The daily demands of diabetes can take a unique toll on your mental health. Type 2 diabetes doubles or triples your chances of developing anxiety or depression. Even the way your doctor talks to you about your high blood sugar can impact your well-being.
Serena Valentine, 41, is a diabetes peer educator and executive director of CORE Initiative, a nonprofit organization in Houston. In support groups, Valentine often hears people blame themselves for getting sick. This feeling that diabetes is their fault, she says, can start at the doctor’s office.
“I experienced that myself,” says Valentine, who has lived with type 2 diabetes for more than 20 years. “Hearing from a physician, ‘Oh, well, you must have been leading a sedentary lifestyle. You must not be eating right. Whatever you’ve done has caused this to happen to you.’”
As a community health educator, Valentine explains how diabetes can affect the body and mind. She emphasizes the importance of managing both physical health and emotional well-being.
“You hear more about eating healthier, exercising, taking your medicine,” Valentine says. “You don’t really talk about the mental health aspect, which is way more important to managing your blood sugar levels than you may think it is.”
How Poor Mental Health Can Worsen Diabetes
Valentine has worked with a lot of people who have diabetes and says they often have one of two reactions.
“It’s either, ‘I’m upset, and I know the horror stories of family members. Or, ‘This is nothing new. Everybody in my family gets (diabetes). It’s no big deal.’”
Neither outlook is likely to help you take charge of your health.
For instance, if you brush diabetes off, you may develop complications because you’re not doing anything to manage your blood sugar. But stressing yourself about it might lead to unhealthy ways of trying to manage the condition. This can also worsen your health and trigger diabetes-related problems.
If you have diabetes and poor mental health, you’re more likely to:
- Smoke
- Skip physical activity
- Drink a lot of alcohol
- Not sleep well
- Use drugs or other substances
- Follow a less nutritious diet
- Eat too much or too little
Your body also releases hormones when you’re stressed.
“And when your cortisol is high, it’s very difficult to manage your blood sugar,” Valentine says.
High levels of diabetes distress (the emotional strain that stems directly from managing diabetes every day) can also lead to diabetes-related burnout. This is when you’re so mentally or physically worn out from managing your blood sugar that you:
- Don’t take your medication even though you know you should.
- Stop checking your blood sugar regularly.
- Skip doctor visits about your diabetes.
- Avoid other kinds of health care, such as eye exams or vaccines.
It’s important to note that diabetes distress and depression are two different things. You can have both at the same time and symptoms may overlap.
Symptoms of depression show up almost every day for 2 weeks and can include:
- Loss of interest in things you used to enjoy
- Sleeping too much or too little
- Feeling less hungry than usual
- Eating more than normal
- Tiredness that doesn’t go away
- Feeling hopeless about the future
- Thinking about hurting yourself
Tell your doctor if you have diabetes distress or depression, even if you don’t think your emotional problems affect your diabetes care. Mental health conditions are easier to manage when you get treatment early.
How Do You Manage Mental Health and Diabetes?
Valentine exercises most days of the week and tries her best to follow a nutritious diet and maintain a healthy weight, all things that’ve been shown to ease symptoms of depression and improve quality of life for people with or without type 2 diabetes.
Here are some of her top tips to ease everyday stress or diabetes distress:
- Pray or meditate
- Listen to music
- Relax or sit in silence for a few minutes
- Connect with your faith community or belief system
- Spend time with people who care about you
- Get involved with diabetes peer support groups
- Take a diabetes self-management education and support class (DSMES)
“I also see a therapist regularly,” Valentine says.
How to Find a Counselor Who Works With People Who Have Diabetes
You can start by asking the doctor who treats your diabetes. They may work closely with mental health professionals such as psychologists, psychiatrists, counselors, or diabetes educators who can offer behavioral support.
Here are some other ways to find a therapist who works with people who have diabetes:
- Use the American Diabetes Association’s Mental Health Directory.
- Ask people in your diabetes support group.
- Go online and search “best diabetes therapist near me” and see what pops up.
