Anxiety is common in people with diabetes due to the constant worry over fluctuating blood sugar levels, which can have serious consequences. Both high and low blood glucose (sugar) levels carry risks, making daily life stressful.
This article explores why people with diabetes are more prone to anxiety, the latest research on the topic, and available treatment options.
Key Points:
- Anxiety is common among people with diabetes due to the constant management of blood sugar and fear of complications.
- Both types experience anxiety, but the triggers differ, with type 1 focused on insulin and type 2 on fear of long-term complications.
- Therapy, medication, and support from healthcare teams can help manage anxiety in people with diabetes.
Table of Contents
- What is anxiety?
- Why anxiety is so common in people with diabetes
- Fear, diabetes, and anxiety
- Research on diabetes and anxiety
- Anxiety in youth with type 1 diabetes negatively impacts management
- People with type 2 diabetes exhibit more signs of anxiety than those without
- Pregnant women with diabetes at a higher risk for anxiety
- Depression and anxiety may increase a person’s risk of type 2 diabetes
- Symptoms of depression or anxiety in people with type 2 diabetes are associated with lower exercise frequency
- Managing and treating anxiety as a person with diabetes
- Remind yourself: living with diabetes is challenging!
What is anxiety?
Anxiety is intense worry about something that might happen or an outcome you can’t control.
While brief moments of concern are a normal part of life, it becomes a problem when it’s excessive or frequent enough to disrupt your daily life. This is often diagnosed as a generalized anxiety disorder or panic disorder.
According to the National Institutes of Health (NIH), symptoms of an anxiety disorder include:
- Excessive worry, most days, for at least 6 months
- Feeling restless or on edge
- Mental or physical fatigue
- Difficulty concentrating or feeling like your mind is blank
- Irritability and anger
- Overreacting to small things
- Muscle tension
- Sleep issues, such as insomnia, frequent waking, or feeling exhausted despite sleep
When these symptoms start impacting your relationships, work, or ability to manage daily tasks, it may be time to seek help.
Symptoms of panic disorder and actual panic attacks include:
- Recurrent and unexpected panic attacks
- Intense fear that escalates within minutes
- Triggers often linked to objects, places, or experiences
- Heart palpitations or racing heartbeat
- Sweating, trembling, or shaking
- Shortness of breath or feelings of being smothered
- A sense of impending doom or loss of control
- The eventual development of severe phobias
Why anxiety is so common in people with diabetes
Researchers at Yale once said that diabetes and anxiety are practically cousins.
Managing a chronic illness like type 1 or type 2 requires constant decision-making, which leads to fluctuating blood sugar levels — often with dangerous consequences. This creates a perfect environment for unease to develop.
Additionally, the ongoing worry about long-term complications is a constant presence, reinforced by healthcare professionals and the media.
Even the physical effects of low and high blood sugar themselves can trigger anxiety.
Type 1 diabetes and anxiety
Managing type 1 involves continual micromanagement of insulin, leading to concern from fears of complications, “imperfect” blood sugar levels, and dangerous low blood sugars.
The more variables a person can control — such as food, activity, hormones, stress, and hydration — the better they can manage blood sugar levels. However, when these variables become uncontrollable, worry easily arises, and diabetes burnout may follow.
Type 2 diabetes and anxiety
For some people with type 2, the use of insulin or other medications that lower blood sugar can create concerns around mild or severe hypoglycemia, much like in type 1 diabetes.
The constant effort to “control” blood sugar — something that can never be fully controlled — can be overwhelming.
Type 2 also brings a sense of helplessness, as the daily discipline required to manage blood sugar levels often feels daunting.
Striving for perfection every day can lead to feelings of failure and defeat, fueling anxiety even further.
Fear, diabetes, and anxiety
Fear is a significant part of anxiety and plays a large role in living with diabetes.
People with diabetes, regardless of age, can develop intense fears around various aspects of treatment, making it difficult to manage their condition and impacting daily life.
