Diabetes and mental health: The overlooked epidemic affecting millions

With cases of diabetes going up exponentially in the recent past, TNIE speaks to health professionals about the unique relationship between the disease and mental health
Representative image
Representative image

KOCHI: In India, as per estimates, around 77 million people above the age of 18 are suffering from diabetes and 25 million are at a higher risk of developing diabetes in the near future. Meanwhile, more than 50% of people are unaware of their diabetic status leading to further health complications. Adults with diabetes have a two- to three-fold increased risk of heart attacks and strokes. However, among these pertinent issues, one is always overlooked. The mental health of diabetes patients.  

Sarah, 47, meticulously crafted a healthy lifestyle to ward off her family’s diabetes curse. However, a routine test gave way to the diagnosis that despite her disciplined life, the disease had found her. Soon, panic attacks followed, her mind swirling with images of her father’s demise from diabetes-induced kidney failure.

Then, there is the 23-year-old Manu who fell unconscious and had to be rushed to the ICU. It was at the hospital he found out that he had Diabetic Ketoacidosis, a life-threatening complication of Type-1 diabetes when not managed properly. The episode persists in his mind as a trauma,  the fear of falling unconscious making his life more anxious.

The distance between diabetes and psychiatric disorders is very minute, almost like a silent dance, it finds a rhythm, entwining body and mind in a delicate and often devastating waltz.

Studies suggest diabetes is one of the most behaviorally taxing chronic medical conditions susceptible to developing mental health disorders. According to the Centers for Disease Control and Prevention, the national public health agency in the US, “people with diabetes are two to three times more likely to have depression than people without diabetes.”

Researches also suggest that around 30 to 50% of individuals with diabetes may experience some form of mental health disorder during their lifetime. This includes conditions such as depression, schizophrenia, anxiety, and diabetes distress.

“Diabetes and psychiatric disorders have a bi-directional relationship,” says Dr Praveen Arathil, consultant psychologist at Renai Medicity. Patients with diabetes are at higher risk of developing psychiatric disorders, and vice versa, he adds.

According to him, the emotional and financial toll of managing a chronic illness significantly impacts mental wellness. Many patients even face sleep terminal insomnia.

“This perpetual exhaustion, coupled with the constant vigilance to manage diabetes, increases the risk of depression and anxiety, impairing cognitive functions and decision-making abilities,” Praveen says.

‘Stressful to manage’

There was a time when diabetes was predominantly a disease of the elderly, affecting those over 55. However, today the scenario has changed. Early detection and unhealthy lifestyles — processed food and easy access — mean even youngsters are diagnosed, say health experts.

Dr Arun B Nair, professor of psychiatry at the Government Medical College, Thiruvananthapuram, recalls a recent patient he encountered.

“He was 15 and diagnosed with Type-1 diabetes. He was famous among his friends, parents and school for his academic brilliance.  But after the diagnosis, he suffered from sleepless nights and depression,” Arun says.

His journey began not only with insulin injections but with a crushing fear of a life diminished. Medication and hearing the experiences of those who triumphed despite their diagnosis helped him manage his fear. “His story is a reminder that the health journey is as much about healing the mind as it is about managing the body,” Arun says.

Type-1 diabetes, the one the boy was suffering from, is an autoimmune disease. “It is particularly stressful to manage due to fluctuating levels,” adds Arun. Long-term diabetes patients, plagued by frequent awakenings, find their sleep becoming superficial — another chronic condition born from chemical changes in the brain.

“Frequent psychological check-ups are as crucial as routine health check-ups. Diabetes distress can lead to thoughts like ‘I cannot cope with this disease,’ ‘I cannot live a normal life,’ and ‘My life is full of obstructions, etc. Which will then lead to other mental health complications,” he says.

According to him, early detection of diabetes distress — where people experience stress, guilt, or denial due to the burden of self-management — followed by psychotherapy and acceptance and commitment therapy, can prevent patients from slipping into depression.

