The double burden of diabetes and mental health


The double burden of diabetes and mental health


For people living with diabetes, it’s not just the physical side of living with a chronic condition to consider, but the mental health aspect as well. Bridget McNulty explores the double burden of diabetes and mental health.


When I first heard that people with diabetes are 2 to 3 times more likely to struggle with depression than people without, I was surprised. But only for a moment or two. Then I considered what life with diabetes - Type 1 or Type 2 - actually encompasses, and it made perfect sense.


People with diabetes are 2 to 3 times more likely to have depression than people without diabetes. Only 25% to 50% of people with diabetes who have depression get diagnosed and treated. But treatment - therapy, medicine, or both - is usually very effective. And without treatment, depression often gets worse, not better.”

CDC (Centres for Disease Control and Prevention)


A 24/7/365 condition


One of the most exhausting parts about living with diabetes is that it’s a chronic condition - which means you never get a break, or a holiday. You can take a holiday, of course - eat the wrong kind of food, pretend you don’t have diabetes, not take your medication properly - but you will feel so awful and ill that it’s actually not worth it. 


Diabetes is a constant companion. Waking up in the morning, deciding what to eat (and what not to eat), remembering to take your medication, choosing what kind of exercise to do (or not do), before driving or sleeping or leaving the house. Diabetes is like having a very demanding baby who never grows up. And this kind of constant attention can take its toll on mental health. 


Particularly because this baby doesn’t come with a set of rules that make any kind of sense - diabetes is notoriously fickle from day to day. There are, in fact, 42 factors that affect blood glucose every day, which means that people with diabetes have to be assessing their blood glucose against a very long list of variables. You can do exactly the same thing two days in a row - the same amount of sleep, the same food, the same exercise - and get two vastly different blood glucose results. This kind of fickleness is not only frustrating and confusing, but can also be demotivating. What’s the point of trying so hard if your attempts don’t seem to bring the right results?


42 factors that affect blood glucose


Adam Brown at diaTribe developed this list of 42 factors from personal experience, conversations with experts, and scientific research. 




  1. Carbohydrate quantity
  2. Carbohydrate type
  3. Fat
  4. Protein
  5. Caffeine
  6. Alcohol
  7. Meal timing 
  8. Dehydration
  9. Personal microbiome




  1. Medication dose
  2. Medication timing
  3. Medication interactions
  4. Steroid administration
  5. Niacin (Vitamin B3)




  1. Light exercise
  2. High-intensity and moderate exercise
  3. Level of fitness/training
  4. Time of day
  5. Food and insulin timing




  1. Too little sleep
  2. Stress and illness
  3. Recent hypoglycemia (low blood sugar)
  4. During-sleep blood sugars
  5. Dawn phenomenon
  6. Infusion set issues (for insulin pumps)
  7. Scar tissue, or problems with how the body stores fat (lipodystrophy)
  8. Intramuscular insulin delivery
  9. Allergies
  10. A higher blood sugar level (glucotoxicity)
  11. Periods (menstruation)
  12. Puberty
  13. Celiac disease
  14. Smoking 




  1. Expired insulin
  2. Inaccurate blood sugar reading
  3. Outside temperature
  4. Sunburn
  5. Altitude


Behaviour and decisions


  1. More frequent blood sugar checks
  2. Default options and choices
  3. Decision-making biases
  4. Family and social pressures


The importance of acceptance


Well, the point of trying so hard is that it’s your long-term physical and mental health at stake. If you can find hacks to make diabetes management easier, you will be able to live a long, happy, healthy life with diabetes. Both today, in the present, and in the future, when you’ll be at less risk of developing long-term complications like blindness, amputation, heart disease and kidney failure.


Long-term complications can seem very far in the future, though, so it’s often the day-to-day ease of diabetes management that makes the most difference. And for that, there is one thing that really helps: acceptance.


Acceptance might seem like an odd priority, but think about it from a macro and a micro point of view. From the macro point of view, accepting that you have diabetes opens the door to making any necessary lifestyle changes, around food and medication and your daily habits. Denial can be very dangerous, particularly if you don’t feel comfortable telling other people about your diabetes, and therefore don’t have the support necessary for daily management, and emergency support if you need it.


From a micro level, acceptance looks like realising that you can’t get it right, every day. You can sometimes get it right for a whole day (that’s known as catching a unicorn, because it’s so rare!) but diabetes is not a problem that can be solved. Think about those 42 factors - what are the odds that all of them align? As a result, there are many opportunities throughout the day for acceptance and forgiveness. If you’re injecting insulin, you are going to get your dose wrong sometimes and either go high or low. That’s okay - take a little extra insulin if you’re high, eat a little sugar if you’re low. Hopefully learn from the experience.


People with diabetes are people first and foremost, and as humans we are going to make choices that are not always best for our diabetes - that’s okay. Accept that too. The less emotion you can attach to your blood glucose values, the easier it will be to live with the constant companion of diabetes at your side every day.


Nobody has diabetes figured out. There’s no such thing as a perfect diabetic. You are not alone in this. Once you accept this, it makes all the ups and downs a little easier.


Being real about your diabetes


Which brings us to something a lot of people struggle with: being real about your diabetes. It’s a struggle for a few reasons - partly because there’s still a lot of stigma attached to diabetes in South Africa, particularly Type 2 diabetes. There’s a misconception that people ‘gave themselves’ Type 2 diabetes by eating the wrong food, or not exercising enough, or carrying extra weight. Although these can be risk factors, this is absolutely not true. There’s a strong hereditary element to developing Type 2 diabetes - it runs in families - and nobody gave it to themselves.


Being real means telling those close to you - or a trusted diabetes community - what it feels like to have diabetes. Sharing when you’re having a hard day or feeling burnt out. Not pretending to have it all together because nobody actually has it all together. 


The power of being who you truly are when it comes to diabetes is that it opens up space for others to feel comfortable as well. In a world of influencers who look like their lives are easy and shiny all the time, it can be hard to be honest - but there is great power for you and others if you can be real about how you truly feel.


You are not alone in this.


A huge part of mental health support is knowing that you are not alone, being part of a community. Please join South Africans with Diabetes on Facebook to feel part of a diabetes community, or get more info on how to live well with diabetes (including meal plans, food, exercise and weight loss tips) at

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