Diabetes & Depression: What You Need to Know

It’s no wonder people with diabetes experience a higher rate of depression compared to the non-diabetic population. Every single day we are tasked with an impossible juggling act. One little slip or miscalculation can leave us vulnerable to the dangers of high and low blood sugars for hours.

And the pressure to do it all perfectly never stops.

Whether you have type 1, type 1.5, or type 2 diabetes, the stress and challenges that come with living with diabetes can lead to depression.

In this article, we’ll look at the prevalence of depression in people with diabetes, the signs and symptoms of depression and anxiety, the difference between “diabetes burnout” and depression, treatment and support, and how to relieve a little of the pressure on your life with diabetes.

Depression in people with diabetes: how common is it?

If you’ve ever lived a day in the life of managing diabetes, there’s no mystery as to why we are more prone to developing depression. Every single day — including every single hour — managing our blood sugars requires constant attention, effort, concern, and diligence.

Whether you’re reaching your HbA1c goals or you’ve stopped caring, diabetes can be the source of your depression.

When reviewing statistics about depression in people with diabetes, the results vary greatly based on inconsistent variables including the definition of depression (mild vs. major, for example), the age of the participants, and the type of diabetes.

A 2009 study published in the American Diabetes Association’s Diabetes Care journal reports an 8.3 percent prevalence of “major” depression in people with type 1 diabetes compared to the non-diabetic population at 5.3 percent.

Another 2009 study from the University of Washington reported that 80 percent of people with type 2 diabetes were struggling with depression.

A 2014 study published in Endocrine magazine concluded that 20 to 30 percent of patients with diabetes suffer from “clinically relevant depressive disorders.” And 10 percent of those patients were affected by a major depressive disorder.

While the studies don’t seem to agree with similar percentages or rates of depression, it is clear that people with diabetes face a higher risk of depression than non-diabetics.

Depression vs. diabetes burnout: signs & symptoms

When talking about depression in people with diabetes, it’s critical to talk about “diabetes burnout,” too, because burnout could easily be described as a very specific form of depression.

The difference between depression and burnout

Quite simply, the difference is that burnout affects how you manage your diabetes.

Depression may affect your diabetes but it also affects other aspects of your life, like your career, social life, relationships, your academics, and your overall wellbeing.

That being said, having diabetes absolutely increases the likelihood of developing depression. Diabetes may be something that causes you depression and stress, but that doesn’t necessarily mean what you’re feeling is “diabetes burnout” if those feelings are affecting many parts of your life, rather than just how you manage your diabetes.

Signs and symptoms of depression

The National Institute of Mental Health lists the following as signs and symptoms of depression.

If you have been experiencing even just a few of these signs and symptoms for a large part of every day for at least two weeks, you may be struggling with depression.

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, or pessimism
• Irritability
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Moving or talking more slowly
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Signs and symptoms of diabetes burnout

Diabetes burnout is a well-known term in the diabetes community, but it isn’t medically recognized at your doctor’s office. There, they would likely refer to it as depression.

Here are a few signs and symptoms of diabetes burnout — but remember, burnout can look a little different for everyone.

• Testing your blood sugar less (or practically never)
• Skipping insulin doses
• Lying about your blood sugar levels
• Skipping appointments with your healthcare team
• Ignoring symptoms of high blood sugars
• Purposefully running blood sugars higher than usual
• Ignoring carbohydrate counts
• Overall denial that you have diabetes
• Lack of acceptance that diabetes is a real part of your life
• For dangerous insulin omission, please read about diabulimia & recovery

If you are struggling with diabetes burnout, many will suggest that the only way out is through. And most importantly, to give yourself permission to feel burnt-out instead of trying to fix it right away.

As long as you are taking enough insulin to keep yourself out of the hospital and keep yourself reasonably healthy, Dr. William Polonsky recommends taking a “diabetes vacation” by lightening up on the pressure of diabetes management.

In other words: step back a little and do what you need to do to simply be healthy enough to stay out of the hospital. Maybe for a few days, maybe for two weeks.

