Anxiety is common among diabetics because they constantly worry about fluctuations in blood sugar levels, and it can have serious consequences. Both high and low blood sugar levels (blood sugar levels) pose risks and make daily life stressful.
This article explains why people with diabetes are more prone to anxiety, the latest research on the subject, and available treatments.
What is anxiety?
Anxiety is intense worry about something that might happen or an outcome that is out of one’s control.
Moments of anxiety are a part of everyday life, but they become a problem when they become excessive or frequent enough to interfere with daily life. This is often diagnosed as generalized anxiety disorder or panic disorder.
According to the National Institutes of Health (NIH), symptoms of anxiety disorders include:
- Excessive worry lasts almost every day for at least 6 months
- feeling restless or irritable
- mental or physical fatigue
- Having trouble concentrating or feeling like your mind is going blank
- irritation and anger
- overreact to small things
- muscle tension
- Sleep problems such as insomnia, waking up frequently, or feeling tired even when you are asleep
If these symptoms begin to affect your relationships, work, or ability to manage daily tasks, it may be time to seek help.
Symptoms of panic disorder and actual panic attacks include:
- Recurrent and unexpected panic attacks
- Intense fear that escalates within minutes
- Triggers are often associated with things, places, or experiences
- palpitations or palpitations
- Sweating, shivering, trembling
- Shortness of breath or feeling of suffocation
- A sense of impending doom or loss of control
- Eventually a severe phobia develops
Why is anxiety so common among diabetics?
Researchers at Yale University once said that diabetes and anxiety are virtually related.
Managing chronic diseases like type 1 and type 2 requires continuous decision-making, which can lead to fluctuations in blood sugar levels, often with dangerous consequences. This creates the perfect environment for anxiety to arise.
Additionally, concerns about long-term complications are ever-present and reinforced by medical professionals and the media.
The physical effects of hypoglycemia or hyperglycemia can themselves cause anxiety.
Type 1 diabetes and anxiety
Type 1 management involves continuous micro-administration of insulin, leading to concerns about complications, “incomplete” blood sugar levels, and dangerous hypoglycemia.
The more variables a person can control, such as diet, activity, hormones, stress, and hydration, the better they will be able to manage their blood sugar levels. But when these variables get out of control, worry can easily arise and diabetes burnout can occur.
type 2 diabetes and anxiety
For some people with type 2 diabetes, mild or severe hypoglycemia may be a concern, similar to type 1 diabetes, due to the use of insulin or other drugs that lower blood sugar.
Constant efforts to “control” blood sugar levels (which can never be fully controlled) can be exhausting.
Type 2 also creates a sense of helplessness, as the daily discipline required to manage blood sugar levels is often daunting.
Striving for perfection every day can lead to feelings of failure and defeat, which can lead to even more anxiety.
fear, diabetes, anxiety
Fear is a big part of anxiety and plays a big role in living with diabetes.
People with diabetes, regardless of their age, can have strong fears about various aspects of their treatment, making the condition difficult to manage and affecting their daily lives.
Common fears include:
- Hyperglycemia or hypoglycemia
- needle and injection pain
- Administer insulin when carbohydrate content is uncertain or for foods that are difficult to eat, such as pizza
- Application of CGM sensor or insulin pump injection site
- View blood sugar level trends with CGM
- carbohydrates or specific food groups
- Fluctuations in blood sugar levels during work, school, or activities
- Development of diabetes-related complications
One of the most common fears is hypoglycemia (low blood sugar). Let’s take a closer look at this.
Fear of hypoglycemia (hypoglycemia)
Fear of hypoglycemia is a common and legitimate form of worry for people who take insulin or drugs that lower blood sugar levels.
Severe anxiety often develops after a traumatic hypoglycemic episode, such as losing consciousness, requiring a glucagon injection (a hormone that raises blood sugar levels), or experiencing hypoglycemia while driving.
These experiences can completely destroy confidence in the management of typical hypoglycemia.
Unfortunately, low blood sugar levels always come back. Constantly raising blood sugar levels to avoid spikes is not a safe solution as it puts your long-term health at risk.
It takes time to regain confidence in dealing with lows. Diabetes psychologist Mark Heyman, Ph.D., CDCES, of the Center for Diabetes and Mental Health, helps people reflect on their experiences and gradually regain their confidence.
For example, he sometimes guides people through mild blood sugar drops in his office so they understand that their blood sugar levels can be managed safely.
For people dealing with high blood sugar levels due to anxiety, your health care team can work with you to titrate your insulin dosage.
Most people with diabetes aim for blood sugar levels of 70 to 180 mg/dL (3.9 to 10.0 mmol/L), but for those managing anxiety, aiming for blood sugar levels of 150 to 200 mg/dL (8.3 to 11.1 mmol/L) may be a safer starting point rather than setting blood sugar levels consistently high.
Talk to your health care team about how you have been dealing with and coping with this anxiety. They can help you find a safer path.
Research on diabetes and anxiety
As a diabetic, you’re not alone in your anxiety. A wealth of research supports the link between these two conditions. In fact, the prevalence of anxiety among people with diabetes is well-documented and confirms the difficulties that people with diabetes can face.
