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Anxiety and Depression

Living with diabetes brings not only physical challenges but also emotional and psychological ones. Managing blood glucose, planning meals, adjusting insulin, and anticipating complications all demand constant attention. Over time, this daily vigilance can take a toll on mental wellbeing. Research has consistently shown that people living with diabetes—both type 1 and type 2—are at significantly higher risk of experiencing anxiety and depression than those without diabetes.

Understanding what anxiety and depression are, how they interact with diabetes, and what can be done to support emotional wellbeing is essential for good health outcomes and quality of life. This article explores both conditions, their relationship with diabetes, and evidence-based strategies for support and recovery.

Understanding Anxiety

What Is Anxiety?

Anxiety is a natural human response to stress or perceived threat. It helps us prepare for challenges, heightening alertness and motivation. However, when anxiety becomes persistent, overwhelming, or disproportionate to the situation, it can interfere with daily functioning. This is known as an anxiety disorder.

Common forms of anxiety include:

Generalised Anxiety Disorder (GAD): excessive, ongoing worry about many aspects of life.
Panic Disorder: sudden, intense episodes of fear or physical panic symptoms such as racing heart or breathlessness.
Social Anxiety Disorder: intense fear of judgment or embarrassment in social situations.
Specific Phobias: excessive fear of specific things, such as needles or blood.

Symptoms of Anxiety

Persistent worry or fear
Restlessness or feeling “on edge”
Difficulty concentrating
Sleep disturbance
Physical symptoms (heart palpitations, sweating, dizziness, stomach upset)

In diabetes, anxiety often shows up in diabetes-specific ways—such as fear of hypoglycaemia, worry about blood sugar readings, or dread of future complications.

Understanding Depression

What Is Depression?

Depression is more than feeling sad or low for a short time. It is a serious mood disorder characterised by persistent feelings of sadness, hopelessness, or loss of interest and pleasure. It affects thinking, behaviour, physical health, and the ability to carry out day-to-day activities.

Symptoms of Depression

Ongoing sadness or tearfulness
Loss of interest or enjoyment in usual activities
Fatigue or low energy
Changes in appetite or weight
Difficulty concentrating or making decisions
Feelings of guilt or worthlessness
Thoughts of death or suicide

Depression is common and treatable. Yet, in people living with diabetes, it is often under-recognised because its symptoms can overlap with diabetes-related fatigue or fluctuating energy.

The Relationship Between Diabetes and Mental Health

A Two-Way Connection

The relationship between diabetes and both anxiety and depression is bi-directional—each can contribute to the other.

Living with diabetes can trigger emotional distress.
Managing diabetes involves constant decision-making, self-monitoring, and fear of negative consequences. This can lead to anxiety or low mood.
Anxiety or depression can worsen diabetes outcomes.
These conditions can make it harder to manage diet, medication, and physical activity. They can increase stress hormones, which raise blood glucose levels, and contribute to poorer glycaemic control.

How Common Are They?

Research indicates:

People with diabetes are twice as likely to experience depression as those without diabetes.
Anxiety disorders are also more prevalent, particularly fear-based anxieties related to glucose monitoring or insulin injections.
Rates of depression in type 1 diabetes (T1D) are estimated around 12–30%, and in type 2 diabetes (T2D) around 15–35%, depending on population and study design.
Many experience sub-clinical symptoms—not meeting full criteria for a disorder but still significantly affecting wellbeing.

Can Diabetes Distress Lead to Depression?

Yes — diabetes distress can lead to depression, especially if it persists over time without adequate support.

What Is Diabetes Distress?

Diabetes distress refers to the specific emotional burden and frustration that come from living with diabetes and managing it every day. It’s not a mental illness, but a natural response to the constant demands of self-care—checking blood glucose, counting carbohydrates, taking medication, and worrying about future complications.

People with diabetes distress often describe:

Feeling overwhelmed by daily management
Frustration or guilt about blood glucose readings
Worry about complications or progression
Conflict with healthcare teams or family
A sense of burnout and exhaustion

It’s specific to living with diabetes and differs from general anxiety or depression—though symptoms can overlap.

How Distress Can Turn Into Depression

If diabetes distress remains unresolved, it can evolve into clinical depression. This often happens gradually, as emotional fatigue, self-blame, and hopelessness accumulate.

Persistent Stress and Emotional Fatigue
Continuous self-management pressure can deplete emotional reserves. When people feel that their best efforts never achieve “good enough” results, feelings of failure and hopelessness can set in.
Loss of Motivation (Diabetes Burnout)
Distress can lead to disengagement—skipping blood glucose checks, avoiding medications, or ignoring appointments. This withdrawal mirrors the loss of interest seen in depression.
Self-Blame and Guilt
People often internalise glucose readings as personal success or failure (“My numbers are bad—so I must be bad”), eroding self-esteem and promoting depressive thought patterns.
Biological Stress Pathways
Chronic stress increases cortisol and adrenaline, which raise blood glucose. Persistently high levels, in turn, affect brain chemistry involved in mood regulation—creating a feedback loop.
Social Isolation
Feeling “different” or misunderstood can reduce connection and belonging, increasing vulnerability to depression.

Diabetes Distress vs Depression

Feature	Diabetes Distress	Depression
Focus	Specific to diabetes management	Generalised across all life areas
Duration	Fluctuates with diabetes challenges	Persists ≥2 weeks or longer
Emotions	Frustration, guilt, burnout	Hopelessness, sadness, disinterest
Impact	Reduced engagement with self-care	Global loss of motivation
Overlap	Can co-exist; distress can lead to depression if chronic or unaddressed

Studies suggest that up to half of those with high diabetes distress also meet criteria for depression — highlighting the need for early identification and support.

