Emotions & Blood-Sugar Levels: How Diabetes Can Affect Your Mood

Dr. Musen is an Assistant Investigator in the Section on Behavioral and Mental Health at the Joslin Diabetes Center and an Instructor in Psychiatry at Harvard Medical School.Dr. Musen is a cognitive psychologist investigating the effects of diabetes on the central nervous system.
John Zrebiec, L.I.C.S.W. is Director of Behavioral and Mental Health services in the Joslin Clinic at Joslin Diabetes Center.  He is also a Lecturer in Psychiatry at the Harvard Medical School.
John Zrebiec, L.I.C.S.W. is Director of Behavioral and Mental Health services in the Joslin Clinic at Joslin Diabetes Center. He is also a Lecturer in Psychiatry at the Harvard Medical School.

by John Zrebiac, L.I.C.S.W., and Gail Musen, Ph.D.

Diabetes can affect both your physical and mental health.

A diagnosis of diabetes certainly adds a huge emotional weight, which can often manifest as depression, anxiety or some other emotional issue.   The same goes for the stress of managing diabetes 24/7.

Recently, Joslin researchers discovered a link between high levels of glutamate (a neurotransmitter in the brain that is produced by glucose) to symptoms of depression in people with type 1 diabetes.

The study showed increased levels of glutamate in the prefrontal area of the brains of such people — an area associated with both higher-level thinking and regulation of emotions. At the same time, the study showed a link between high levels of glutamate and poor glucose control, , and lower scores on some cognitive tests.

We believe that if health care practitioners emphasize good glucose control, it may help reduce the probability that patients with diabetes will also become depressed. Clinical depression is more than the normal response of feeling down for a couple of hours or days. It is more dramatic — taking you down further and longer.

A psychologist would diagnose clinical depression if a patient has five or more of these symptoms for at least two weeks. At least one of these symptoms has to be depressed mood or loss of interest or pleasure.

  • Depressed mood (feeling sad or empty) most of the day, nearly every day
  • Markedly diminished interest or pleasure in all, or almost all, activities, nearly every day
  • Significant weight loss when not dieting, significant weight gain (more than 5 percent of body weight in a month), or significant decrease or increase in appetite nearly every day
  • Trouble sleeping, or sleeping too much, nearly every day
  • Feeling agitated or sluggish nearly every day
  • Fatigue or energy loss nearly every day
  • Feeling worthless or excessively and/or inappropriately guilty nearly every day
  • Diminished ability to think, concentrate or make decisions nearly every day
  • Recurring thoughts of death (not just a fear of dying) or suicide, a suicide attempt, or a plan to commit suicide

If you think you fit the above criteria, you should talk with your doctor and ask for a referral to a mental-health professional. Research indicates that professional counseling, sometimes in combination with anti-depressant medication, is a highly effective treatment for depression.

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  1. As a type 1 diabetic myself I know how hard it is to live with this condition and yes I feel very gloomy sometimes but we also have to remember that without insulin we’d all be dead! blunt but true, there is still a lot to be grateful for and I for one am going to enjoy my life, diabetic or note.

  2. Boy I wish this information had been out when I was a child. I am ow a 47 year type I diabetic. Most of the hell I had been through in school would of been avoided if this research had been available to my 1) Dctors 2) Teachers 3) Parents. When I was sad as a child my parents would always say to people or his blood sugar must be low instead of listening to me and seeing that I was really upset about something. I am still dealing with issues from my childhood and Type I diabetes has been the cause of 95% of what I have to deal with now.

    • I am someone who deals with someone who has emotional problems associated with diabetes. For me there seems to be a problem of did the chicken or the egg come first when dealing with situations and my diabetic friend. What I mean is did said situation actually lead my friend to feel down and his diabetes aggravated it, did my friends diabetes lead him to feel down about a situation or did neither occur and my friends reaction is genuine and uncomplicated by his condition. This is my experience with my friend, so I can see why sometimes people may seem to be cold and uncaring when explaining a diabetics reactions/moods. To complicate things my friend will often deny that his diabetes may be affecting his reactions/moods. This can lead people to attribute sharp pointed angry remarks and other emotional expressions to blood levels in order to soften the impact of these episodes on the recipient.

