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

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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.

All July, the Joslin Blog is highlighting stories about taking care of yourself emotionally. This story was originally posted on Feb. 18, 2011.

This guest post is written by by John Zrebiec, L.I.C.S.W., Director of Behavioral Health at Joslin, and Gail Musen, Ph.D., Investigator in the Section on Clinical, Behavioral & Outcomes Research.

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.

For more information:


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

  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.

    • Natalie Knight says:

      Very true…. We got to keep on moving forward. I get upset when I have lows… I had type 1 (juvenile diabetes) for 34 yrs…. Wishing you the best!!

  2. Garret says:

    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.

    • Eric says:

      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.

      • Debaria Benson says:

        I will some one would tell my husband this angry,mean are just a few nice words and he act like he’s done or said anything wrong he will run out of meds and won’t open his mouth sometimes I just want to leave!!! Like today

        • Debaria Benson says:

          Type 2

        • Debbie Frawley says:

          Let me know when you’re leaving, I will go with you.. My husbands outbursts make me ill and drain all my energy. I know it’s from a high sugar spike but it’s unbearable at times. It upsets me to know that he won’t take care of himself. He is also insulin resistant and the other products on the market don’t help or make him sick. He’s been referred to a specialist. STill, it’s hard to deal with.

  3. Barry says:

    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.

    • John Zrebiec says:

      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

    • Sandy Lucas says:

      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.

      • Jason says:

        Hi Sandy, Iv come across tbis post when searching for effects of glucose on mental health, yr problems if you still have them aren’t uncommon. I myself am type 1 and hv been for over 30 years. Im heavily into sport and coaching and suffered a major car crash in 2007.

        So.much can be said but being brief, try and be kinder to your body by eating for nutrition rather than pleasure, the reduction in viceral fat (that you wont see physically) will aid insulin sensitivity and in turn reduce glucose which will help you sleep and lessen anxiety and depression.

        Exercise where you get out of breath will also help. This isn’t a short fix but lifestyle change.

        It seems any problems you have start with your junk food diet. It will take some will power at lesst initially but eating bad junk food isnt a treat to your body just your perception ie the dopamine release. Try it fir a month and see. Don’t crack even once during that time.

  4. M says:

    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. Beth says:

    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!

    • Sandy says:

      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. JC says:

    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. margarita says:

    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. Tara Gonelli says:

    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.

    • Gini says:

      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.

      • Anne Fagan says:

        I too am on a pump. It has been almost 9 years now and I have been diabetic for 47 years. It has made a major difference in my life as well, particularly when it comes to nighttime hypoglycemia. I generally have not suffered from mood changes, depression, etc., so I think I am very fortunate in that regard.

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  12. Catherine says:

    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.

  13. 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.

  14. PROSPER MPOFU says:

    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.

    • Nora (one of the Joslin Dietititans) says:

      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.

  15. Catharine Blake says:

    I am a 41 year old Type I diabetic of 35 years. I have dealt with the emotional roller coaster ride of life with diabetes. I have discovered highs (realizing that I live a very healthy lifestyle since the age of 7 which has resulted in aging well) to lows (losing a relationship with a partner who did not understand the invisible disease). I feel so lucky to not have any side effects of diabetes and I continue to make it my life mission to stay on track. One of my coping decisions was turning around my frustration towards helping others with the emotions of diabetes. I run a psychotherapy practice specializing in diabetes and its’ astounding how many of my patients note that not one professional ever asked about their mental health needs. We are advancing and I am excited to see how the world of neurobiology will help our understanding of how the brain is impacted by diabetes.

    • Esteban Montes says:

      Hello. My name is Esteban and I have had problems with my emotional side of diabetes. I am grateful for my life and being able to live through fighting my disease but have to be honest and admit that I do deal with the emotional side of my diabetes. I was a very happy young man and have had to battle with depression since being diagnosed at the age of 21. It has been difficult to overcome.I have had diabetes for exactly 15 years now. Can you please help with perhaps some recommendations?I would greatly appreciate it.

