Living Well: Diabetes and Depression: What’s the Link?

Depression and diabetes appear to be a two-way street — having one can put you at a higher risk for developing the other. Having both can make coping more challenging, but it’s possible to take steps to improve your physical and mental health.

“Mental health is physical health.”

“Your mental health is just as important as your physical health.”

“Mind-body connection.”

These are common phrases on social media. It’s easy to become burned out by all the discussion, but the idea that your mind and body are connected may feel very real to you if you have diabetes and depression, and it’s important not to dismiss that.

Perhaps you noticed your mood plummeted after your diabetes diagnosis, making it feel nearly impossible to enjoy things you once loved — dinners with friends, art, a weekly exercise class you thought would help keep blood sugar in check and now seems pointless.

Or, maybe you already had clinical depression and now have diabetes and feel like both conditions are spiraling and out of your control.

Your feelings are valid and common. Having either diabetes or depression can put you at a greater risk for developing the other, and it can be hard to manage both. However, there are practical steps you can take to improve your physical and mental well-being, which can feel empowering.

What is the link between type 2 diabetes and depression?

The link between type 2 diabetes and depression is a winding, complicated, and two-way street, explains Libu Varughese, MD, an endocrinologist and diabetes medical advisor at Aeroflow Diabetes.

CDC data show that people with diabetes are two to three times more likely to have depression, though it’s hard to give precise numbers because only 25% to 50% get diagnosed and treated.

Varughese says that managing diabetes can also put you at a higher risk of depression because of troubles, including:

• blood sugar regulation/management
• stress
• anxiety

“Low blood sugar can worsen cognition, cloudy judgment, anxiety, and symptoms [of depression],” Varughese said. “Chronically high sugars can cause fatigue and irritability.”

Varughese added that the stress of managing diabetes — tweaking lifestyle, taking medications, attending doctor appointments — can also contribute to depression or worsen the condition if you already have it.

The mind-body connection

However, having depression might also put you at a higher risk of developing diabetes. One 2019 study suggests that a person is more likely to develop diabetes if they’re depressed rather than develop depression if they have diabetes. There may be truth to the mind-body connection.

Jasmine Kaur, MD, a psychiatrist with Mindpath Health, explained that depression can up your body’s production of glucocorticoids, or hormones that play roles in stress response and metabolic health (including blood sugar management).

Some research suggests that having higher concentrations of a biomarker, proinflammatory cytokines, increases the odds of depression and may do the same for diabetes. Plus, Kaur points out that some research, including a 2023 review, found that long-term stress can affect mood and blood glucose levels.

Habits, including diet and exercise, that are considered “gold standards” in lowering diabetes risk can become more challenging to stick to when you have depression.

Gary Small, MD, the chair of psychiatry at Hackensack University Medical Center, shared that emotional eating is more common with depression. And the foods you might reach for include carbohydrates and refined sugars. Small says these foods can worsen blood sugar, mood, and energy swings. These energy shifts can make it harder to feel up to staying physically active, potentially making insulin resistance worse.

Depression symptoms in people with diabetes

Small said some symptoms can trigger or worsen insulin resistance. Plus, the clinical symptoms of depression are the same whether or not you have diabetes and include:

• appetite changes
• weight changes
• issues with sleep
• change in moods
• loss of interest in activities you once enjoyed
• suicidal thoughts

The symptoms can show up in specific, distinct ways when you’re managing diabetes, though, such as:

• guilt about not managing diabetes well enough
• frustration with health
• increased focus on physical symptoms, raising stress and lowering mood
• feeling stressed and helpless over finances, such as purchasing medications and purchasing produce, which is often more expensive than processed, shelf-stable foods

Monica Cwynar, LCSW of Thriveworks, who specializes in depression and life transitions and has worked in hospital and hospice settings, adds that blood sugar changes can make it challenging to focus and make decisions. Cwynar says it can compound feelings of helplessness and despair.

Tips to manage both conditions

Helplessness and despair are two common feelings you may have when trying to manage depression and diabetes. But there’s some positive news: Kaur says tools and resources are available to help you manage your physical and mental health and lead a fulfilling life. She and others shared their tips.

Check blood sugar frequently

Cwynar shared that blood sugar levels can affect mood and physical health. Knowing where yours stands can help you determine whether you need to make changes (and pinpoint the most specific, best tweaks for your overall health).

