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Mental Health and Diabetes

People living with either type 1 or type 2 diabetes are at an increased risk for depression, anxiety, and eating disorders. In fact, the rates of depression are two times greater for people with diabetes. Many of these mental health conditions, up to 45%, go undetected among patients being treated for diabetes. Specifically, it is estimated that only around 33% of people with diabetes and mental health conditions receive a diagnosis and proper treatment. It is important to conduct regular screenings for mental health conditions and be able to recognize symptoms.

Depression

Depression and diabetes have similar risk factors including poor diet, lack of exercise, poor sleep, and psychosocial stressors. Some of the day-to-day struggles of managing diabetes, or any chronic condition, can be stressful and lead to symptoms of depression.

Some symptoms of depression include:

  • Loss of interest or pleasure
  • Change in sleep patterns
  • Waking up earlier than normal
  • Change in appetite
  • Trouble concentrating
  • Loss of energy
  • Nervousness or guilt
  • Morning sadness
  • Suicidal thought
  • Withdrawal from friends and activities
  • Declining school and work performance

Eating Disorders

Eating disorder rates for people without diabetes are 6-8% in females and 3-4% in males. The rates for people with diabetes are 2-4 times higher. People with diabetes experience a stronger emphasis on their weight, physical activity, and both the amount and types of food they eat. These strong focuses are put in place in order to manage the diabetes, however, they can be risk factors for developing an eating disorder. The two most common eating disorders are anorexia nervosa and bulimia nervosa. People with anorexia restrict their food intake to avoid weight gain. On the other hand, people with bulimia overeat and then purge the food by vomiting or taking laxatives. In addition, individuals who are prescribed to take insulin may develop diabulimia. Diabulimia is a dangerous practice where an individual lowers or skips insulin doses to lose weight.

Anxiety

Managing diabetes and other chronic conditions can create stress. For some people with diabetes, self-management practices and health concerns become intense and can result in anxiety. One study found that Americans with diabetes are 20 percent more likely to be diagnosed with anxiety than those without diabetes. Common symptoms of anxiety include:

  • Nervousness, restlessness, or being tense
  • Feelings of danger, panic, or dread
  • Rapid heart rate or breathing
  • Trembling or muscle twitching
  • Weakness
  • Difficulty focusing
  • Insomnia
  • Digestive problems
  • Obsessions about certain ideas
  • Increased or heavy sweating

Treatment for Mental Illness

For people with diabetes, the American Diabetes Association Standards of Care recommends that a diabetes treatment team include a mental health professional with expertise with the disease. The Standards of Care also recommend regular screening for mental illness.

It is important to talk with your doctor if you experience the symptoms of a mental illness. Your doctor is a great resource for creating a treatment plan that works for you, which may include medication, therapy, and other lifestyle changes.

Therapy is an extremely helpful treatment option, which can include cognitive-behavioral therapy, family therapy, or dialectical-behavioral therapy. Cognitive-behavioral therapy is a common type of talk therapy. It is a short-term, goal-orientated psychotherapy that takes a hands-on, practical approach to problem-solving. The goal is to change patterns of thinking or behavior that are behind people’s difficulties. Dialectical-behavioral therapy provides clients with new skills to manage painful emotions and change negative thinking patterns or unhelpful behaviors. It specifically focuses on providing therapeutic skills.

Lifestyle changes can also be helpful in reducing and management stress and anxiety. This can include getting active and incorporating relaxation exercises like meditation or yoga. Other changes could include reducing and limiting both alcohol and caffeine, maintaining and eating a healthy diet, and getting the recommended 7-8 hours of sleep each night.

Seeking Help for Others

It is important to look for warning signs and know what to do if you know someone who is experiencing a mental health disorder or suicidal thoughts. Be prepared. Seek out local agencies that offer Mental Health First Aid certification.

If you have concerns for someone you know, you can start by asking direct questions. Look for warning signs, such as the person talking about suicide, withdrawing from social contract and wanting to be left alone, increasing use of alcohol or drugs, changing normal routine, or engaging in risky or self-destructive behaviors.

If a friend or a loved one is thinking about suicide, you can assist them to getting professional help. Encourage the person to call a suicide hotline number. In the U.S., the National Suicide Prevention Lifeline is at 800-273-TALK (800-273-8255) to reach a trained counselor. You can encourage the person to seek treatment by suggesting finding help from a support group, crisis center, faith community, teacher or other trusted person.

Always be respectful and acknowledge the person’s feelings. If someone has attempted suicide or is actively seeking to cause harm to themselves, do not leave the person alone. Call 911 or your local emergency number right away, try to find out if he or she is under the influence of alcohol or drug, and tell a family member or friend right away.

Sources

  1. Balhara, Y. P. S. (2011, October). Diabetes and psychiatric disorders. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193776/
  2. Diabetes and Eating Disorders. (2002, April 1). Retrieved from https://spectrum.diabetesjournals.org/content/15/2/106
  3. Diabetes and Mental Health. (2018, August 6). Retrieved from https://www.cdc.gov/diabetes/managing/mental-health.html
  4. Mental Health. (n.d.). Retrieved from https://www.diabetes.org/diabetes/mental-health
  5. Suicide: What to do when someone is suicidal. (2018, January 31). Retrieved from https://www.mayoclinic.org/diseases-conditions/suicide/in-depth/suicide/art-20044707
  6. The Intersection of Eating Disorders and Diabetes. (2018, November 27). Retrieved from https://emilyprogram.com/blog/the-intersection-of-eating-disorders-and-diabetes/
  7. Types of Eating Disorders. (n.d.). Retrieved from https://www.diabetes.org/diabetes/mental-health/eating-disorders

If this document didn’t answer your questions, please contact HGIC at hgic@clemson.edu or 1-888-656-9988.

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