Type 2 Diabetes and Mental Health

When you have type 2 diabetes, it’s easy to feel like you’re doing everything right but still not making progress. That frustration can take a toll on your mental health and trap you in a negative cycle — managing the disease causes you stress, and stress hormones raise your blood sugar.

When you understand this mind-body connection, you can take steps to improve your mental health and control your type 2 diabetes at the same time.

The Bidirectional Link

“Emotional health is not separate from diabetes — it is central to outcomes,” says Barbara Eichorst, RD, CDCES, the vice president of healthcare programs at the American Diabetes Association in Chicago.

“I put it to patients as a feedback loop,” says Ritu Goel, MD, a double board-certified psychiatrist with a private practice based in Long Beach, California. “Stress raises blood sugar, higher blood sugar causes more physiological stress, which in turn causes cortisol to rise.”

The body cannot distinguish between emotional and physical stress, so breaking this cycle means working at both ends simultaneously — not only addressing glucose, but also your body’s stress response, Dr. Goel adds.

The Medication ‘Catch 22’

Certain medications that are used to treat depression can increase metabolic risk.

“Discussing the metabolic effects of psychiatric medications with my patients is one of the most sensitive topics,” Goel says. But the metabolic risks of some medications are often outweighed by the dangers of not getting effective treatment for mental health issues, she says. “Untreated depression in diabetics can negatively affect A1C, blood pressure, cardiovascular risk factors, quality of life, and other measures.”

Goel’s approach is to selectively use medications with favorable metabolic profiles, such as bupropion (which may assist with weight control), serotonin and norepinephrine reuptake inhibitors (SNRIs) or other SSRIs like fluoxetine (Prozac) — and monitor weight, fasting glucose, and cholesterol, working closely with the patient’s endocrinologist.

“Patients should ask their psychiatrist about the metabolic profile of any medication they consider, request baseline metabolic labs, and recognize that medication choices vary,” Goel says. “Refusing psychiatric care due to metabolic risks without this thorough discussion is not advised.”

Diabetes Management Burnout

A particular issue when you’ve been living with type 2 diabetes is a phenomenon referred to as diabetes burnout.

“Many people feel exhausted managing diabetes, especially when they are doing everything right and not seeing the results they expect,” Eichorst says. “I focus on shifting from perfection to progress and helping people with diabetes see outcomes as data, not failure.”

Validation also helps. Goel tells patients: You’re not a failure. Your body is complicated, and the disease is intense. Your exhaustion is valid when faced with too much to handle.

“That validation can foster collaborative problem-solving and help you sort through the challenging aspects of management, identify what most people struggle with, minimize unneeded work, address sleep issues that interfere with tracking blood sugar levels, and determine whether depression or anxiety might exacerbate the physical struggles behind them,” Goel says.

Integrated Treatment and Support

For someone with type 2 diabetes and a mental health condition, your whole-person care team may include an endocrinologist, psychiatrist, primary care doctor, registered dietitian, and a therapist, Goel says.

“The key is integration: these providers need to communicate well and avoid working in silos,” Goel adds.

Beyond medication, some interventions that may both benefit your mental health and improve your A1C include:

• Mindfulness Practices One review found that mindfulness interventions had a small but statistically significant effect on A1C in most studies, but more research is needed.

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• Peer Support Groups One review of nine randomized controlled trials found that support through in-person groups, peer coaches, community health workers, and telehealth programs was associated with a significantly lower A1C in most trials, dropping up to almost 3 percent after 12 months.

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• Regular Aerobic Exercise Another review found that aerobic exercise improved type 2 diabetes and accompanying mental disorders at the same time through overlapping mechanisms, with both better glycemic control and reduced depression and anxiety.

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