Managing a chronic condition such as diabetes can be very stressful and affect a person’s mental health. People may experience sadness and grief, which, over time, can lead to depression. Fatigue or pain can limit physical activity and prevent people from doing what they enjoy. Stress about the future and the unpredictability of the chronic condition can also cause anxiety.

Some people with diabetes develop diabetes distress. They may experience overwhelming feelings of frustration and feel tired of having to manage their condition daily. Diabetes distress may cause people to slip into unhealthy habits, stop checking their blood sugar, and even skip doctor’s appointments. It can look like depression or anxiety, but medicine cannot treat it effectively.

A person with diabetes is 2–3 times more likely to develop depression than someone without the condition. On the other hand, depression increases the risk and severity of diabetes.

The common causes of diabetes and depression are poor sleep, lack of exercise, and an unhealthy diet. These factors are also associated with chronic stress, hormonal imbalances, and increased inflammation in the body.

Research also suggests that long-term use of antidepressants can increase diabetes risk.

Additionally, both high and low blood sugar levels affect how the brain functions in terms of mood and thinking ability. Over time, diabetes can change the brain’s structure, leading to mood disturbances.

People with diabetes are 20% more likely than those without diabetes to have anxiety at some point in their lives. Managing a long-term condition such as diabetes can be a major source of anxiety for some. Receiving a diagnosis or finding out that they have a diabetes complication can be a trigger for some people.

It is important to note that anxiety has similar symptoms to hypoglycemia (low blood sugar), so people should check their blood sugar if they feel anxious and treat it if it is low.

Additionally, women with type 1 diabetes may be at risk of developing eating disorders and purposely restricting insulin to lose weight (diabulimia). Some older research suggests that eating disorders occur in 31–40% of women with type 1 diabetes between the ages of 15 and 30.

Having depression or anxiety can make it difficult to manage diabetes and can worsen a person’s prognosis.

They may be less motivated to do self-care activities. People with depression are more likely to be sedentary and have an unhealthy diet, which can lead to higher blood sugar levels. Smoking is also more common in people with mental health conditions and increases the risk of diabetes complications such as stroke and heart disease.

Older research suggests that people with mental health conditions may be more likely to have trouble following treatment recommendations, attending appointments, and keeping up with glucose monitoring and foot care.

Yes, it is safe for people to take medications for mental health conditions if they live with diabetes.

However, many drugs for the treatment of depression and anxiety can make it harder for people to manage their blood sugar. Medications can change the way the body processes glucose and makes and responds to insulin. A doctor may recommend stopping or reducing these medications if a person’s blood sugar levels become too high.

Black and Hispanic people in the U.S. may often be uninsured or underinsured. According to a 2012 statement from the Endocrine Society, people with diabetes who do not have insurance receive a lesser quality of care than those who have insurance. Therefore, those without insurance have a higher risk of developing complications of type 2 diabetes and are more likely to have advanced disease at diagnosis, which can increase the risk of depression.

People in certain racial or ethnic groups often have a lower socioeconomic status due to societal barriers and systemic issues, which can increase the risk of type 2 diabetes and cause depression.

Additionally, factors such as childhood adversity, stress, and decreased access to healthy food stores and safe places to exercise have links to less nutritious diets, decreased physical activity, diabetes, and depression.

If a person believes they have depression or anxiety, they should reach out to their doctor right away. A doctor can refer the person to a mental health professional who may recommend therapy and medications. Treating a mental health condition can help a person better manage their diabetes.

People can also make changes on their own to help cope with diabetes. Strategies may include finding healthy ways of lowering their stress and anxiety levels, staying active, eating a healthy diet, limiting alcohol and caffeine, and getting enough rest. Staying in touch with friends and family who provide support and asking for help when necessary can also be beneficial.

Dr. Kelly Wood is an ABMS board certified endocrinologist and internal medicine physician who treats adults with diabetes, thyroid disease, osteoporosis, and other hormonal conditions. She achieved her fellowship in endocrinology from University of Wisconsin Hospital and Clinics.