Diabetes affects much more than blood sugar. It can lead to sudden mood changes that may place an emotional strain on relationships and personal life.

For some people, the stress of living with diabetes can contribute to both changes in mood and concerns about potential complications. The physical effects of diabetes may also lead to nervousness, anxiety, and confusion.

Sometimes, friends and family may struggle to understand these mood swings, but learning about how diabetes can affect mood and providing support can help promote a stronger, healthier relationship.

In this article, we look at how diabetes might affect a person's mood and relationships.

We also spoke to Jenn Catterall, who lives with type 1 diabetes and manages the condition using an insulin pump, about her emotional experiences with diabetes.

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Diabetes often has a complex emotional impact.

Diabetes can affect a person's mood, causing rapid and severe changes.

The symptoms of low blood sugar levels that might contribute to mood swings include:

  • confusion
  • hunger
  • co-ordination and decision-making difficulties
  • aggression and irritability
  • personality or behavior changes
  • concentration difficulties

Signs that indicate a person may have high blood sugar levels include:

  • difficulty thinking clearly and quickly
  • feeling nervous
  • feeling tired or having low energy

Changes in blood sugar level can affect a person's mood and mental status. When blood sugar returns to a normal range, these symptoms often resolve.

Fluctuations in blood glucose can result in rapid mood changes, including low mood and irritability. This is especially true during hypoglycemic episodes, during which blood sugar levels drop below 70 milligrams per deciliter (mg/dL).

However, when some people have low blood sugar, they experience a slightly euphoric feeling, in a similar way to being mildly drunk. Jenn reports the following with her own experiences:

"Low blood sugars can be almost a nice experience, similar to being tipsy. When I was a teenager, my brother jokingly commented, "You're much nicer when your blood sugars are low!"

The body compounds this pleasant sensation by releasing adrenaline in an attempt to convert any available glycogen in the liver back into glucose to boost levels in the bloodstream."

This surge in adrenaline can lead to a fight-or-flight response. In Jenn's words, "Anything that might get in the way of a hypo recovery is now a danger, and your brain now focuses on keeping you conscious or alive."

This fight-or-flight state contributes to the feelings of irritability that might result from hypoglycemia in some people.

The speed of mood swings can vary, according to Jenn.

"The changes in mood, like the symptoms, can vary a lot in how suddenly I'll feel them, and they don't always parallel each other. However, we are talking a matter of minutes, up to maybe half an hour. It's not as sudden as an epileptic fit."

Hyperglycemic episodes, when glucose levels rise above 130 mg/dL when fasting and 180 mg/dL after meals, may also cause confusion in people with type 1 diabetes. This is less common in type 2 diabetes.

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Diabetes can lead to depression.

Having diabetes can also lead to a mental health condition that doctors call diabetes distress. This condition shares some elements of depression, anxiety, and stress.

While symptoms may not be severe enough for a doctor to diagnose diabetes distress as a mental illness, the symptoms can affect a person's quality of life.

The sources of distress might include the responsibilities of managing the condition and worrying about potential complications.

Some people with diabetes may feel stressed and powerlessness when trying to control their condition. Others may believe that they are not doing a good enough job in managing their diabetes.

Others may experience anxiety about whether their blood sugar is too high or too low or worry that they will not recognize low blood sugar quickly enough to avoid social embarrassment or danger if it occurs during sleep or while driving.

Some people become distressed by worrying about what a friend will think about their diabetes, or whether they will treat them differently. Family and friends may become overly involved and treat them as fragile or try to manage their diet or exercise for them.

Many people with diabetes also have concerns regarding their employers or the potential for employment.

Following a rigorous insulin schedule might disrupt a person's daily routine and trigger concerns about missing a dose, causing regimen distress.

The need to make dietary adjustments and check blood sugar regularly can also add to the stress and interrupt leisure and relaxation time, leading to further feelings of anxiety and depression.

Unpredictable elements may also cause anxiety and distress.

For example, a person who uses an automated insulin pump may not be able to take it through an airport security scanner, as this may damage the pump.

They may need to plan and bring a doctor's letter when flying. This can involve discussions with airport security that could cause embarrassment or inconvenience.

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Diabetes can put a strain on relationships.

The mood swings and emotional demands of diabetes can affect relationships.