Read more about diabetes burnout in these books:

• Dealing with Diabetes Burnout: How to Recharge & Get Back on Track by Ginger Vieira
• Diabetes Burnout: What To Do When You Can’t Take It Anymore by Dr. Polonsky

Treating and managing depression in people with diabetes

Here are the recommended steps from the American Diabetes Association and the National Institute of Mental Health for treating and managing depression as a person with diabetes.

Talk to your primary care doctor or diabetes healthcare team

While it may be difficult to speak up and ask for help, remember that your doctor probably has many patients who have struggled with depression. There’s no reason to be embarrassed or ashamed — depression is common!

Take a look at your blood sugars…  

When our blood sugars are high, we aren’t getting the fuel we need to function physically or mentally, and it can increase feelings of depression. Making a few simple changes in your insulin regimen may help bring your blood sugars down a bit — without any other effort. You may notice your feelings of depression lessen as your blood sugars are under 250 mg/dL more often.

Your doctor will likely recommend scheduling a session with a therapist

This is an opportunity to get help. All too often, patients struggling with depression may avoid actually showing up for that therapy appointment, because sometimes it’s easier to stay where we are (even if we aren’t happy there) than it is to face what we’re feeling and work through it. And if you don’t like that first therapist, ask your doctor to help you find another one.

Antidepressants can be very helpful for some people

There’s no shame in needing an antidepressant, but they aren’t a magical fix either. Taking antidepressants requires patience (they don’t usually work right away) and discipline (you need to take them consistently to feel the effects).

Categories of  antidepressants include:

• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Selective serotonin reuptake inhibitors (SSRIs)
• Atypical antidepressants
• Tricyclic antidepressants
• Monamine oxidase inhibitors (MAOIs)

Some antidepressants might call for an increase in your insulin dosages, or they might increase your appetite which can also require more insulin both with meals and in your background insulin doses. Talk to your doctor carefully about starting any antidepressants and how they might impact your diabetes management needs.

Also, remember that there are several different kinds of antidepressants, so the first you try may not be the right fit for your body and your depression.

Remember depression doesn’t always last forever

Remember this may just be a phase in your life. You may need antidepressants for one year or 10. You may just need therapy appointments to help you work through a stressful period in your life. Life is a constant ride of ups and downs. The “ups” never last forever, and the “downs” never last forever either.

If you’re having thoughts about suicide… 

Please — please — contact the National Suicide Prevention Hotline at 1-800-273-8255 for support.

Tips for reducing the stress of diabetes management

With a disease like diabetes, it’s no wonder we’re at a higher risk for depression. We have to be constantly on the ball or we feel like we’re failures.

Instead, there are a few things you can do to help relieve some of that diabetes management pressure and that unattainable expectation of perfection.

Remind yourself: I’m doing the best I can.

Some days that looks like this, and some days it looks like that.

Remind yourself: It’s just a blood sugar

It doesn’t define anything about who I am. It’s simply a number that means I need more or less of a certain medication or food or activity! It’s just a number.

Remind yourself: One day at a time

Diabetes is a long game. We’ve gotta deal with this for years to come, so obsessing and stressing over every minute of that game is going to get tiring fast. Realistically, the best we can do is approach it day-by-day.

Remind yourself: It doesn’t need to be perfect

Real life with diabetes isn’t perfect. Your food choices don’t need to be perfect all day long. Your blood sugars don’t need to be perfect all day long. It’s not about perfection. Aim for the 80/20 rule. 80 percent of the day is healthy choices, with room for 20 percent being not-so-healthy.

Find your diabetes community

There are so many wonderful diabetes groups, hashtags, and people (Instagram, Twitter, Facebook) out there. Keep looking for the one that feels right to you. Here are a few:

• Diabetes Strong facebook community
• The BeyondType1 app
• DiabetesSisters.org
• ChildrenwithDiabetes.com
• Follow hashtags on Instagram and Twitter: #type1diabetes #type2diabetes #T1Dlookslikeme #doc #gbdoc #T1D #T2D #diabetes
• And more! Go look for them! There are so many diabetes groups and communities out there.

Diabetes and depression is a big deal. And you’re not alone! Reach out for support. Ask for help. And definitely let those closest to you know what you’re going through. You never know, they might be dealing with the challenges of depression, too.