  3. Is this strictly Type I or also for Type II. I have Type II and while I do not have every symptom they list I do feel sleeplessness or at times excessive sleeping and slugish at times. There is just that feeling like you just do not care to get out and do anything. It takes awhile to muster the energy or desire to do anything.

    • Depression is equally common in type 1 and type 2 diabetes. It’s not surprising when you think about the changes and challenges that diabetes creates, regardless of the type of diabetes. I think that type 2 diabetes might present more of a challenge because a person may need to change a lifetime pattern of eating and drinking. In either type of diabetes, I think the diagnosis itself is an abrupt reminder of one’s mortality which is not something most of us like to think about everyday.
      John Zrebiec

    • I have type 2 and have a lot of problems with sleeping too much and sometimes sleepless nights too. I sleep during the day and early evening and I know that is probably why I have sleepless nights when I do sleep too much during the day. I used to love music and singing and have a real talent for it, but now that I am back doing it again I have to force myself to get up and clean up/etc to go out. Soetimes it seems like too much trouble so I don’t get up and go out like I had planned. I am a semi-pro with my music so I do book shows at times and while I have fun doing my shows(and make money), I am also glad when they are over because they do drain me physically and emotionally. I won’t miss my shows because they are a committment I can’t get out of, but it’s tiring too.
      My dr has me on an antidepressant, but I have no energy to get up and get out of bed. If I make a plan to get up and go somewhere it helps me get out of bed some mornings. I should mention that I have to get up at 5am to take a granddaughter to her bus at 6:15am and breaks up my sleep since I don’t go to bed until 11 or 12 most nights. I usually come home and go to bed again at 6:30am and then wake up at 10 or so.

      Also when I eat I get extremely sleep about 30 to 45 minutes later and will lay down about an hr after I eat and can sleep for another 4 hrs easily if nobody wakes me. So you aren’t alone. Oh, I’m the original junk food junkie and I don’t watch what I eat much. My sugar isn’t horribly out of control but it will pop up occasionally if I eat too many sweets or carbs.

  4. Does the research refer only to sustained high levels of glutamate that drive sustained depression, or can it also relate to short-term spikes related to short-term elevations in glucose (e.g., 6 – 12 hours) that correlate with feeling blue or gloomy? While diagnoses of depression refer to patients exhibiting symptoms for at least a 2-week period, can your study correlate, among type 1 diabetes patients, shorter-term depressed moods with no obvious external drivers (e.g., “had a bad day,” “received bad news”) to spikes in blood glucose?

  5. I have been a Type 1 diabetic for over 41 years. I find myself depressed everyday the past few years even with medication and changes of the meds. Counseling has addressed other issues but the main issue I believe when you get a diagnosis of diabetes is that you are never going to be “normal”. When you are first diagnosed, the condition seems manageable, but as time goes on and some problems develop, no one around you really understands and you feel quite alone. If sugars are not perfect, you feel like a child who did something wrong even though many physical and emotional stresses can alter your blood sugars in a flash. None of us want to be the center of attention for having hypo or hyper glycemia as then we feel we are a burden and in my life most people are understanding, but it just takes 1 or 2 people to leave a burning impression that you have a “problem”. I read all of your comments and this is the only place I do not feel alone. Waiting for a cure!

    • I’ve been diabetic for a mere 17 years (congratulations on your 41!) and it’s really refreshing to read this. That’s exactly how I feel and am beginning to feel rather weary from putting on a brave face. I’m currently working on upping exercise regime and give my Diabetes a good kicking!
      Thanks to all for sharing your experiences, Sandy (UK)

  6. Beth, congratulations on your length of time, you must be doing a great job of managing your health !

    I myself have been Type 1 for thirty six years and agree it is not easy but the key is staying opptimistic and exercising daily.

