Can Type 2 Diabetes Cause Behavior Problems?

Being diagnosed with type 2 diabetes can impact your health, lifestyle, and the way you interact with others. Some people find it affects the way they think, feel, and behave.

There is a complex link between type 2 diabetes and mental health. Behavioral risk factors can increase your chance of developing type 2 diabetes, while the condition itself can raise your risk of experiencing poor mental health.

Find out about the link between type 2 diabetes, mental health, and behavior, and understand the changes you can make to improve your health and wellbeing.

Risk factors for type 2 diabetes

Your behavior and lifestyle can increase your risk of developing type 2 diabetes, in addition to your age and genetics.

Type 2 diabetes is the most common type of diabetes, and cases are rising. Researchers believe lifestyle factors are the primary driver for the increase, including:

• Unhealthy diet (particularly excessive sugar consumption)

• Lack of exercise

• Low-quality sleep

• Stress

All of these factors can affect mental health. Stress is the most obvious: when poorly managed, stress can cause various mental health issues and health conditions.

Anxiety or depression may cause poor-quality sleep, and people with depression are more likely to have an unhealthy diet and lead a sedentary lifestyle. This may explain why people with depression are 37% more likely to be diagnosed with diabetes. However, there is no strong link between anxiety and type 2 diabetes.

Mental health conditions can also make it harder to change these behavioral factors, both before and after diagnosis. This means it may be necessary to treat mental health conditions —ideally after a diagnosis of prediabetes — to help slow or stop progression to diabetes.

Can type 2 diabetes cause mental health conditions?

Type 2 diabetes can lead to many complications, including mental health conditions.

Depression

There is a complex relationship between diabetes and major depressive disorder.

Major depressive disorder is defined as depression symptoms lasting at least two weeks. These symptoms include:

• Persistent sadness or emptiness

• Feeling hopeless and/or pessimistic

• Guilt

• Feeling worthless

• Loss of interest in activities you normally enjoy

• Irritability

• Low energy

• Slowed movement and speech

• Difficulty concentrating, remembering, and making decisions

• Sleeping too much or too little

• Changes in appetite

• Weight changes

• Restlessness

• Physical aches and pains, headaches, cramps and/or digestive issues without a clear physical cause

• Thoughts of death or suicide

Depression is common in people with diabetes, so watch yourself (or your loved one) for these symptoms. Symptoms can be highly variable as everyone is affected by depression differently. Depression can be treated with therapy and medication in some cases.

Rates of depression are elevated by about 24%¹ in people with diabetes who did not have depression when diagnosed. The rates are higher amongst people using insulin, although there is no strong evidence that insulin causes depression.

Depression risk is also increased by other diabetes complications, including neuropathy (nerve damage), nephropathy (diabetic kidney disease), and poor control of blood sugar levels.

Diabetes distress

Diabetes distress was traditionally thought to be the primary cause of depression among people with diabetes, but the relationship is more complicated than that.

Diabetes distress is a specific emotional state experienced by people with diabetes. It differs from major depressive disorder, as it’s directly linked to the stress of living with the condition.

For example, your diabetes may cause you to experience denial and avoid accepting you’re unwell. You might feel you’re becoming a burden to yourself and others, causing feelings of guilt.

Diabetes distress does not meet the qualifications for depression, but it can negatively affect your health. Being depressed, stressed, or guilty can make it harder for you to manage your condition.

Some factors can worsen diabetes distress, such as not getting enough support from family and friends.

Anxiety

Anxiety can affect everyone from time to time, but it’s a serious mental health condition for some people. For example, you might have an anxiety disorder if your worries and fears don’t go away on their own and worsen over time.

While anxiety does not appear to increase your risk of type 2 diabetes, you may be more likely to develop an anxiety disorder if you have the condition. Clinically significant anxiety is about 20% higher² among Americans with diabetes, independent of other factors.

Subclinical anxiety is also common among people with diabetes. The stress of the diagnosis itself is likely to raise anxiety levels.

For example, you might feel anxious about complications and the changes you need to make to help manage the condition (such as altering your diet). You may also feel as if you have lost control over your health.

Given its complexity, diabetes self-care can also induce anxiety, and anxiety can lead to poorer glycemic control. Some people with anxiety stop taking care of themselves properly, leading to uncontrolled diabetes and complications.

Eating disorders

The American Diabetes Association suggests that women and young girls with diabetes are more likely to be diagnosed with an eating disorder, such as bulimia and anorexia.

Diabetes management requires tightly controlling weight and diet, which may lead to an unhealthy relationship with food. Some people use diabetes to hide or justify their eating disorder, which can cause dangerous complications.

People with diabetes may also demonstrate tendencies towards orthorexia nervosa,³ an obsession with healthy eating. While it’s important for people with diabetes to stick to their diet, becoming overly anxious about it can be harmful.

Can type 2 diabetes change the way you behave?

Type 2 diabetes increases your risk of mental health conditions and behavioral changes. In turn, these things can worsen your diabetes.

Behavioral problems may include symptoms of depression and anxiety. For example, you might experience symptoms of depression that can cause behavioral changes, including:

• Nervousness

• Loss of energy

• Difficulty concentrating

• Guilt

• Suicidal thoughts

Some people with diabetes attempt suicide or intentionally stop trying to control their condition and manage their health. It’s important for people with diabetes to get proper therapy, even if they are not yet depressed. Therapy can help you deal with your condition and manage stress in a healthy and positive way.