Preventing the Transition

Early recognition and screening
Healthcare providers should ask about emotional wellbeing at every visit. The Diabetes Distress Scale (DDS) is a helpful screening tool.
Supportive care
Person-centred, non-judgemental care helps people feel heard and supported rather than blamed for their results.
Psychological interventions
Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), and mindfulness-based approaches reduce both distress and depressive symptoms.
Strengthening social and cultural support
Peer groups, whānau involvement, and culturally grounded models like Te Whare Tapa Whā (balancing physical, mental, spiritual, and family health) restore connection and wellbeing.
Addressing practical barriers
Financial hardship, limited access to care, and inequities all fuel distress — tackling these is essential for emotional health.

Anxiety in Type 1 Diabetes

Type 1 diabetes (T1D) often begins in childhood or adolescence, a developmental stage already marked by social and emotional changes. The sudden transition from being carefree to needing constant self-management can be overwhelming.

Unique Anxiety Triggers in T1D

Fear of hypoglycaemia (low blood glucose):
People who have experienced severe lows may develop intense anxiety about it happening again, leading them to run glucose levels high “just to be safe.”
Needle anxiety:
Regular injections or continuous glucose monitoring can heighten anxiety, particularly in young people.
Performance anxiety around glucose numbers:
Each blood sugar check can feel like a “test result,” producing guilt or shame when readings aren’t in target.
Social anxiety:
Managing diabetes publicly can cause embarrassment or fear of stigma.

Psychological Impact

The daily burden of managing T1D can erode confidence and heighten perfectionism. Over time, this pressure can trigger chronic anxiety, burnout, or depression.

Anxiety in Type 2 Diabetes

Type 2 diabetes (T2D) often carries a different emotional load. Many people experience anxiety linked to lifestyle change, complications, or social perceptions.

Common Anxiety Drivers in T2D

Diagnosis shock
Health anxieties about long-term complications
Treatment anxiety when starting insulin
Stigma and self-blame
Socioeconomic pressures that limit access to care or healthy food

Anxiety may also arise from past trauma, social inequities, or cultural expectations—factors particularly relevant for Māori and Pacific communities in Aotearoa New Zealand.

Depression in Type 1 Diabetes

The need for constant vigilance—checking glucose, adjusting insulin, planning for every meal—can be emotionally exhausting.

Contributors to Depression in T1D

Diabetes burnout
Unpredictable glucose responses
Feelings of isolation or “being different”
Physical symptoms from fluctuating glucose

Impact

Depression in T1D is linked to:

Poorer glucose control
More frequent hospitalisations
Lower adherence to treatment
Reduced quality of life

Depression in Type 2 Diabetes

Depression is common both before and after diagnosis. In fact, depression may increase the risk of developing T2D via reduced activity, emotional eating, and stress-related metabolic changes.

Contributors to Depression in T2D

Adjustment to diagnosis
Complications or chronic pain
Medication fatigue
Sleep disruption
Social isolation and stigma

Depression can create a self-perpetuating cycle of low motivation, poor glucose control, and worsening mood.

Biological Links Between Diabetes, Anxiety, and Depression

Inflammation: chronic low-grade inflammation is linked to both insulin resistance and mood disorders.
Stress hormones: cortisol and adrenaline raise blood glucose and affect mood regulation.
Neurotransmitters: insulin resistance may disrupt serotonin and dopamine activity.
Sleep disruption: common in diabetes, and a key trigger for mood symptoms.

These overlapping pathways reinforce the need for integrated care—treating body and mind together.

When to Seek Help

It’s normal to feel frustrated or anxious about diabetes. But when sadness, fear, or apathy persist, professional help is needed.

Warning signs include:

Hopelessness or loss of motivation
Avoiding self-care or appointments
Sleep or appetite changes
Withdrawal from others
Increased alcohol or substance use
Thoughts of self-harm (always a medical emergency)

Coping Strategies and Support

Psychological Therapies

CBT: challenges unhelpful thoughts (“I’ll never manage this”).
ACT: helps accept difficult emotions while pursuing meaningful goals.
Mindfulness: improves emotional regulation and reduces stress.

Medical Treatment

Antidepressant or anti-anxiety medication may be appropriate and can be safely combined with diabetes management under medical supervision.

Lifestyle and Social Support

Regular activity, balanced nutrition, and good sleep
Peer and whānau connection
Relaxation, creative or spiritual activities
Culturally grounded wellbeing models (e.g., Te Whare Tapa Whā, Fonofale)

The Role of Healthcare Teams

Emotional wellbeing should be a routine part of diabetes care.
Effective teams:

Screen for distress, anxiety, and depression
Provide integrated diabetes–mental health support
Foster compassion and collaboration, not blame

When mental health is prioritised, glycaemic control and quality of life both improve.

Moving Forward: Hope and Healing

Living with diabetes can feel overwhelming at times, but it doesn’t have to mean living with anxiety or depression. With early recognition, supportive care, and access to psychological resources, recovery and resilience are absolutely achievable.

People who engage with emotional support often report not just improved mood but also renewed motivation, confidence, and sense of control over their diabetes. Healing involves restoring balance—physically, emotionally, socially, and spiritually.

Key Takeaways

Anxiety and depression are common but treatable in diabetes.
Diabetes distress can lead to depression if left unaddressed.
Type 1 and type 2 diabetes carry different emotional challenges but share common themes of pressure and fear.
Integrated care and social support improve both emotional and physical outcomes.
Holistic and culturally grounded approaches strengthen long-term wellbeing.