“Use a glucose monitor to check levels regularly,” Cwynar said. “Develop a schedule for monitoring and keep a log to identify patterns and triggers.”

For instance, you might find that eating a bedtime snack consisting of peanut butter and banana improves your fasting numbers in the morning and leaves you feeling like you got up on the right side of the bed. That’s excellent data.

Get regular physical activity

Varughese explains that exercise can help your body respond to insulin better, which can even out blood sugar levels, energy, and mood. It can also release feel-good endorphins.

Exercise can feel like a tall mountain to climb if you aren’t currently in the habit of logging it or are feeling chronically depressed. Start small, and aim to work up to 150 minutes of moderate-intensity activity per week. Cwynar says the secret sauce is to find something you like, which can boost mental health and make you more likely to stick with an activity.

“Find enjoyable activities, such as walking, swimming, or group classes, to make exercise sustainable,” Cwynar said.

Eat a nutrient-rich diet

Varughese suggests eating a balanced diet rich in:

• whole grains, like whole wheat pasta and brown rice
• lean proteins, such as legumes and chicken breast
• fruits
• vegetables

Making diet changes is often the first piece of advice given for diabetes management, but what about mood? As with exercise, the blood-sugar stabilizing benefits of consuming nourishing foods can boost mood.

A 2023 review pointed to data that people with mental health conditions, including depression, are more likely to have diets that are:

• low in fiber, whole grains, fruits, and vegetables
• high in refined carbohydrates, sugar, and calorie-dense foods

The study indicates these diets can increase the risk for high cortisol and proinflammatory cytokines, which are also linked to greater odds of developing diabetes. On the other hand, researchers cited studies indicating that polyunsaturated fats (like omega-3s found in salmon) might help with depression and anxiety symptoms.

Breathe

Small said that chronic stress can trigger chronic, high levels of cortisol production and insulin sensitivity. However, Varughese says the opposite is also true — lowering stress can stabilize cortisol production (and glucose levels). You already possess a tool that can help.

“Practices such as meditation, deep breathing, or mindfulness can reduce stress and improve mental health,” Varughese said.

If you find it difficult to focus on the breath or do self-guided exercises, Cwynar suggests beginning with short daily mindfulness meditations or yoga sessions. Several apps and online resources can guide you through these.

Find community

Humans are designed to live in a community, so building a village of people you trust is important.

“Sharing experiences with others who understand diabetes can reduce feelings of isolation and provide practical advice,” Varughese said.

Experts recommend joining a support group for people with diabetes or online communities like Bezzy.

Your doctor may be able to direct you to some, or you may be able to find resources through your local chapter of the American Diabetes Association. Sharing experiences and challenges with family and friends might also help, Cwynar added.

Get more support

You may find that the above doesn’t move the needle at all or as much as you would like. That’s OK — understandable, even. Managing one condition — let alone two that can feed into one another — is challenging. Kaur says that therapy, especially cognitive behavioral therapy, can help.

Kaur says a therapist might work with you to challenge thought patterns that aren’t helpful for your depression or diabetes and replace them with ones that are.

For example, “My body is broken, so why bother to eat healthy?” might turn into “I can take steps to manage my diabetes, which is important to my health.”

A therapist might help you think of ways to do that, like taking a morning walk (which can also boost mood).

You may also learn to schedule activities you love to ensure you find enjoyment in life, and the therapist might point you to diabetes educators, educational materials, and support groups to better help you understand and manage your health.

Kaur added that medications for mood are also available.

Work with your care team — like a doctor and psychiatrist or psychologist — to best understand how they might interact with medications you’re taking for diabetes or other conditions, plus blood sugar levels.

Takeaway

Having diabetes or depression may increase your chances of developing the other. They can also worsen one another. Researchers have looked into this relationship, including physiological factors (depression may increase markers for diabetes and vice versa). They also share risk factors like diets high in refined carbs and sugar and decreased physical activity.

The stress of managing one can also put you at greater odds of developing the other. Although it can feel overwhelming, you can take steps to manage both conditions. Diet and exercise can stabilize blood sugar and mood, and monitoring blood sugar can help determine what works for your body and mind.

Support in the form of family and friends, groups, your doctor, and a therapist can also help you feel less alone and find tools that assist you as you navigate (a more fulfilling) life with depression and diabetes.