get lost in your thoughts, simply bring your focus back to your breath and being present in the moment
• Gently end the practice when it feels right for you. Take a moment to notice how your mind and body feels afterwards

Some people like to repeat a particular word or phrase (mantra) in their head as they meditate. Others like to stare at a mandala (a series of circular, interconnecting patterns) to help them to focus and tune out thoughts and negativity.

Both mindfulness and meditation techniques can help to reduce stress and improve emotional regulation which may help you to feel calmer and less stressed during challenging situations that arise due to having diabetes.

Deep breathing techniques – deep breathing techniques can help us to feel better both mentally and physically. Deep, rhythmic breathing increases our oxygen flow can help boost our circulation as well as helping us to feel more calm and less stressed.

Deep breathing can be done anywhere and needs no special equipment, making it an ideal technique when you are struggling and need a quick, mental boost.

Relaxation – relaxation techniques such as progressive muscle relaxation (PMR) or yoga are known to help to reduce stress, promote a sense of peace and calm and help with emotional regulation which can help us to manage stress and anxiety.

Taking breaks and self-care – whilst it is important to remain aware of your responsibilities regarding diabetes management, occasionally you may need to disconnect emotionally and give yourself a mental break. Take time to do activities that you enjoy such as socialising with friends, engaging with hobbies or interests or just chilling out at home with a good film.

Asking for adjustments – if you are struggling at work or school due to having diabetes, you can ask for reasonable adjustments to be made to make life easier. Don’t be afraid to reach out and ask for help or educate others about your condition to reduce judgment, stigma and to make your life easier. 

Using technology – technology can be harnessed to alleviate some of the overwhelm caused by diabetes in terms of scheduling, planning and setting reminders. There is enough to remember in day to day life with work, school and having a social life and diabetes creates the need to be increasingly organised and on the ball.

To help with the mental load you are carrying try using assistive digital tools such as:

• Setting reminders in your phone
• Using organisational apps
• Leaving yourself voice notes

The above can be used to remind you about doctor’s appointments, therapy sessions, blood sugar checks etc, to help you feel more in control and less overwhelmed.

The Importance of Integrating Mental and Physical Health in Diabetes Care

A holistic approach to diabetes management treats the whole person, rather than simply focusing on the symptoms of the condition itself. This allows for a person’s physical, emotional and mental wellbeing to be supported.

Diet and exercise play a pivotal role in diabetes management. Being overweight is a significant risk factor in developing type two diabetes and can make the symptoms of type one diabetes worse. Carrying too much weight can also make us feel down and impact on our self-esteem, causing us to feel less confident.

Tips to eat well with diabetes include:

• Eat a healthy balanced diet that contains plenty of fresh fruit and vegetables
• Don’t skip meals 
• Reduce sugar and salt intake
• Avoid ultra-processed foods and ready meals that are high in saturated fat

Exercise and being physically active is good for both diabetes and our mental health. Being physically active helps insulin to work better in the body (both naturally produced insulin and injected insulin). This can help keep blood sugar levels within target and may reduce insulin resistance. Regular exercise can also reduce the risk of developing complications related to diabetes, for example high cholesterol and cardiovascular disease.

Exercise is also great for our mental health as it releases endorphins (feel good hormones) which boost our mood. Exercise can also improve our blood circulation and oxygen levels, helping our brain to function better.

In additional to eating a healthy, balanced diet and staying active, sleep plays a key part in keeping us healthy, both mentally and physically. Being tired can make us sluggish, irritable, emotional and demotivated which can impact our mental wellbeing and make us prone to unhealthy coping mechanisms such as caffeine and sugary drinks. Too much caffeine and sugar can affect the way our body functions and cause spikes in blood sugar, which can be dangerous if you have diabetes.

Poor sleep over long periods of time can also lower our immune system and put us at a higher risk of developing diseases and health conditions that are also associated with diabetes, including obesity and cardiovascular disease.

A lack of sleep may also affect our memory which is risky for people with diabetes who need to adhere to a treatment plan and do routine blood tests, attend medical appointments and remember to eat at regular intervals.

Tips for a good sleep include:

• Maintain a routine of going to bed and getting up at roughly the same time each day
• Sleep in a calm, quiet area that is a comfortable temperature
• Switch from caffeinated drinks to herbal tea, such as relaxing camomile
• Avoid screen time just before bed
• Wind down before you get into bed by taking a hot shower or warm bath, meditating or doing some gentle stretching

It is important to talk openly with healthcare providers about your mental health and any struggles you are having with diabetes. Doctors, nurses and therapists can use their training, experience and expertise to provide useful advice and assistance to help with both your mental and physical problems.

Conclusion

A diabetes diagnosis can have a serious impact on both our physical and mental health. If you find yourself struggling with the emotional ups and downs that come with diabetes, it is important to seek help from others and to use self-help and self-care techniques to aid you to live well despite having diabetes.