Catch-22

Dr Girish P, Consultant Endocrinologist at Renai Medicity, says in normal populations, 10 per cent suffer from depression, but in the diabetic population, it’s nearly 35%.

“This being a chronic disease might cause frustration in some. But support from family and friends can help them overcome it. After the initial shock, people can comprehend the situation and adjust to a new lifestyle. It might take a while to grasp this new reality,” says Girish.

He adds another layer to the narrative. “While anxiety and depression do not trigger Type-1 diabetes, they can contribute to Type-2 through overeating. For example, many people with depression tend to overeat. Also, most psychiatric drugs can cause weight gain, increasing the risk of Type-2 diabetes.”

Eating disorders, particularly binge eating disorder and bulimia nervosa, are associated with an increased risk of diabetes. Girish stresses that these disorders can lead to weight gain and obesity, which are major risk factors for diabetes. “The erratic eating patterns and potential purging behaviours can disrupt normal glucose metabolism,” he adds.

Also, according to studies, people with schizophrenia have a significantly higher prevalence of diabetes compared to the general population. “Antipsychotic medications, especially second-generation antipsychotics, can lead to significant weight gain and insulin resistance,” adds Girish.

This interconnectedness of physical and mental health highlights the importance of a comprehensive approach to diabetes care, addressing not only the physical but also the psychological aspects of the condition.

“In our community, the stigma against any sort of mental disorder continues, hence people still do not pay attention to the sort of turmoil a diagnosis such as diabetes can bring to an individual, causing the negligence of mental health,” says Girish.

Those who have hypoglycemia, a condition where the blood sugar level is lower than the standard range, experience a sense of impending doom, heart palpitations, and sweating, even when their blood sugar is normal. This can lead to anticipatory anxiety and panic attacks. Continuous panic attacks may develop into an anxiety disorder, further complicating the management of diabetes.

“During stress, diabetes worsens,” observes Dr Arun. “We often see patients with anticipatory anxiety, worrying about their blood sugar levels even when they are normal.”

Leading healty life

Managing a healthy lifestyle can be challenging for youngsters, particularly when it involves dietary restrictions. But it is doable.

Case in point is Meera, a 16-year-old with an insatiable love for sweets. She began facing some issues — persistent thirst, unexplained weight loss, fatigue, and blurred vision, and was diagnosed with Type-1 diabetes. Hanging out with friends who could eat everything and anything under the sun, became difficult for the teenager. However, she soon learnt to live with it by having sugar-free meals and staying away from fast food and desserts when out with friends. She also started using substitutes in her coffee.

According to Rajiv Ambat, founder of NuvoVivo, it’s important to adopt a nutritional plan that isn’t restrictive or dull, but one that encourages mindfulness about what one eats. Instead of rigid dieting that deprives you of enjoyment and adds stress, Rajiv advocates for the 80-20 principle. Concentrate 80 per cent on managing a nutritional meal while for 20 per cent live the life as one wish. This approach promotes a balanced and sustainable lifestyle, he explains. 

“For instance, when you know you are going out later in the day, adjusting the intake of carbohydrate to maintain control can be beneficial,” he says.

Type-1 diabetes

A chronic condition that appears in adolescents, where the pancreas produces little or no insulin. Symptoms include increased thirst, frequent urination, hunger, fatigue and blurred vision. Treatment aims at maintaining normal blood sugar levels through regular monitoring, insulin therapy, diet and exercise.

Type-2 Diabetes

A chronic condition that affects how the body processes blood sugar. It typically affects middle-aged or older people. Symptoms include increased thirst, frequent urination, hunger, fatigue and blurred vision. In some cases, there may be no symptoms. Treatments include diet, exercise, medication and insulin therapy.

Hypoglycemia

A condition that occurs when the glucose levels in the blood are too low. Prolonged hypoglycemia affects brain function, causing trouble focusing, judgment, memory loss, trouble speaking, and, in extreme cases, seizures or coma. Hyperglycemia happens when glucose levels are high. Experts suggest the condition is emotionally challenging and lowers mental wellness.

The names of diabetic patients have been changed on request of anonymity

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