Type 1 Diabetes Anxiety and Depression Management

Type 1 diabetes is nonstop.

There are no vacations or breaks. You couldn’t ignore your type 1 diabetes (T1D) if you tried because it requires hour-by-hour effort just to keep yourself safe and healthy.

There’s a special name for the impact of T1D on your mental health: diabetes distress. The term was created to better acknowledge how much this condition impacts a person’s emotional well-being. Diabetes distress can include anxiety and depression, but it’s very specific to your diabetes without affecting other parts of your life.

Anxiety, depression, and burnout are very real parts of living with T1D. Understanding the differences between these mental health concerns is important because it changes what kind of support might help.

Anxiety

Anxiety is about worry over what might happen. And there’s plenty to worry about when you live with T1D. You’re worrying about the immediate and long-term challenges of this condition. This includes the hour-by-hour risk of lows and highs, getting the medications and supplies you need, scheduling appointments, juggling nutrition, and so much more.

The long-term worry is hard to ignore too: complications. When all that worry piles up, it’s easy to feel anxious regularly. That anxiety might spill over into your everyday life too.

Anxiety can be easy to dismiss as, “Oh, I’m just stressed out. I’m just a worrier.” But anxiety can also impact your daily life and ability to enjoy the day, so we shouldn’t ignore it.

Anxiety can also come out in other ways that aren’t so obvious, like anger, tears, trying to control everything around you, or avoiding everyday activities and interactions with friends.

If you think you’re experiencing a lot of anxiety, don’t dismiss it. Talk to your healthcare team.

Depression

According to the World Health Organization, depression affects over 350 million people across the globe. For people with diabetes, depression can be even more common—affecting one in four people with type 1 and type 2 diabetes. But many people never get support or treatment.

Dealing with depression on your own can make life with T1D harder, too. Research has found that depression can affect your A1c and your ability to perform at school or work. It can also increase your risk of diabetic ketoacidosis (DKA) and severe hypoglycemia.

Symptoms of depression in adults include:

Feelings of sadness or hopelessness
Loss of interest or pleasure in activities you used to enjoy
Changes in sleep—either too much or not enough
Changes in appetite—either eating too much or not enough (and sometimes changes in weight)
Tiredness and lack of energy, so even doing small thing take extra effort
Slowed thinking, speaking, or body movements
Trouble concentrating, making decisions, or remembering things
Feelings of worthlessness or guilt, fixating on past failures, or self-blame
Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts, or suicide

In children, symptoms of depression may also include:

Clinginess
Irritability
Body aches and pains
Refusing to go to school
Poor performance in school

In older children and teenagers, symptoms of depression may also include:

Irritability and anger
Poor performance or poor attendance at school
Feeling misunderstood
Being extremely sensitive
Avoiding social activities
Use of recreational drugs or alcohol

Asking for help can be hard, but speaking up is worth it. You don’t have to deal with this alone, and there are resources to help. Ask your diabetes care team for evaluation and a referral.

Distress and burnout

Diabetes distress is defined as a range of emotions specific to living with diabetes. This includes feeling overwhelmed by the burden of managing diabetes, fear of complications, dealing with complications, fear of hypoglycemia, feeling defeated with your A1c or time-in-range, the stress of wearing diabetes technology, anxiety over the cost of diabetes and health insurance struggles, and the impact of diabetes on your other day-to-day responsibilities.

Compared with major depressive disorder or anxiety, diabetes distress:

Is diagnosed in people with diabetes
Is not considered to be a psychiatric disorder
Is far more common than depression or anxiety
Shares some similar symptoms but does not meet the criteria for major depressive disorder or anxiety
Is unlikely to respond to medications like depression or anxiety do
Is often directly linked to challenges with diabetes management and self-care (even at low levels of distress)

Diabetes distress shouldn’t be dismissed. You have every right to feel overwhelmed by this condition. While you cannot change your diagnosis, you can get support—which starts with telling your healthcare team you’re struggling.

Diabetes burnout comes right along with distress. Who wouldn’t be tired of managing a condition that is non-stop?

For some people, burnout can mean you’ve nearly stopped all daily steps in managing diabetes—potentially putting yourself in grave danger, too. For others, it might mean you’re still taking your insulin and checking your blood glucose, but you’re feeling very discouraged and exhausted.

All forms of diabetes burnout are valid, but if your burnout has led you to skip insulin and risk hospitalization, it’s time to ask your healthcare team for more support. T1D is hard, every single day. Don’t go through it alone.

Ask for support

You don’t need to face this alone. There are resources, treatments, and communities who will understand exactly what you’re going through, but getting support starts with letting your friends, family, and healthcare team know that you are struggling.

Immediate assistance through 988

If you or a loved one is having thoughts of suicide, feeling emotional distress, or struggling with substance misuse, call 988 and visit the SAMHSA website. 988 is a free national hotline to provide mental health support—think of it like 911 but for mental health. You can call any day or time, 365 days a year.

visit the SAMHSA website