- Call your insurance provider to see if they have suggestions.
Mad You Have Diabetes? That’s Normal
You can’t ignore diabetes if you want to avoid serious health risks. But any emotion, including denial, is natural.
You may have an easier time accepting that you have diabetes if you acknowledge your complex feelings about your condition, says Mihail Zilbermint, MD, chief and director of the Division of Endocrinology, Diabetes and Metabolism at Suburban Hospital in Bethesda, MD.
“It’s OK to be frustrated. It’s OK to be angry. It’s OK to be resentful,” Zilbermint says, “Your emotions don’t mean you’re failing. They mean you’re a normal human.”
For some, life with diabetes can become so overwhelming that it seems easier to give up on managing it altogether. Valentine understands that feeling, which is why she spreads awareness about how to handle everyday emotional challenges that can interfere with your diabetes care.
“I did a couple TikTok videos about diabetes distress, and I got a big response from it,” Valentine says “People were like, ‘I didn’t know that was a thing. I just thought something was wrong with me.’ But, no, almost everyone experiences that. Even me.”
Things can still go wrong even when you think you’re doing everything right in terms of your diabetes care. This can be depressing or even traumatic, Valentine says, referring to when she developed diabetic retinopathy while on treatment. She’s now legally blind in her left eye and has no sight in the other.
“I’ve been thrown off course so many times,” Valentine says. “The key is to deal with the failure and get back on. Never stay off.”
Connect With Your Diabetes Community
As the project lead for the Houston Diabetes Peer Support Program, Valentine and other facilitators aim to help people with diabetes keep a positive outlook even when they have setbacks. The general vibe of her group is one of optimism and hope.
“Our goal is to remind them, as often as possible, that no matter what happens, they should still expect changes for the better,” Valentine says. “Without that expectation, it is very difficult to even attempt to make changes for a better lifestyle.”
According to Valentine, peer support groups can:
- Encourage you to set goals.
- Celebrate with you when you reach those goals.
- Share healthy lifestyle habits.
- Help you learn from your mistakes and figure out next steps.
- Help you move past feelings of shame or guilt
- Give you a safe space to vent and ask for advice.
If you were in Valentine’s peer support program, she’d encourage you to name some positive reasons for why you should take care of yourself. Is your goal just not to be sick? Do you want to get healthy and help others manage their diabetes? Do you have a family to care for?
“Pick that motivation and keep it in front of you at all times,” she says.
Control What You Can
Oscar Camejo, 51, had a health scare that landed him in the hospital. His blood sugar was through the roof, and he needed to get to the emergency room right away. There, he learned his prediabetes had turned into type 2 diabetes.
“In that moment of discovery, it was like I was hit with a ton of bricks,” says Camejo, host of The Beating Diabetes Lifestyle podcast. “A lot of things went through my mind. It was a depressing time.”
When he left his 6-day stay in the hospital, Camejo resolved to make diet and lifestyle changes that were “challenging but doable.” Over time, his physical and mental health improved. He reversed his type 2 diabetes and no longer needs to take medication to manage his blood sugar.
“I’m not foolish to say, well, I can go back to how I lived and how I used to eat,” Camejo says. “But because I make healthy choices every day, I’m able to remain meds-free.”
Here are some of Camejo’s tips for managing diabetes and mental health:
Focus on realistic changes. Take stock of the foods you eat and what you drink. Can you replace less nutritious choices with healthier options in simple ways?
Camejo didn’t make drastic changes, at least not at first. He cut out some pasta here and some pizza there. Next to go were the sugary sodas he drank with every meal. He also swapped packaged pastries for green apples to satisfy his midnight sweet tooth.
“Then I started feeling more energetic, more alive, if you will, and more motivated. I just fell in love with putting healthy things in my body,” he says. “And the bouts of sadness and depression over my health just slowly started going away because I started seeing improvements.”
Get moving. Like Valentine, Camejo exercises most days of the week. This boost in physical activity helped him lose more than 80 pounds in a year. He also gained energy and self-esteem along the way.
