We know that there are lots of ways in which diabetes and mental health affect each other.
In the UK, around 36,000 young people aged under 19 have diabetes*. It’s really important that they can access high-quality information and advice about managing their wellbeing.
We spoke to Dr Catherine Theodoraki, a Consultant in Endocrinology and Diabetes at Chelsea and Westminster Hospital, to find out more about diabetes and mental health.
Could you start by giving us a quick explanation of what diabetes is?
Absolutely! Diabetes is the term we use for diabetes mellitus, which is a condition of high blood sugar.
We all have sugar (also called glucose) in our blood to give our cells energy. Our bodies need a hormone called insulin (made by an organ called the pancreas) to control how much sugar is in our blood. When someone has diabetes mellitus, the level of sugar in their blood becomes too high.
For the vast majority of people, diabetes mellitus is a chronic condition, which means it lasts for a long time and needs to be ‘managed’, rather than ‘cured’.
Diabetes can happen for different reasons. Most people have type two diabetes. This is where high levels of insulin over time mean that, after a while, insulin becomes ineffective.
The second most common subtype of diabetes is type one diabetes, which is an autoimmune condition. Our immune system protects us from bacteria and viruses. Autoimmune conditions happen when someone’s body attacks their own cells because they mistake them for something else. In type one diabetes, a person’s antibodies (proteins in our blood that usually protect us against bacteria and viruses) attack and destroy the specialised beta islet cells in their pancreas, which produce insulin.
Which type of diabetes is more common in children and young people?
Type one diabetes is more common in young people. It’s not caused by lifestyle choices People have a predisposition to type one diabetes – they’re more likely to develop it because of the genes they were born with.
In the past two decades, the number of young people living with type two diabetes has also increased. In the past, type one diabetes was almost the exclusive form of diabetes in young people and children, but nowadays we do see children and young people with type two diabetes as well.
Are there links between diabetes and mental health? How does diabetes affect mental health?
Diabetes is a chronic condition that relies a lot on self-management skills that people learn. This includes taking medications at certain times and adjusting them based on their food intake and activity levels. As such, it has a big impact on people’s day-to-day activities and sometimes things don’t go to plan despite people’s best efforts.
Due to the complexities of living with diabetes, people can feel stressed about the demands of living with it or develop symptoms of low mood. In fact, people with diabetes are two to three times more likely to have depression and 20% more likely to have anxiety at some point in their life (compared to people without diabetes).
‘Diabetes distress’ is a term we use to describe the mental health symptoms that people develop because of living with diabetes. The symptoms can include feeling overwhelmed, tired, and frustrated. Diabetes distress can happen in both type one and type two diabetes.
There are also specific issues that arise from the monitoring of blood glucoses and the treatment with injections. The majority of people with type one diabetes are on insulin injections, up to four or five injections a day – as you can imagine, at least in the beginning, it’s not easy. People learn to do it, but they also have to check their blood glucose many times a day. This has an impact because it can cause a lot of anxiety. Also, some people have needle phobias, which is another way diabetes and mental health are linked.
Being on insulin can sometimes lead to hypoglycaemia as a complication – that means low blood sugar levels that need to be treated urgently. Hypoglycaemia causes symptoms such as sweating and palpitations, and if it’s not treated (or the blood glucose is very low for a long period of time) it can be very serious. Sometimes people might develop a fear of hypos – they might keep their blood glucose above the range to avoid them at all costs, which means less well controlled diabetes.
Wow, that’s a lot. I can imagine that some mental health symptoms can also affect how you manage your diabetes. If your mood is really low, for example, you might not feel motivated to check your blood sugar or struggle to look after yourself?
Yes, you’re absolutely right. We know that higher levels of diabetes distress are associated with higher levels of blood sugar levels (less well controlled diabetes) on average in clinical studies.
Feeling very anxious, overwhelmed, or low can affect people’s day to day decisions when living with diabetes, which can make the diabetes control worse. Problems with diabetes can make mental health problems worse too. But fortunately, if one gets better, the other tends to get better, too.
We also know that higher levels of diabetes distress are sometimes linked with disordered eating. People may developmaladaptive eating behaviours, but these can lead to harm.
It’s important that, if you’re struggling with diabetes distress, you talk to someone about it.
Do you often see young people whose mental health is affected by diabetes?
There are tools (for example, questionnaires that have been developed and extensively tested) that we use to assess people’s mood and symptoms of distress and anxiety. These help us to understand if people have symptoms that suggest high levels of distress or disordered eating. And of course we ask people in clinic how they feel.
In terms of disordered eating and diabetes, I think it is something that is relatively under-reported, which in fact is true with most mental health symptoms. It can be difficult to talk about – it’s important that people know that they’re not alone and that their teams are there to help them.
Sometimes doctors and nurses can come in and focus on the ‘medical’ aspects of things, you know, the blood glucose, the blood pressure, the foot examination, the retinal (eye) screening… sometimes we don’t focus as much on the wellbeing, but that’s perhaps the most important aspect of care! If someone’s not in a good place, it’s less likely that they can manage their diabetes.
Definitely. What can friends and family do to support a young person who’s been diagnosed with diabetes?
The first thing is to listen to the person and try to understand what they’re saying and are asking for.
Try to find where you can support them. Knowing how to manage in case of an emergency is really important, for example, knowing how to help in case of hypoglycaemia. It might also help them feel less anxious.
And encourage them to be open about their condition – it really needs to be accepted as part of life, rather than something separate that is hidden. I think this can make it easier to encourage your friend or family member to look after themselves.
There’s a lot of information out there. It’s important to know which resources are more useful, and that’s something friends and family can help explore too. It’s best to use reliable sources like the NHS website, Diabetes UK, and JDRF (a type one diabetes charity).
Who can young people with diabetes talk to if they’re struggling with their mental health or feeling low or anxious?
There are NHS mental health teams for young people in each borough. Best For You has information about mental health support for young people in North West London as well as information about digital mental health support. Lots of mental health teams have a branch for people with chronic conditions, like diabetes.
I think having a strong group of peers is important too. For example, Diabetes UK has links to peer support groups. Sugar buddies is one place people over 18 can get more informal support, if that’s something they’d like to explore.
It’s very important for people to speak to their diabetes team, such as their diabetes nurse and diabetes doctor. Often, specialist psychologists and psychiatrists work with diabetes teams to offer support.
When people are open with their team, we can think of solutions and support people throughout their lives. We may mention numbers in our appointments, and it may sound like we’re being slightly clinical. But in reality, we’re only here to help! That is, we want to support people and provide individualised care depending on their needs.
If you need urgent support, check out the Get help now page.
* Statistic from the diabetes page on the Royal College of Paediatrics and Child Health website.