Diabetes and Anxiety: Connection, Symptoms, & Treatment

What Is Anxiety?

Anxiety disorders are a classification of experiences having to do with chronic, constant, and unsubstantiated worry, sometimes focused on specific triggers that sometimes manifest into states of physical discomfort. It is estimated that about 19% of adults, or about 40 million people, are experiencing an anxiety disorder, while only about 36% of those affected receive treatment.¹ It is universal for humans to experience some worry and uncertainty, however, when it becomes chronic, difficult to manage, and impedes everyday functioning, this may be pointing to an anxiety disorder.

Common symptoms of anxiety include:

• Trouble sleeping
• Irritability
• Intrusive thoughts
• Dizziness
• Excessive worrying
• Rapid heartbeat
• Feeling nervous, tense or restless
• A sense of impending doom
• Trouble concentrating
• Muscle tension

What Is Diabetes?

Diabetes is a chronic condition that impacts the way your body metabolizes your food. It occurs when you either don’t make enough insulin or don’t use insulin effectively. According to the CDC, “More than 37 million US adults have diabetes, and 1 in 5 of them don’t know they have it.”²

There are two types of diabetes. Type 1 diabetes is considered an autoimmune reaction where the immune system mistakes healthy cells for unhealthy ones and attacks the cells in the pancreas that produce insulin, making the body deficient in insulin. Type 2 diabetes is caused by the body misusing insulin and flooding too much sugar into the bloodstream.

Common symptoms of diabetes include:

• Frequent urination
• Extreme thirst
• Extreme hunger
• Numb or tingling hands or feet
• Blurry vision
• Sores that heal slowly
• Fatigue
• Unexpected weight loss
• Red, swollen gums
• Frequent infections

Diabetes & Anxiety

People with diabetes are 20% more likely than those without to have anxiety at some point in their lives, with other studies finding that individuals with diabetes are twice as likely to experience anxiety.² One study even found that the presence of anxiety increased the likelihood of an individual with prediabetes progressing to type 2 diabetes by 31%.³ Of those diagnosed with diabetes, women tend to have higher rates of anxiety than men.

With the brain running largely on glucose, it is no wonder that stress and anxiety have a large impact on blood sugar levels. Poor glycemic regulation impacts neurotransmitter function, cognitive processing, and synaptic plasticity, which can all drive the presentation of irritability, depression, and anxiety.

Anxiety Symptoms When You Have Type 2 Diabetes

Individuals with diabetes can experience anxiety symptoms such as irritability, a sense of brain fog, and impulsivity, largely because when glucose levels are too low or too high, it impedes one’s ability to exert self-control.⁴ It is difficult to tell which symptoms are psychological or blood sugar-related, given that they could easily stem from either source. If you have diabetes and are experiencing heightened symptoms of anxiety, it is important to check your blood sugar levels and consult a medical professional to rule out blood sugar dysregulation as a source of your distress.

Causes of Anxiety For People With Type 2 Diabetes

Individuals with diabetes are more prone to experiencing anxiety due to both environment and physiology. Environmental factors, the stress of increased self-care and management tasks, worries about hypoglycemic reactions, future complications and/or high blood sugar, and other stressors unique to those living with diabetes can cause or exacerbate underlying anxiety.

On a physiological level, “chronic psychological stress is known to activate the hypothalamic-pituitary-adrenal axis, stimulate the sympathetic nervous system, increase inflammatory and platelet aggregation responses and decrease insulin sensitivity, thereby contributing to poor glycaemic control and increasing the risk of complications.”⁵

Can Anxiety Cause Diabetes?

There is no definitive evidence that anxiety causes diabetes. However, anxiety has been shown to be a risk factor for individuals with insulin resistance and prediabetes that may increase the likelihood of developing type 2 diabetes. It also can exacerbate type 2 diabetes by impacting one’s ability to manage the illness as well as causing stress which impacts blood glucose.