Common fears include:
- High or low blood sugars
- Needles and injection pain
- Dosing insulin for uncertain carb contents or difficult foods like pizza
- Applying CGM sensors or insulin pump infusion sites
- Watching blood sugar trends on a CGM
- Carbohydrates or specific food groups
- Blood sugar fluctuations during work, school, or activities
- Developing diabetes-related complications
One of the most common fears is hypoglycemia (low blood sugar). Let’s explore this in more detail.
Fear of low blood sugar (hypoglycemia)
Fear of low blood sugar is a common and justified form of worry for anyone taking insulin or medications that lower blood sugar.
Severe anxiety often develops after a traumatic low blood sugar episode, such as losing consciousness, needing a glucagon injection (a hormone that raises blood sugar levels), or experiencing a low while driving.
These experiences can completely erode a person’s confidence in managing typical low blood sugars.
Unfortunately, lows will inevitably happen again, and constantly running blood sugars high to avoid them is not a safe solution, as it puts your long-term health at risk.
Rebuilding confidence in managing lows takes time. Diabetes psychologist Dr. Mark Heyman, PhD, CDCES, from the Center for Diabetes & Mental Health helps people by reflecting on their experiences and gradually restoring their confidence.
For example, he sometimes guides people through mild lows in his office, allowing them to see that they can safely manage their blood sugars.
For those dealing with high blood sugars due to anxiety, healthcare teams can work together to adjust insulin doses gradually.
While the target for most people with diabetes is blood sugars between 70 and 180 mg/dL (3.9 to 10.0 mmol/L), aiming for 150 to 200 mg/dL (8.3 to 11.1 mmol/L) may be a safer starting point for those managing anxiety, compared to persistently high levels.
Talk to your healthcare team about how you’ve been managing and coping with this anxiety. They can help you find a safer path forward.
Research on diabetes and anxiety
If you’re feeling anxious as a person with diabetes, you’re not alone — a wealth of research supports the connection between these two conditions. In fact, the prevalence of anxiety in people with diabetes is well-documented, validating the struggles you may face.
Anxiety in youth with type 1 diabetes negatively impacts management
Managing diabetes as a teenager is challenging enough, but adding anxiety and depression makes it even harder.
See more in: Diabetes & Depression: What You Need to Know.
A 2016 study from Australia found that young people with type 1 who dealt with anxiety and depression had significantly compromised blood sugar management.
Higher blood sugars often lead to feelings of depression, fatigue, and a loss of enthusiasm for life, which in turn heightens anxiety.
The study emphasizes the importance of screening youth with diabetes for signs of anxiety and depression and providing early support.
A 2018 Yale study also highlighted that these young people are at an increased risk for eating disorders, likely stemming from the worries around food, activity, and body weight.
People with type 2 diabetes exhibit more signs of anxiety than those without
A 2016 study from North Carolina found that people with type 2 show both clinical and subclinical symptoms of anxiety more often than those without diabetes.
Researchers also noted that individuals with anxiety had more difficulty reaching their blood sugar targets and experienced higher rates of diabetes-related complications.
Similarly, a 2018 study from Bulgaria revealed that women with metabolic syndrome, which includes type 2 diabetes, had higher levels of anxiety and depression compared to those without metabolic syndrome.
Pregnant women with diabetes at a higher risk for anxiety
The pressure to maintain near-perfect blood sugar levels during pregnancy can be overwhelming. According to a 2016 study from Brazil, anxiety isn’t just likely — it should be expected.
Managing diabetes during pregnancy, with its increased variables, requires constant monitoring and insulin adjustments, along with the added stress of knowing that blood sugar levels directly impact the baby’s well-being.
The study also found that the concern experienced by pregnant women with diabetes was more generalized around the entire pregnancy, rather than linked to specific blood sugar levels at any given time.
Depression and anxiety may increase a person’s risk of type 2 diabetes
A 2017 study from Florida and Indiana found that 25 percent of people with depression and anxiety developed type 2 diabetes over a 10-year period.
The researchers concluded that better treatment and screening for mental health issues could help prevent the development of diabetes.
“These findings suggest that screening positive for anxiety is a risk factor for diabetes mellitus in older adults, independent of depression and traditional diabetes risk factors,” the researchers explained.
