Mental health includes emotions and affects how we think and feel. It also includes how we interact with those around us and how we handle stress. Your daily living, relationships, and physical health are impacted by your mental health—and can also contribute to mental health issues.

One in five American adults have a mental health issue and one in six adults experience serious depression before adulthood.1 Sadly, people living with diabetes are at increased risk for mental health issues, including stress, anxiety, depression, disordered eating, and self-management burnout. For those who also have additional chronic conditions such as heart disease, arthritis, kidney disease, or stroke, the risk is even higher.

The Association of Diabetes Care and Education Specialists (ADCES) recognizes seven self-care behaviors for successful diabetes self-management:

  1. Healthy coping
  2. Healthy eating
  3. Being active
  4. Taking medication(s)
  5. Monitoring
  6. Problem-solving
  7. Reducing risks


Sources of Diabetes-Related Stress

Healthy coping skills are critical to learning strategies for successful diabetes self-management practices. Defined as “a positive attitude toward diabetes and self-management, positive relationships with others, and quality of life”, healthy coping, or positive mental health determines a person’s ability to learn and then practice behaviors associated with successful diabetes self-management. Here are common sources of diabetes-related stress:

  • Diabetes diagnosis. Acknowledging concerns, beliefs, and potential fears at diagnosis is critical to moving forward to positive self-management. People who believe diabetes cannot be managed can lack the motivation to learn how to be successful.
  • Day-to-day living with diabetes. Fear of hypoglycemia, hyperglycemia, and long-term complications, plus the unpredictable nature of diabetes can frequently overwhelm the most resilient person.
  • Inadequate support structure. A lack of support from significant others and/or access to healthcare intervention can present a barrier many people have difficulty overcoming.
  • Singular focus on self-management behavior. For example, eating behaviors can be a target of scrutiny and criticism and an inability to achieve a goal sometimes results in unhealthy coping responses.
  • Time management demands. Increased self-management tasks can be disruptive and/or time demanding.
  • Living becomes a number game. Focusing on the “numbers” of diabetes sometimes sacrifices the quality of life associated with living with diabetes.
  • Financial circumstances. Changing diet, new medications, monitoring supplies, time away from work, doctor appointments, and lab work—for many people, the financial tension never stops.

An understanding of diabetes self-management is important; many of the above stress-related triggers are addressed by Diabetes Care and Education Specialists. Unfortunately, though, less than 10% of people diagnosed with diabetes receive a comprehensive education in diabetes self-management skills.


Signs and Symptoms of Mental Health Disruption

However, knowing what to do is not the same as doing what needs to be done. Life can get in the way and putting behaviors in action can become an obstacle course. Even the most capable person with diabetes may stumble and begin to feel challenged. Signs and symptoms include:

  • Feeling down, depressed, or hopeless
  • Feeling nervous, anxious, or on edge
  • Not being able to stop or control worrying
  • Little interest or pleasure in doing things
  • Lingering feelings of guilt over small mistakes or indiscretions
  • Difficulty concentrating and staying on task; the simplest diabetes self-management task seems overly complicated and resented
  • Feelings of being controlled by diabetes rather than engaging in self-management frequently leads to feelings of anxiousness, irritability, and poor sleep.
  • Disregard to routine wellness and safety behaviors

No matter what triggers depression and no matter how the depression feels, for persons with diabetes, addressing mental health challenges and/or treating diabetes-related stress is part of managing diabetes. Tips to avoid diabetes-related stress include:

  1. Keep medical appointments and seek advice. Your healthcare provider can be a valuable resource to issues surrounding the day-to-day demands of living with diabetes.
  2. Join a diabetes support group. Face-to-face or virtually, just reach out and engage. Today, many support groups are available through online resources.
  3. Have realistic expectations. Diabetes management changes over time with new medications, comorbidities, age-related changes, and more. Living with diabetes involves a learning curve that extends across the lifespan.
  4. There is no one-size-fits-all in diabetes. Every individual’s physiology is unique. You may not be the best candidate for the newest medication, or you may respond to foods and some glucose influencers differently than others. Expect the unexpected and commit to learning about your diabetes.
  5. Be resilient. Sometimes you will do all the right things and get all the wrong results. While it is easy to complain about this, remember, there will be times you’ll test fate and will be pleasantly surprised by the outcomes.
  6. Learn to laugh. The hormones associated with laughing—even forced (fake) laughing—have a positive therapeutic effect by releasing endorphins, our “feel good hormone.” While the hormone release won’t solve your diabetes management issues, it will change the way you look at them.


A person struggling with mental health issues will usually need to make changes to their lifestyle to facilitate mental wellness. Treatment options are many, but the journey to wellness begins with first, recognizing there may be a problem, and then seeking assistance.


“Mental health . . . is not a destination, but a process. It’s about how you drive, not where you’re going.”

~ Noam Shpancer, PhD


  1. “Mental Health Myths and Facts.”