While he goes to a gym, he prefers to move his body outdoors whenever possible. Some of his favorite exercises include:
- Hiking
- Trail running in the woods
- Races like 5ks or marathons
He also meets with a running club two days a week. The group, called Black Men Run, promotes health and fitness among African-American men through running or jogging. “It’s just been a great thing to be part of a community of like-minded people,” Camejo says.
Manage stress. When something triggers a bad mood, Camejo tries to identify what’s stressing him out so he can break away from it for a bit. For instance, he goes for a 20-minute walk when he gets overwhelmed at work, usually somewhere quiet around nature.
“Just breathing the fresh air, and not dwelling too much on the issue has worked wonders for me,” he says.
He says you may also feel better if you:
- Do deep-breathing exercises.
- Go for a 15 or 20-minute walk or bike ride.
- Do any physical activity you like.
- Go somewhere peaceful (even if that’s sitting in your car at work).
Your doctor can help you find other ways to manage stress if these techniques aren’t enough.
Focus on sleep. Camejo became more intentional about sleep and rest. He takes timed naps during the day if he feels fatigued, and he stopped staying up until 2 a.m. scrolling social media or watching TV.
“I set an alarm to make sure that I had a notification when it was time to go to bed,” Camejo says. “And no matter what, my head needs to hit the pillow at 10 o’clock.”
Here are some of his tips to improve your sleep:
- Go to bed and get up at the same time every day.
- Give yourself a full 8 hours to sleep.
- Set an alarm for when to wind down before bed.
- Avoid screens or social media in bed or if you wake up at night.
- Get enough physical activity every day.
- Manage stress during the day.
If you make healthy lifestyle changes and still have trouble sleeping, talk to your doctor. You could have another health condition that needs treatment.
How to Find More Diabetes Management Resources
To learn more about diabetes distress and how to cope with it, visit:
- The Diabetes Distress Assessment & Resource Center
- The Diabetes and Emotional Health Workbook (from the American Diabetes Association)
- The Behavioral Diabetes Institute
- The American Diabetes Association
- The Association of Diabetes Care and Education Specialists
Tell your doctor if you have trouble managing your mental health or following your diabetes treatment plan, especially if you lack access to or can’t pay for medical care. They may be able to connect you with local diabetes management resources.
Show Sources
Photo Credit: DigitalVision/Getty Images
SOURCES:
Mihail Zilbermint, MD, MBA, associate professor of clinical medicine, Johns Hopkins University School of Medicine; director, Endocrine Hospitalists, Johns Hopkins Community Physicians; chief of Endocrinology, Diabetes and Metabolism, Suburban Hospital; director, Johns Hopkins Community Physicians Academy of Clinical Excellence.
Oscar Camejo, diabetes advocate; founder and host, The Beating Diabetes Lifestyle website and podcast.
Serena Valentine, MBA-HCM, diabetes advocate; executive director, CORE Initiative.
Diabetes Therapy: “Diabetes Distress or Major Depressive Disorder? A Practical Approach to Diagnosing and Treating Psychological Comorbidities of Diabetes.”
CDC: “Diabetes and Mental Health,” “Community-Based Organizations.”
BMC Psychiatry: “Determinants of depression and anxiety among type 2 diabetes patients in governments’ hospitals at Harari regional state, Easter Ethiopia: A multi-center cross-sectional study.”
Diabetic Medicine: “Twenty-five years of diabetes distress research.”
Canadian Journal of Diabetes: “Diabetes and Mental Health.”
Cureus: “Stress-Induced Diabetes: A Review.”
Diabetes and Emotional Health: “Chapter 3: Diabetes Distress.”
Diabetes Research and Clinical Practice: “Psychiatric disorders as risk factors for type 2 diabetes: An umbrella review of systematic reviews with and without meta-analyses.”
American Diabetes Association: “Mental Health: Understanding diabetes and mental health,” “Ease Diabetes Stress,” “Health Insurance Aid.”
