The link between diabetes and mental health conditions

Diabetes is characterised by high glucose levels in the blood. It occurs when the body's ability to produce insulin - a hormone which allows the cells in your body to take in glucose - is impaired, or the effectiveness of the insulin produced is reduced.

People with type 1 diabetes are unable to produce insulin. It is unclear why, but it is unrelated to weight or diet - neither is it preventable. It affects around 8% of people with diabetes, and is the most common type amongst children and young adults. It is treated with daily doses of insulin via injection or insulin pump.

Around 90% of people with diabetes have type 2 - either their body doesn't make enough insulin, or the insulin it does produce is ineffective. People with this condition may have a family history of diabetes, or their chance of developing it is greater because of their age, lifestyle or ethnic background. It can always be improved with a healthy diet and increased physical activity, but usually tablets or insulin - sometimes both - are needed as well.

The remaining 2% of people have other types of diabetes - often related to other illnesses or medications.

'A bolt from the blue'

Managing the physical symptoms of diabetes can be all-consuming, and can affect every aspect of a person's life, including their emotional and mental health. This could range from day-to-day frustration and low mood to depression and anxiety, to living in fear of their blood sugar dropping too low and experiencing a hypo.

Nicki Hornby, 50, has had type 2 diabetes for 14 years. "It was very much a bolt from the blue. Anger and shock have been prominent, but I get very low mood too - especially when I've had a hypo. I often feel, why me? I've done everything right. I've led a healthy life."

The daily challenges that come with diabetes management can feel overwhelming, making it difficult for Nicki to keep negative thoughts at bay.

"It has often driven me to tears," explains the teaching assistant. "Feelings of frustration have led to much darker thoughts."

The psychological impact of having diabetes is sometimes called 'diapression' or 'diabetes distress'.

Dr Farah Gilani, Medicspot, explains: “This is a condition where people with diabetes experience emotional distress, with negative thoughts and feelings. It is not the same as depression or anxiety, but can lead to these if unrecognised."

People with diabetes are twice as likely as the general population to develop depression or anxiety. They may be concerned about whether they are managing it appropriately, what other people think, and the possible serious complications of the condition. They may also feel a lack of control in their lives. All these worries can cause them to feel overwhelmed and lead to stress and distress.

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How mental health affects diabetes management

"The stigma associated with having a long-term condition, such as diabetes, can make these feelings worse," explains Gilani. "Psychological distress can cause people to disengage with their diabetes management plan, leading to a vicious cycle where the diabetes is poorly managed, and makes the psychological suffering worse."

Chris Askew, OBE, Chief Executive, Royal College of General Practitioners says: "The day-to-day demands of managing diabetes can be a constant struggle, affecting people's emotional well-being and mental health. In turn, struggling emotionally can make it even more difficult to keep on top of self-management."

Mental health is just as important as physical health in managing diabetes. However, this isn't always reflected in available services.

"We need to bridge the divide between physical and mental health services to ensure those with emotional and psychological difficulties related to their condition do not have their needs overlooked," says Askew. "It is critical that all diabetes care sees and supports the whole person, and explores what matters most to them."

Where to get support

Gilani suggests those with diabetes can improve their mental health by seeking professional help.

"Speak with your doctor about not only your physiological symptoms but also your emotional well-being," she advises. "They will be able to offer appropriate support, recommending lifestyle changes and prescribing medicine if needed.

"For people newly diagnosed with diabetes, referral to an education programme can help them feel more empowered to manage the condition. They may also receive peer support from others who've experienced similar health issues."

Gilani says there is an increasing number of diabetes teams throughout the UK who are recognising the need for psychologists and counsellors to specifically help patients with diabetes who have mental health concerns. A good support network is also key to managing diabetes. Sharing concerns about the condition will help those with diabetes feel less isolated and overwhelmed by the symptoms they are experiencing.

Exercising regularly has also been shown to improve mood, reduce glucose levels and maintain a healthy weight. This can help alleviate the feeling of diabetes distress.