They emphasized that anxiety requires greater consideration in diabetes risk assessment and prevention efforts.
Symptoms of depression or anxiety in people with type 2 diabetes are associated with lower exercise frequency
A 2017 study from Canada found that people with type 2 diabetes who struggled with mental health issues like depression and anxiety exercised less frequently.
Researchers concluded that depression is not just a co-occurring condition but a genuine barrier to regular exercise in this population.
Managing and treating anxiety as a person with diabetes
Getting help for anxiety can be difficult for several reasons. One major hurdle is the stigma that often surrounds mental health issues, leading people to feel weak or flawed for struggling.
In reality, conditions like depression and anxiety are very common, even if they aren’t discussed as openly as more familiar topics like insulin pumps or low-carb recipes. Remember, you are not alone.
Ask your primary care doctor or healthcare team for help
Dealing with worry now doesn’t mean you’ll be dealing with it forever — especially if you get the right support.
Talk to your healthcare team about a referral to a therapist or discuss medications that can help.
There are many options available, but they can only help if you reach out.
Consider therapy
If you’re hesitant about therapy, remember that there are many different types. Not all involve sitting on a couch and talking about your life.
Options like cognitive therapy, EMDR, hypnotherapy, and even equine therapy can be effective in treating anxiety.
If your first therapist doesn’t feel like the right fit, ask your doctor to help you find another.
Consider taking a medication
Medication can help improve your mental state while you work on other aspects of your life.
Your worry might be tied to areas you can change, but in the meantime, medications that boost good chemicals like dopamine and serotonin can make a big difference.
Some medications for generalized anxiety are actually classified as antidepressants, such as:
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Selective serotonin reuptake inhibitors (SSRIs)
- Atypical antidepressants
- Tricyclic antidepressants
- Monoamine oxidase inhibitors (MAOIs)
Medications for anxiety or panic attacks, which act more quickly, include:
- Benzodiazepines
- Beta-blockers
It’s important to note that some of these medications might affect blood sugar levels and insulin resistance, so talk to your doctor about these potential impacts before starting any treatment.
Also, remember that finding the right antidepressant or anti-anxiety medication can take time, as the first one you try may not be the perfect fit.
Get help immediately if your anxiety or panic becomes severe
If your anxiety or a panic attack feels unmanageable, go to the nearest emergency room or urgent care clinic.
If you’re having thoughts about suicide
Contact the Suicide & Crisis Lifeline at 988 for immediate support.
Remind yourself: living with diabetes is challenging!
You’re doing a great job, even if it doesn’t always look perfect on paper. Perfection isn’t the goal.
Above all, remember you’re not alone — anxiety and depression are common struggles for people with diabetes because managing diabetes is inherently tough.
It’s normal to struggle and feel overwhelmed when your body isn’t handling something it’s supposed to manage on its own.
Take a deep breath — you can get through this.
Did you find this article helpful? Click Yes or No below to let us know!
M. Holland
I receive your emails several times a week. The content is usually so relevant and helpful. I’ve had T1D since 1971 and continue to learn new information.
This article about anxiety and depression is very interesting. I’ve had these conditions since childhood but didn’t realize that they are related to my diabetes. Yes… diabetes is a stressful fulltime job!
Frequent hypoglycemic episodes for 50+ years has definitely caused me anxiety and cognitive difficulties, several which are permanent. My new Endocrinologist put me on the Omnipod 5 pump and is keeping my glucose levels higher than I normally have. I now realize that it’s better to be “in range” than experience very low lows then swing to high highs – like a roller coaster! Hopefully this will stop my constant anxiety.
N/A
I believe high blood sugar and diabetes causes anxiety as a direct symptom, unrelated to worrying about the disease. Sometimes I would test my blood sugar when I was anxious for no reason, even at a time I did not suspect I could be T2. It was always high. I suspect the high blood sugar in and of itself causes the anxiety.
Rachel
Yes! This happens to me often. I believe a symptom of high blood sugar is rapid heartbeat which in turn, feels like a panic attack is coming. Knowing this has helped. I can take comfort knowing the feeling will go away when I take my insulin.