Having a chronic disease can both increase the need for emotional support and increase the potential for frustration and tension. This can lead to conflict in relationships.

Understanding how diabetes can impact an individual's lifestyle and emotions can help a loved one support the person with diabetes and strengthen the relationship.

Also, high blood sugar levels can lead to bladder and sexual problems that might reduce a person's enjoyment of sex.

Here, learn about the link between diabetes and erectile dysfunction.

Lifestyle tips

A person with diabetes can benefit from making healthful choices that they can enjoy and maintain.

Examples include:

  • Keeping to a routine meal schedule whenever possible. Eating regular-sized, healthful meals at fixed times can help a person manage their blood sugar levels.
  • Exercising regularly. Physical activity can help boost mood, reduce glucose levels, and maintain a healthy weight. People with diabetes should check their blood sugar levels before and after exercise, particularly if they use insulin, and if the activity is intense.
  • Taking medicines on time. Taking medications at the same time every day and regularly checking blood sugar to ensure the levels are within their ideal range, can help people regulate their glucose levels and their moods.
  • Making small changes and not expecting dramatic results. For example, a person might set a goal of eating one more serving of vegetables in a week or drinking more water. Small, achievable goals can promote a sense of personal accomplishment while improving a person's overall sense of well-being.
  • Enrolling in a diabetes self-management program. These programs focus on healthful behaviors that can help a person maintain a healthy weight and meet blood sugar targets.
  • Having a strong support network. Some people will benefit from joining a support group, while others may prefer to share their concerns and fears with friends and loved ones. Having a reliable support system can help a person face the challenges of diabetes.

A person may benefit from "preventive" mental health visits where they can share their concerns and fears about their condition, even if they do not have symptoms of a mental health disorder.

These visits can help reduce the effects of diabetes distress.

Learn more about self-monitoring blood glucose levels.

Learning about diabetes can help a person with diabetes and their loved ones to cope with its emotional effects.

It is crucial to understand why a person with diabetes may experience mood swings, anxieties, and fears.

Here are some ways a person can help a friend or loved one with diabetes.

  • Ask them about their condition. Questions may include: "What can I do to help make living with diabetes easier for you?" or "What is life like when you have to monitor blood sugar constantly?" Showing interest can reduce feelings of isolation and burden.
  • Offer to join them on healthful activities. This could mean taking a class on cooking healthful foods or going on a walk together.
  • Ask if they would like company on a health visit. One way to help could be by offering to write down questions for a future doctor's appointment.
  • Emphasize your readiness to listen. The person might need a listening ear when they need to talk or share their concerns.
  • Understand that maintaining glucose levels is difficult. Remember, too, that mood swings are not always the result of neglecting glucose management.

Supporting and talking to someone with diabetes can go a long way toward helping them through the mood swings, anxieties, and fears related to their condition.

The individual may also need help in recognizing the symptoms of high or low blood sugar, as people can react in different ways. They may appreciate sensitive feedback from a friend who notices any changes.

The person with diabetes should also seek medical and psychological support for any worrying mental health symptoms they might experience. A loved one can support and encourage this.

A person should seek immediate medical attention or call 911 if they or someone they know are experiencing suicidal thoughts or thinking of harming themselves.

Friends and family should also help an individual seek emergency medical attention if they are experiencing signs of confusion, where they may not know who or where they are. This could be a sign of low glucose levels or diabetic ketoacidosis, a severe complication of high blood sugar levels.

People with diabetes may also benefit from reviewing their current medications with their doctor to see if any prescribed drugs could be contributing to diabetes distress, mood swings, or unstable blood sugar control.

Medications are also available to help treat depression and anxiety related to a person's diabetes.

Q:

What is the difference in stress and distress for people with diabetes?

A:

Stress can occur in different ways, from physical to mental or emotional tension. People usually describe this as feeling overwhelmed.

The difference in people experiencing distress is that stress becomes severe enough to reduce function in daily tasks. It might affect a person’s ability to concentrate at work or reduce motivation. Physical symptoms may occur, such as over or undereating, headaches, stomach ache, or sleep disturbance.

Emotional symptoms may include irritability, depression, and avoidance of social encounters. Individuals may have other signs that stress has escalated to the point of distress.

A person should report any feelings of overwhelming stress to their doctor.

Deborah Weatherspoon, PhD, RN, CRNA Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.