Anxiety in young people with type 1 diabetes negatively impacts management
Managing diabetes in teens is difficult enough, but when you add anxiety and depression into the mix, it becomes even more difficult.
For more information, see: Diabetes and depression: what you need to know.
A 2016 study in Australia found that young people with Type 1 who suffer from anxiety and depression had significantly impaired blood sugar control.
High blood sugar levels often cause feelings of depression, fatigue, and loss of enthusiasm for life, which in turn increases anxiety.
This study highlights the importance of screening young people with diabetes for signs of anxiety and depression and providing early support.
A 2018 Yale University study also highlighted that these young people are at increased risk for eating disorders, likely stemming from worries about eating, activity, and weight.
People with type 2 diabetes show more signs of anxiety than people without diabetes.
A 2016 study in North Carolina found that people with type 2 were more likely to show both clinical and subclinical symptoms of anxiety than people without diabetes.
Researchers also noted that people with anxiety had more difficulty meeting blood sugar goals and experienced higher rates of diabetes-related complications.
Similarly, a 2018 study in Bulgaria found that women with metabolic syndrome, which includes type 2 diabetes, had higher levels of anxiety and depression than women without metabolic syndrome.
Pregnant women with diabetes are at higher risk of anxiety disorders
The pressure to maintain near-perfect blood sugar levels during pregnancy can be immense. According to a 2016 study in Brazil, anxiety is not only likely, it should be expected.
Managing diabetes during pregnancy, where the variables increase, requires constant monitoring and insulin adjustments, along with the stress of knowing that blood sugar levels directly affect the health of your baby.
The study also found that the anxiety experienced by pregnant women with diabetes was more common throughout pregnancy, rather than being associated with specific blood sugar levels at specific points in time.
Depression and anxiety may increase risk of type 2 diabetes
A 2017 study in Florida and Indiana found that 25% of people with depression or anxiety developed type 2 diabetes over a 10-year period.
Researchers concluded that better treatment and screening for mental health problems could help prevent the development of diabetes.
“These findings suggest that a positive screen for anxiety is a risk factor for diabetes in older adults, independent of depression and traditional diabetes risk factors,” the researchers explained.
They emphasized the need for further consideration of anxiety in diabetes risk assessment and prevention efforts.
Symptoms of depression or anxiety in people with type 2 diabetes are associated with lower exercise frequency
A 2017 study conducted in Canada found that people with type 2 diabetes who suffer from mental health issues such as depression and anxiety exercise less frequently.
The researchers concluded that depression is not just a co-morbidity, but a real barrier to regular exercise in this population.
Managing and Treating Anxiety as a Diabetic
Getting help for anxiety can be difficult for several reasons. One of the big hurdles is the stigma that often surrounds mental health issues, making people feel weak or deficient for struggling with them.
In fact, conditions like depression and anxiety are very common, even if they’re not as openly discussed as familiar topics like insulin pumps and low-carb recipes. Remember you are not alone.
Seek help from your doctor or medical team
Dealing with your worries now doesn’t mean they’ll last forever, especially if you have the right support.
Talk to your health care team about referring you to a therapist or discuss medications that may help.
There are many options available, but it only helps if you reach out.
consider treatment
If you are unsure about treatment, remember that there are many different types. It’s not all about sitting on the couch and talking about your life.
Cognitive therapy, EMDR, hypnotherapy, and even equine therapy are all effective ways to treat anxiety.
If you don’t feel like your first therapist is a good fit, ask your doctor to help you find another.
Please consider taking medication
Medications can help improve your mental state while you work on other aspects of your life.
Your concerns may be related to areas that can be changed, but in the meantime, drugs that increase good chemicals like dopamine and serotonin can make a big difference.
Some medications for generalized anxiety are actually classified as antidepressants.
- Serotonin and noradrenaline reuptake inhibitors (SNRIs)
- Selective serotonin reuptake inhibitors (SSRIs)
- Atypical antidepressants
- Tricyclic antidepressants
- Monoamine oxidase inhibitors (MAOIs)
Some of the more quickly effective anxiety and panic attack treatments include:
- Benzodiazepines
- beta blocker
Some of these drugs can affect blood sugar levels and insulin resistance, so talk to your doctor about these potential effects before starting treatment.
Also, keep in mind that finding the right antidepressant or anti-anxiety medication may take time, as the first drug you try may not be a perfect fit.
If your anxiety or panic becomes severe, seek help immediately
If your anxiety or panic attacks feel out of control, go to your local emergency room or urgent care clinic.
If you are thinking about suicide
For immediate assistance, please contact the Suicide & Crisis Lifeline at 988.
Remember that living with diabetes is difficult.
You’re doing a great job, even if it doesn’t always look perfect on paper. Perfection is not the goal.
Above all, remember that you are not alone. Diabetes is inherently difficult to manage, so anxiety and depression are common afflictions for people with diabetes.
It’s normal to struggle and feel overwhelmed when your body can’t handle what it needs to handle on its own.
Please take a deep breath. You can overcome this situation.
Was this article helpful? Let us know by clicking Yes or No below.
