Anxiety is common in people with diabetes as it can have serious consequences due to constant worry about fluctuations in blood sugar levels. Both hyperglycemia and hypoglycemia (sugar) levels are risky and stressful in everyday life.
This article explores why people with diabetes are more likely to experience anxiety, latest research on topics, and the available treatment options.
What is anxiety?
Anxiety is intense worry about what can happen or consequences you can’t control.
A brief moment of concern is a normal part of life, but when it is overly or frequently enough to disrupt your daily life, it becomes a problem. This is often diagnosed as a common anxiety disorder or panic disorder.
According to the National Institutes of Health (NIH), symptoms of anxiety disorder include:
- Excessive worry for at least six months on most days
- Restless or on the edge
- Mental or physical fatigue
- It’s difficult to concentrate or feel your mind like a blank space
- Annoyed and angry
- Overreaction to small things
- Muscle tension
- Sleep problems such as insomnia, frequent awakening, fatigue despite sleep
If these symptoms begin to affect your relationship, work, or your ability to manage your daily tasks, it may be time to ask for help.
Symptoms of panic disorder and actual panic attacks include:
- Recurrent and unexpected panic attacks
- A fierce fear that escalates within minutes
- Triggers that are often linked to objects, locations, or experiences
- Heart motion pit or racing heartbeat
- Sweat, tremble, or shaking
- Shortness of breath or choking emotions
- A sense of impending fate or loss of control
- The ultimate development of severe phobia
Why anxiety is so common among people with diabetes
Yale researchers once said diabetes and anxiety were essentially cousins.
Managing chronic diseases like Type 1 and Type 2 requires certain decisions, which can lead to fluctuations in blood glucose levels. This often has dangerous consequences. This creates the perfect environment for anxiety to develop.
Furthermore, the ongoing concern about long-term complications is a constant presence, reinforced by healthcare professionals and the media.
Even the physical effects of hypoglycemia and hyperglycemia itself can cause anxiety.
Type 1 diabetes and anxiety
Type 1 management involves ongoing micromanagement of insulin, leading to fear of complications, “incomplete” blood glucose levels, and concerns due to dangerous hypoglycemia.
The more variables a person can control, such as food, activity, hormones, stress, and hydration, the more you can control your blood sugar levels. However, if these variables become out of control, worry can easily arise and lead to diabetic burnout.
Type 2 diabetes and anxiety
For some people with type 2, the use of insulin or other drugs that lower blood glucose, like type 1 diabetes, can create concerns about mild or severe hypoglycemia.
The constant effort to “control” blood sugar – something that cannot be fully controlled – is overwhelming.
Type 2 also gives you a feeling of helplessness. The daily discipline required to manage blood sugar levels is often daunting.
Espering for perfection every day leads to feelings of failure and defeat, further promoting anxiety.
Fear, diabetes, anxiety
Fear is an important part of anxiety and plays a major role in living with diabetes.
People with diabetes can cause intense fears surrounding various aspects of treatment, regardless of age, making it difficult to manage their condition and affect their daily lives.
Common fears include:
- High or hypoglycemia
- Needle and injection pain
- Dosing uncertain carbohydrate content or insulin for difficult foods like pizza
- Application of CGM sensor or insulin pump injection sites
- See blood glucose trends with CGM
- Carbohydrate or specific food groups
- Blood glucose fluctuations during work, school, or activities
- Onset of diabetes-related complications
One of the most common fears is hypoglycemia. Let’s take a closer look at this.
Fear of hypoglycemia (hypoglycemia)
The fear of hypoglycemia is a common and legitimate form of worry for people taking insulin or glucose-lowering medications.
Severe anxiety often occurs after traumatic hypoglycemia episodes, such as losing consciousness, glucagon injections (the hormone that raises blood glucose levels), or experiencing low levels while driving.
These experiences can completely erode a person’s confidence in managing typical hypoglycemia.
Unfortunately, low levels inevitably occur again and constantly running your blood sugar levels high to avoid them is not a safe solution as it puts your long-term health at risk.
Rebuilding confidence in managing low prices takes time. Diabetes psychologist Dr. Mark Heyman, PhD, CDCES, Centers at the Diabetes & Mental Health Center reflect on their experiences and help people by gradually regaining confidence.
For example, he sometimes leads people through mild lows in his office, allowing them to see that they can safely manage their blood sugar levels.
For those dealing with hyperglycemia due to anxiety, medical teams can work together to gradually adjust their insulin dose.
The target for most people with diabetes is blood glucose levels of 70-180 mg/dL (3.9-10.0 mmol/L), but aiming for 150-200 mg/dL (8.3-11.1 mmol/L) may be a safer starting point for those managing anxiety compared to sustained high levels.
Talk to your healthcare team about how you manage and deal with this anxiety. They can help you find a safer path.
