Diabetes is one of the world’s most common long-term health conditions. It is estimated that one in every eleven people worldwide suffer from the condition with Type 2 Diabetes accounting for some 90% of cases.
There are believed to be some four million diabetes sufferers in the UK, with diabetes management taking up 10% of the NHS budget. [1]
Quite naturally, traditional approaches to diabetes centre around managing the physical side of the condition. Those with Type 2 Diabetes, in particular, may be encouraged to lose weight, stop smoking or eat a more balanced diet in a bid to reduce or even manage the impact of the condition. Others may need insulin monitors and injections in order to help balance the body’s regulatory mechanisms.
However, whilst the focus is on physical management of the condition there is another side to diabetes which can have a significantly negative impact on the quality of life of diabetes sufferers. That is the toll that diabetes can have on mental well-being and vice-versa.
It’s not really surprising that a diagnosis of diabetes could lead to a negative mental outcome. Discovering that you have a lifelong condition which will require regular monitoring and treatment would be stressful for anyone, but for some, it is understandable, it could potentially have a much worse effect, perhaps even leading to depression. Added to this, particularly in the early days, the challenge of getting to grips with a new lifestyle and health regime can provoke feelings of anxiety. Some of this can fade with time as new routines are established.
However, it is known that those with diabetes are two to three times more likely to suffer from depression and 20% more likely to suffer from anxiety than those without diabetes. [2]
For those who experience a negative mental impact from diabetes, the watchword here is to take action straight away. Some may find that a chat with a friend, a call to a diabetes group or taking ‘you’ time might be enough. Others may need a more formal intervention is needed to help them with their mental challenges. As an aside, taking time out for a walk or perhaps to play some sport could not only help with mental well-being it could also help someone to lose weight and therefore improve diabetes management.
Whatever the approach, neglecting mental health in order to concentrate on physical health is not an option as it can lead to a mental health condition known as diabetes distress. Over time, between thirty and forty per cent of those with diabetes can develop diabetes distress. This can lead people to stop taking their medication, develop unhealthy eating habits, or skip check-up appointments. [3]
Diabetes distress has been described as an emotional response to the challenge of living with ongoing diabetes. It mainly affects those who have a lack of support such as those living on their own or who have difficulty accessing health care. Left unchecked, this condition can result in an escalation of the severity of diabetes, or the rapid development of other health conditions which are linked to poor diabetes management. These include heart, kidney and eye damage.
In a lose-lose scenario, poor diabetes management can also lead to mental health issues.
Fluctuating blood sugar levels can cause rapid changes in mood and in our ability to think clearly.
Blood sugar fluctuations can also leave an individual feeling well one moment and fatigued the next; itself a cause of anxiety when trying to manage daily life. [4]
There is another aspect which we should consider when looking at diabetes and mental health. That is the increased likelihood of those with existing mental health conditions developing diabetes. So much so that around 16% of people with severe mental illnesses such as schizophrenia or bipolar disorder have diabetes, compared to 7.6% of the general population. [4]
The reason for this is quite simple. When daily life is governed by mental health issues, there is little time left over for other concerns. Or as one participant in a study so eloquently put it “If part of your mind is thinking of suicide, it's like very difficult then, to be particularly panicky when someone says your blood sugar's gone up by two points.’ [5]
The same is true for the family members of those with severe mental illness. Their focus is quite naturally on the everyday management of the mental health condition with diabetes management coming a poor second. And yet, that focus on diabetic care is vital, not only to prevent the secondary mental health impact of fluctuating sugar levels mentioned above but also to stave off the development of other physical conditions which could exacerbate mental health problems.
What this shows us is that diabetes control is not a linear function. It should be viewed in light of its potential impact on mental health as well as any potential complications which could arise from untreated diabetes. Or, as one study concluded:
“Addressing the psychiatric and psychological barriers to good glucose control can help to reduce the burden of diabetes and its complications, on both the individual and the wider health service.” [6]
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