    Once in a while I get bummed but have always attributed it to getting older, losing loved ones, etc. A good glass of red one or trip to the gym (or both !) usually does the trick.

    Good luck everyone !!

  7. I am Diabetic type II, for about 8 years, but I take insuline shots , I also have a son who is type 1 since he was 6 and now is 17. Having two diabetics in the family is hard, sometimes have some advantages because we help each other,but it´s crazy too..I have to be a good example for my kid. He is mosly the one who shows me what to do,,feelings is something that diabetes affect a lot,,Some days I feel I don´t know how to cope with everything,,House, kids work,,too much stress,, For me praying is the only way I find some peace and strengh,

  8. I have recently diagnosed with type 1 last November, having a real hard time dealing with this. my AC1 keeps climbing, Iam on Insulin 2x daily. I wake in the AM with high readings over 250 and just want to cry? then it seems like after I take my shot, I do have breakfast, then within 3-4 hours Iam starting to crash! with low reading. I cant seem to regulate my sugar. Going thru alot right now. My dad just passed away about a month ago. My only son is in the Marines and is deployed. I work the 3rd shift. Just wish I could have normal readings. I was going to ask my Dr about the pump. Seeing if that would regulate my readings.

    • I use the pump. It changed my life. I have been using it for over 10 years. Before the pump I was always tired I would sleep all weekend to build up my energy to deal with the long week ahead. The pump gave me back my life. Love it.

  9. I somewhat concur with you. I was diagnosed at 7 & now 43. For us, it was living in the dark ages- the management then was byzantine, but it was the best at the time. 30 years from now they’ll say what we’re doing today is ancient. Nonetheless, today’s gen is at a far better place than we were. Ours is the last that had to boil needles, tube test & dramatically adapt to countless management & treatment changes since the 70s. Compounded by family & friends who didn’t understand the emotional side created some childhood “issues” for me too, primarily shame, but I got over that a long time ago.

    Each generation probably has unique emotional challenges related to diabetes. & everyone (diabetics & non diabetics) has their demons. But we’re alive thanks to what we did have. & thanks to so many medical professionals who persevere so they can get funding to do research & bring improved care for us. We’re alive to carve any path we want.

    • Greetings Catherine, reading your post grounded me. My 21 year old son was just diagnosed with type 1 and he was already suffering from depression and anxiety. Reading what you had to go through, put it into perspective for me. You have such a brave and beautiful outlook. I admire your strength. I hope you are doing well. I was a ER nurse for 2 decades and I have seen the worst cases of every disease process, so I don’t have a grip on this at all. I thought that they would have a cure by now.UCSF is now testing a prototype that is using nanotechnology. It is genius. It removes the problem with having to use immunosuppression. Beta cells are implanted into this tiny device and it senses sugar and releases insulin immediately just like a real pancreas would. The immune cells, being large proteins can’t get through the nanomesh. My hope and thoughts go out to every one of you out there dealing with this difficult disease. Blessings to all.

  10. Yes, but you can also flip around that title, because it works the other way too. In fact more so! Its a bit of a chicken/egg thing here, or a basic domino effect. I mean; your mood and mental health effects your blood sugars and that in turn effects your mood and health! Happy mind = happy body, fact.

  11. I was diagonised of type 11, 3 months ago and i have suddenly lost interest in love making . is that normal ? i am very moody most of the times .i feel pity for my partner.

    • Dear Prosper MPOFU:
      A diagnosis of diabetes can make anyone feel sad and angry. Sometimes negative emotions can dampen one’s libido. The long-term complications of diabetes can cause physicial problems, such as erectile dysfunction in men. Although not well understand, diabetes can also affect sexual functioning in women. The physicial complications usually take time to appear, however.. It is best to discuss this with your health care provider and your partner.

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