Diabetes and Anxiety Research
If you are feeling anxious as a diabetic person, you are not alone – a wealth of research supports the relationship between these two conditions. In fact, the prevalence of anxiety among diabetics is well documented and examines the struggles you may face.
Anxiety in young people with type 1 diabetes has a negative effect on management
Managing diabetes as a teenager is challenging enough, but adding anxiety and depression makes it even more difficult.
See more details: Diabetes and Depression: What You Need to Know.
A 2016 study from Australia found that type 1 youth who dealt with anxiety and depression significantly impaired blood glucose control.
Higher blood sugar levels often lead to depression, fatigue and loss of enthusiasm for life, which increases anxiety.
This study highlights the importance and early support of screening diabetic youth for signs of anxiety and depression.
A 2018 Yale study highlighted that these young people are at an increased risk of eating disorders, which are likely due to concerns about food, activity and weight.
People with type 2 diabetes show more signs of anxiety than people who don’t
A 2016 study in North Carolina found that people with type 2 exhibited both clinical and asymptomatic symptoms more frequently than those without diabetes.
The researchers also noted that people with anxiety had more difficulty reaching blood glucose levels and experienced a higher incidence of diabetes-related complications.
Similarly, a 2018 study from Bulgaria revealed that women with metabolic syndrome, including type 2 diabetes, had higher levels of anxiety and depression compared to women without metabolic syndrome.
Pregnant women with diabetes at high risk of anxiety
The pressure to maintain near perfect blood sugar levels during pregnancy is overwhelming. Anxiety is probably not the case, according to a 2016 survey in Brazil. It should be expected.
Management of diabetes during pregnancy requires constant monitoring and insulin adjustment due to increased variables, and the additional stress of knowing that blood sugar levels directly affect the baby’s well-being.
The study also found that concerns experienced by diabetics are more generalized throughout pregnancy, rather than related to specific blood glucose levels.
Depression and anxiety can increase the risk of type 2 diabetes
A 2017 survey in Florida and Indiana found that 25% of people with depression and anxiety developed type 2 diabetes over a decade.
Researchers concluded that better treatment and screening for mental health issues can help prevent the onset of diabetes.
“These findings suggest that positive screening for anxiety is a risk factor for diabetes in older people, regardless of the risk factors for depression or traditional diabetes,” the researchers explained.
They emphasized that anxiety requires greater consideration in diabetes risk assessment and prevention efforts.
Symptoms of depression or anxiety in people with type 2 diabetes are associated with reduced frequency of exercise
A 2017 study from Canada found that people with type 2 diabetes suffering from mental health issues such as depression and anxiety are not used very often.
The researchers concluded that depression is not just a co-occurrence state, but a true barrier to regular movement in this population.
As a person with diabetes, manage and treat anxiety
Getting help with anxiety can be difficult for several reasons. One of the big hurdles is the stigma that is often surrounds mental health issues, which makes people feel struggling and weak or flawed.
In reality, conditions such as depression and anxiety are very common. Remember, you are not alone.
Ask your primary care physician or health care team for help
Tackling worries now doesn’t mean you’ll handle it forever – especially if you get the right support.
Talk to your healthcare team about referrals to your therapist or discuss useful medications.
There are many options available, but they are only useful if you reach out.
Consider treatment
If you are hesitant to treat it, don’t forget that there are many different types. Not everything involves sitting on the couch and talking about your life.
Options like cognitive therapy, EMDR, hypnotherapy, and even equine therapy are effective in treating anxiety.
If you don’t feel that your first therapist is in a proper fit, ask your doctor to help you find another one.
Consider taking medication
The medicine will help you improve your mental state while working on other aspects of your life.
Your concerns may be tied to areas where you can change, but in the meantime, drugs that boost quality chemicals like dopamine and serotonin can make a huge difference.
Some generalized anxiety drugs are actually classified as antidepressants such as:
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Atypical antidepressants
- Tricyclic antidepressants
- Monoamine oxidase inhibitor (MAOI)
Drugs for anxiety or panic attacks that act more rapidly include:
- Benzodiazepines
- Beta Blocker
It is important to note that some of these drugs can affect blood glucose levels and insulin resistance. Consult your doctor about these potential effects before starting treatment.
Also, remember that finding the right antidepressant or anti-anxiety medication can take some time, as it’s not the perfect fit to try first.
If your anxiety or panic gets worse, get help right away
If you feel that your anxiety or panic attacks are unavailable, please visit your nearest emergency room or emergency clinic.
If you’re thinking about suicide
For immediate support, contact Suicide & Crisis Lifeline at 988.
Reminiscence: Living with diabetes is challenging!
You do a great job, even if you don’t always look perfect on paper. Perfection is not the goal.
Above all, remember that you are not alone. Anxiety and depression are a common struggle for people with diabetes, as diabetes management is inherently tough.
It’s normal to feel struggling and overwhelmed when your body isn’t dealing with anything that is supposed to be managing yourself.
Take a deep breath – you can get through this.
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