Diabetes and Mental Health

On this page:
How are diabetes and mental health connected?
Diabetes and mental health data
Ways to manage diabetes and mental health
Recommendations for health care workers
Managing prediabetes and mental health
Other resources
References

How are diabetes and mental health connected?

People with diabetes are at increased risk for developing mental health conditions that can make managing diabetes more difficult. Living with diabetes can also increase day-to-day stress and impact mental health and well-being. This can differ depending on the mental health condition and each person’s diabetes experience and life challenges.

Mental health and diabetes self care

• Stress can cause an unexpected increase or decrease in blood sugar which can make insulin management more challenging.¹
• People experiencing depression may have symptoms like low energy, loss of interest in activities, or feelings of despair and hopelessness. That can impact eating habits, physical activity, self-care, and decision-making, which all affect diabetes management.
• Low blood sugar can mimic anxiety symptoms.
• Weight gain can be a side effect of medications that treat mental health conditions. This may make it harder for people with diabetes to maintain a healthy weight.

Diabetes-related stress

The day-to-day responsibility of managing diabetes can also contribute to mental health conditions or feeling overwhelmed, depressed, or anxious. People may stop engaging in self-care, like skipping appointments, missing medication doses, or avoiding blood sugar checks. The Center for Disease Control and Prevention (CDC) estimates within an 18-month period, one-third to half of people with diabetes experience some form of diabetes-related distress.¹

Other factors that affect health and well-being

Many social, economic, and environmental factors can impact mental health.² The same is true for diabetes, and these factors can intersect.

Cost of diabetes care with or without insurance is higher than it would be without diabetes.³ This could contribute to mental health challenges, or complicate management of both conditions. Racism and structural inequities may create more barriers to health for black, indigenous, and people of color with diabetes.⁴

Diabetes and mental health data

CDC estimates people with diabetes are 2 to 3 times more likely to have depression, and 20% more likely to have anxiety sometime in their life.¹ Eating disorders can also be more common. As many as one-third of women with type 1 diabetes report restricting insulin to lose weight.⁵

In Minnesota, nearly one in four adults living with diabetes in Minnesota has ever been diagnosed with depression.⁶ (23.7%)

• Rates are higher among women (30.2%) than men (18.1%).⁶
• Rates are higher among younger adults:*⁶
  • 34.7% of people with diabetes 18-44 years-old.
  • 28.4% of people with diabetes 45-64 years-old.
  • 17.6% of people with diabetes 65 years and older.

Mental health conditions were the second most common reason for hospitalization for younger adults with diabetes in 2015 (18-44 years-old).⁷ These age-related differences could reflect differences in depression rates, recall, and willingness to report depression.

Learn more about diabetes in Minnesota.

Ways to manage diabetes and mental health

Nobody should be alone in their diabetes and mental health journey. People living with diabetes can work with their providers and support systems to address mental health challenges. Taking steps to manage both your diabetes and mental health can be mutually beneficial and improve your overall well-being.

• Meet with a diabetes educator. They can help you create a self-care plan and find solutions to diabetes challenges. Learn more about diabetes education.
• Talk to your doctor about your mental health. They can connect you to support, resources, or treatments.
• You can also search FastTracker MN or the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Services Locator.
• Incorporate tools and tips to support well-being into your routine.
• Rationing insulin is dangerous and can cause damage to your body. If it is difficult to pay for your insulin, see if you are eligible for the Minnesota Insulin Safety Net Program.
• If you are restricting insulin to lose weight, talk to your doctor. This is dangerous and can lead to serious complications.
• Find time for movement. This can help control blood sugar and manage anxiety or depression symptoms. Find a program to help you be active, like Walk with Ease or Living Well with Chronic Conditions.

Learn more: 10 Tips for Coping with Diabetes Distress

Recommendations for health care workers

The CDC estimates that 25-50% of people with diabetes who experience depression do not receive a depression diagnosis.¹ Health care workers should screen for mental health conditions, such as depression and anxiety, and talk to patients about how diabetes could be causing stress. If a patient scores high on the PHQ-9, GAD-7, or diabetes distress screening, refer to behavioral health or a social worker.

When talking to patients about diabetes and/or mental health, be sure to:

• Be aware of ways mental health symptoms could be impacting outcomes. Work with your patient to identify steps that could help address the issue.
• People who are experiencing mental health symptoms may avoid care. If a patient begins to miss appointments, follow up with them.
• Validate patients’ diabetes distress. Acknowledge diabetes-related stress can be quite common. Create space for patients to share their experience.
• Avoid shame or blame, especially if patients are struggling with their disease management.
• Acknowledge the impact social determinants of health, structural racism, and barriers to care.
• Encourage patients who are experiencing a lot of stress to consider strategies for improving their well-being (for example: meditation and mindfulness, connecting with friends and community, spending time in nature, etc.). 

Managing prediabetes and mental health

People with serious mental health conditions are at an increased risk of chronic disease, particularly heart disease, diabetes and obesity.

If you have a mental health condition and prediabetes, a lifestyle change program could help you make healthier choices to prevent type 2 diabetes, and manage your mental health symptoms. Studies show lifestyle choices, especially eating healthy foods or exercising, can help manage stress and mental health triggers.

Learn more about how lifestyle change programs can support mental health and well-being.

Other Resources

• Mental Health Promotion - MDH
• Diabetes and Mental Health - CDC
• National Alliance on Mental Health (NAMI)
• Mentalhealth.gov - U.S. Department of Health and Human Services
• Understanding diabetes and mental health (ADA) - ADA
• Behavioral health & diabetes resources - Association of Diabetes Care and Education Specialists (ADCES)
• #StayConnectedMN toolkit (PDF) - MDH

References

¹Diabetes and Mental Health. CDC
² Healthy People 2020: Mental Health. Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services.
³ The Cost of Diabetes. American Diabetes Association.
⁴ Recognizing the role of systemic racism in diabetes disparities. American Journal of Managed Care. 2021.

⁵Types of Eating Disorders. American Diabetes Association.
⁷ Minnesota Behavioral Risk Factor Surveillance System Data Analyses. 2020.
⁶Diabetes Treatment, Control, and Hospitalization Among Adults Aged 18 to 44 in Minnesota, 2013–2015. Prev Chronic Dis 2018;15:180255.