You might also experience anxiety symptoms, including panic attacks. Anxiety can make it challenging to go about your daily life and put strain on your relationships.

More directly, diabetes has been linked to mood swings. These mood swings are caused by blood sugar fluctuations, and can be mitigated by getting your diabetes under control.

Unfortunately, mood swings also make diabetes harder to manage. When your blood sugar is high, you are likely to be angry or sad. When it is low, you may feel anxious and nervous.

Understanding your blood sugar levels

Your blood sugar levels can influence your mood and behavior, so you need to understand how to recognize high or low blood sugar levels and how to manage them.

Low blood sugar levels

Low blood sugar levels, or hypoglycemia, is usually indicated by a reading lower than 70mg/dL — although this isn’t the same for everyone.

You might experience hypoglycemia if you are taking insulin, but other medications can also cause a drop in blood sugar levels. It is also more common in people aged 65 or older and people with other health problems.

Hypoglycemia has obvious symptoms, including:

• Shakiness

• Hunger

• Fatigue

• Dizziness

• Confusion

• Irritability

• Fast or irregular heartbeat

• Headache

• Vision problems

• Slurred speech

In extreme cases, low blood sugar levels can cause seizures or coma, although this is more common in people with type 1 diabetes.

If you experience hypoglycemia symptoms, eat something containing about 15 grams of glucose or carbs straight away, such as regular soda, fruit juice, or glucose tablets or gel. Talk to your doctor to work out why you experienced low blood sugar levels and reduce the risk of it happening again.

High blood sugar levels

High blood sugar levels, or hyperglycemia, is typically defined as a reading over 125mg/dL when fasting, or 180mg/dL after eating. Diabetes management focuses on bringing blood sugar levels down.

Hyperglycemia symptoms include:

• Thirst or dry mouth

• Blurred vision

• Dry skin

• Fatigue

• Frequent urination

Keep in mind that you might not experience hyperglycemia symptoms until your blood sugar levels are very high.

Experiencing hyperglycemia may suggest you are not following your meal plan enough, or that it needs to be altered. It may also show your medication dose is too low.

Stress or an infection can also cause blood sugar to spike.

How are behavioral problems diagnosed?

You may receive a diagnosis for your behavioral problems if they are recurrent. Diagnosis often involves talking to friends and loved ones about your behavior and monitoring your blood sugar levels to see if there’s a connection.

Some people realize they’re experiencing behavioral problems themselves, while others remain in a state of denial. Some people hide their behaviors because they feel embarrassed or guilty.

Speak to your doctor if you or those around you notice your behavior has changed, or if you experience symptoms of hyper or hypoglycemia. Your doctor will try to understand why your behavior has changed and recommend a solution. This may include keeping a closer eye on your blood sugar levels to control them better and changing your medication dosage.

Keep in mind that your doctor might not diagnose your behavior, but the underlying health condition or complication that’s causing it. For example, depression or hypoglycemia.

Managing behavioral problems

Behavioral problems and changes can be disruptive in your relationships and everyday life. They may cause you to lose your job, have issues in your marriage, or fall out with friends.

Getting a diagnosis and treatment is essential to minimize the impact on your quality of life and wellbeing.

Behavioral problems can also make it more challenging to manage your diabetes, causing a vicious cycle where fluctuating blood sugar levels cause behavior that lowers your ability to practice self-care.

Treatment

Treatment partly depends on what has caused your behavioral problems. In some cases, altering your diabetes medication dosage or tweaking your care plan could help you feel better.

If your doctor changes your treatment plan, be sure to follow their recommendations to help manage your blood sugar levels more effectively and improve your quality of life.

Depression is often treated with therapy, although medication may be used. However, medication can be tricky for people with diabetes because antidepressant drugs can alter your blood sugar levels or interact with your medication. You should discuss the pros and cons with your doctor.

Studies have shown clonazepam is typically a better choice than sertraline, since sertraline can neutralize glucose overload and make it more challenging to treat hypoglycemia. You may also need to alter your insulin dose to help you take antidepressants safely and effectively.

Anxiety can also be treated with therapy or medication.

Diabetic distress is generally less severe and is not considered a psychiatric condition. It does not respond to medication, and is generally treated with self-care. Support groups can be particularly helpful, as can taking the time to do things you enjoy.

Prevention

Following your treatment plan and your doctor’s advice is the best way to prevent behavioral issues linked to your diabetes.

You should also monitor yourself for symptoms of depression or anxiety and discuss them with your medical team. By sharing your concerns and experiences, you can get advice, self-care tips, and support.

Ultimately, effectively managing your diabetes is the best way to prevent diabetes-related behavioral problems.

The lowdown

There is a complex link between diabetes, mental health, and behavior. Type 2 diabetes can cause behavioral problems, and some behaviors can cause diabetes.

Behavioral changes can be directly caused by fluctuating blood sugar (for example, hyperglycemia can cause anger or sadness), or comorbid mental health conditions like depression, which can be a symptom and cause of type 2 diabetes.

Depending on the cause, these behavioral problems can be treated and resolved with therapy, medication, or by improving your diabetes management.

Talk to your doctor about your behavior and any emotions you are experiencing so they can work with you to manage your diabetes and improve your wellbeing.