Panic Attacks & Hypoglycemia

Panic attacks are a surge of intense fear, often without warning, that lasts about 5-20 minutes and reaches its peak within minutes. It can sometimes be triggered by an event or stimulus, while other times, it may happen seemingly without cause. Some who experience a panic attack for the first time can confuse it with a heart attack. A panic attack that lasts longer than 20 minutes and feels debilitating may require immediate medical attention.

An episode of hypoglycemia is when blood glucose drops below 100, and the brain feels it is “starving” for sugar. This can lead to a rapid onset of symptoms that are disorienting and severe. Many symptoms of hypoglycemia are similar to those of a panic attack. If caught early, symptoms can be mitigated with fast-acting carbohydrates. If symptoms are too severe and become debilitating, you may need to see a medical professional immediately.

Panic attack symptoms include:

• Chest pain
• Difficulty swallowing
• Rapid heartbeat
• Sense of impending doom or danger
• Tightness in throat
• Hot flashes
• Abdominal cramping
• A feeling of detachment from reality
• Chills
• Trembling or shaking
• Difficulty breathing
• Nausea
• Headache
• Fear of death or loss of control

Hypoglycemia symptoms may include:

• Rapid heartbeat
• Sudden nervousness
• Dizziness
• Excessive sweating
• Fatigue
• Confusion
• Blurred vision
• Becoming pale
• A sudden feeling of excess hunger
• Increased heart rate
• Irritability
• Tingling or numbness of the lips, tongue, or cheek

Treatment Options for Anxiety & Diabetes

It is paramount for people with both diabetes and anxiety to learn to distinguish between rational concerns about their diabetes management and anxious thinking. They first need a diabetes treatment plan from their medical doctor, and then they can seek treatment for anxiety. Treating both simultaneously can feel overwhelming, however, without getting both in a manageable place, they will exacerbate each other and lead to severe symptoms that will be more difficult to remedy.

Treatment options for anxiety include talk therapy, medication, homeopathic remedies, and a combination of one or more of these options.

Lifestyle Changes

Many people find great success in managing their anxiety through lifestyle changes in conjunction with other therapies. Movement, diet, sleep, social connections, and other self-care methods can make it much easier to get your anxiety under control. Thoughts, feelings, and behaviors are all interconnected, so behavioral modifications can have a significant impact on thoughts which impact mood and emotions.

Common lifestyle changes to help cope with anxiety include:

• Getting daily exercise
• Avoiding alcohol
• Avoiding recreational drugs
• Limiting caffeine
• Maintaining a healthy diet while focusing on foods that help anxiety
• Ensuring each meal has a protein, fat, and fiber source to maintain balanced blood sugar levels
• Getting adequate sleep
• Practicing meditation for anxiety
• Spend time with loved ones
• Maintaining treatment plan
• Limiting social media use
• Decreasing consumption of breaking news or current events
• Limiting screen time
• Spending as much time outdoors as possible
• Reducing sugar intake

Therapy

There are many options for anxiety therapy available, such as individual or group therapy, in-person or virtual. It is important to research and try out different therapists, styles, and formats to find the best fit for you. For many, especially in the beginning of your therapy journey, people usually do one group or individual session per week. Some may find it helpful to do a combination of the two, though one should suffice.

Common types of anxiety therapy include:

• Acceptance and Commitment Therapy (ACT): ACT is an action-oriented approach that focuses on moving from avoidance and denial of their emotions to accepting them as a part of their human experience and committing to behavioral changes despite what is happening in their life.
• Art and music therapy: Two of the most widely used forms of expressive therapies are art and music therapy, which utilizes art and music to process emotions and promote healing and well-being.
• Cognitive behavioral therapy (CBT): CBT for anxiety is grounded in the fact that thoughts, feelings and behaviors are inextricably linked and targets changing one of the three to influence the other two. It seeks to identify and interrupt unhelpful and transform thought patterns that lead to mental health symptoms.
• Dialectical behavioral therapy (DBT): DBT is a skills-based approach that focuses on educating the client on tools and skills regarding emotion regulation, interpersonal effectiveness, distress tolerance and mindfulness. It empowers clients to use these techniques to manage everyday stressors.
• Exposure therapy: An effective and common treatment modality for anxiety is exposure therapy, which involves placing the client in contact with their trigger in real time, whether in reality or by simulation, and coaching the client to cope with their distress and become more comfortable with the experience.
• Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a modality where a clinician utilizes directed eye movements to reprocess trauma by stimulating the brain’s neural networks.
• Interpersonal therapy (IPT): IPT is a treatment modality that targets relational distress as a source for everyday triggers and symptoms. It seeks to resolve interpersonal traumas to promote healing and balance so that one can access social support in a healthy way.
• Psychodynamic therapy: A widely known modality that has been practiced for many decades is psychodynamic therapy. When engaging in psychodynamic therapy, a therapist supports the uncovering and processing of the unconscious and the underlying emotions that lead to our conscious beliefs and experiences.
• Neurofeedback: This is a type of biofeedback that monitors and adjusts abnormal brain waves through a machine that is delivered through a computer-based program. Neurofeedback is one of the leading non-pharmaceutical interventions aside from talk therapy for anxiety and other disorders.

Medication

For some, medication may need to be explored as a part of their anxiety treatment plan. This could be to expedite results or to bring a person to a place of stability where talk therapy can be more effective. For some anxiety disorders, medication may be a shorter-term solution and can sometimes be weaned out as the client progresses through their treatment plan. Medication management would be through a licensed prescriber that may also be able to carry out the talk therapy, such as a psychiatrist, or with a team approach of a prescriber collaborating with a clinician.

Common medications prescribed for anxiety include:

• Antidepressants: Common brands of SSRIs, SNRIs, and tricyclic antidepressants include Lexapro, Zoloft, and Cymbalta. These medications work to increase serotonin and norepinephrine in the brain, which support mood, sleep, and overall feelings of well-being.
• Beta blockers: Beta blockers are a blood pressure medication that can be used to treat anxiety with its ability to cause the heart to beat more slowly and with less force. It blocks the hormone epinephrine, which is commonly known as adrenaline, which supports the stabilization of a hyperactive nervous system.
• Benzodiazepines: These medications act on GABA-A receptors to make the nerves in the brain less sensitive, which has a calming effect. Some well-known benzodiazepines are Xanax, Klonopin and Valium.
• Monoamine oxidase inhibitors (MAOIs): These medications were first developed to treat anxiety, however, they have largely been replaced by antidepressants due to the amount of side effects these medications typically cause.

When to Seek Professional Help for Anxiety & Diabetes

Professional help can be life-changing, and even life-saving for someone living with both diabetes and anxiety. If you are learning to manage both conditions, and you find your anxiety interferes with your ability to manage blood sugar levels, or your excessive worry about diabetes management contributes to increasing anxiety, support from a therapist or other professional is key. Support is more accessible than ever due to a wide range of different online therapy options and an online therapist directory.

In My Experience

Blood sugar is an often overlooked piece when treating anxiety, depression, and other mood disorders. I am grateful to the growing body of research on this subject and the larger conversation that is happening around this correlation, as it not only can help people get more effective treatment for their anxiety but may also help to increase the number of individuals who have diabetes and go undiagnosed because it is masked as a mood disorder, or vice versa. Both diabetes and anxiety, due to innovations in care, are quite manageable conditions with the right treatment plan and the ability to adhere to it. If you are experiencing diabetes and anxiety, an integrated team of registered dieticians, mental health clinicians, and physicians can get you potentially life-saving results. If you are experiencing anxiety, do not discount the impact blood sugar may have on your symptoms, whether or not you are diagnosed with diabetes, and check in with your primary care doctor to rule out any blood glucose issues that may be causing or exacerbating your symptoms.