  16. Interesting this information, my wife is diabetic, and we are trying to get a baby, but is essencial to mantain good levels of glucose

  17. Lisa Zarafonetis says:

    My husband is Type 1 & has been since he was 30. He’s 62 now. Its been an emotional roller coaster for both of us thru the yrs! He is what drs call a brittle diabetic. He cannot let his blood sug drop below 100 or he will bottom out quickly! Drs want to treat him like a textbook/cookie cutter diabetic & we’ve literally had to come to verbal blows with the med profession! They tell him to do things their way, he tries it, then he would end up having severe HYPOglycemia, bottom out, have a seizure & wind up in the ER multiple xs! It was horrifying for our children see their daddy be out cold on the floor having a seizure & flopping around like a poor fish outa water!!! And just as terrifying for me also because Im always worried that he will hit his head on the concrete or a sharp object, etc.
    Then in early July 2010 he had been on an insulin pump & had beautiful results for a couple of yrs when he got up from the table & accidentally hit his stomach where the little pump needle was under the skin, it knocked the needle out & he didnt realize he had done that. For 3 days the insulin was NOT pumping into his body & on July 9, 2010 he had to go to ER for ketoacidosis!!! ER docs said his bs level was up to 945!!! We thought he was going to die!!! He was in a coma for 4-5 days! He developed traechae problems also from paramedics inserting a breathing tube. On Aug 3, 2010 he had to have a traecheotomy because the vocal chords were closing on him & they would’nt stay open, henceforth the traech tube was inserted so he could breathe! He was finally able to come hm from the hospital 1 mo later(9/3/13). He was in that hospital for 3 months, and NO insurance! Needless to say this was the very DARKEST time for us but I am very grateful he pulled thru & is coping fairly well now. Our family’s & friends prayers being lifted for us was a great comfort & the Lord was obviously guiding us thru this very dark journey against terrible odds. My husb still has the traech tube to this day & he’s been able to get Disability. I’m telling this story so others who may find themselves in similar situations can know that they are NOT alone! Never give up hope & faith because its the only thing that we have to hold on to when we need it the most. And 1 last thing, DO NOT allow yourselves to be around negative, critical & what I call emotionally unsafe people!!! They only drag u down with their bad attitudes & nasty comments. Trust me, its hard enough when you’re going thru this kind if horror to keep yourself from getting negative all on your own w/o having debby & donny downers pull you under with them!!! Get away & stay away from anyone like that because its the VERY last thing you need. God Bless anybody reading this post! I pray if I can help even just 1 person with our story to be able to stand firm in your faith in the Lord then its been worth the time its taken to type this up. Thanks for reading! 🙂

  18. Nancy Adams Armendariz says:

    I was diagnosed with sudden-onset type 1 diabetes in 1971 at age 33. I will have lived with diabetes for 43 years in August of 2014. As I look back over these years of my experiences living with type 1, there are several changes in resources I have found available in managing with the challenges and stress of self-care of type 1 diabetes. In the 1970s, where I was living in Ann Arbor, Michigan, there was a “Diabetes Support Group” facilitated by an educated, intelligent volunteer, who was herself a type ! diabetic with many years experience managing her diabetes, including receiving a kidney transplant. I attended our weekly meeting regularly, as did many others, with whom I shared comraderie along with whatever direction we took in our discussions. I always looked forward to these get-together meetings with others who shared much of the challenges of living with diabetes. As I recall, most of us, if not all, were type 1. For several years that group was a “life ine” for me, until some other demands in my life occupied my time and attention: I went back to school to train for a new career, was hired as a computer programmer at Commission of Professional and Hospital Activities in Ann Arbor, where I continued to work for five years, including three years as a Systems Engineer for Electronic Diabetes Systems. I was about to climb the walls when leaving there (and that work) — after all, I had in my life prior to data processing been a professional dancer, teacher, choreographer and anything BUT sitting at a desk person! I think in this now ending desk period of my life I was attempting to move on in my life in a long-suppressed, long-denied part of my identity. Whoops! Getting back to type 1 diabetes. There was never getting away from diabetes….It was constant. All through these years with other demands in my life…diabetes was a constant. I managed brilliantly! I feel confident in awarding myself for my control. Skipping along in the course of my life…I came out as a lesbian, met a lesbian from Australia, at Michigan Women’s Music Festival, when she was traveling in the U.S. We became lovers. She invited me to Australia…to apply for immigration to live there…..which I did!! Sometimes things move along very fast, when it is time!!! I applied for residency in Australia (which accepts lesbians and gays for immigration, when an applicant is supported by a same-sex partner who is a Resident of Australia, as was my partner, Sue. Unfortunately, our relationship did not last even really two years. I was the first to acknowledge this. I was devastated by the realizations of it. This was really the largest single major negative outcome in my life of any effort/intention/goal/ in my life as a lesbian. I was determined to find and use my creative self again to survive. I continued to live another five years in Australia, in pursuit of my creative abilities in writing and performance of my writing within the LGBT community. Those next five years were years of perseverance, rewarded with my writing and performances of my writing. Finally, in 2003, I responded to the pull to homeland, and returned for a three month visit (Nov-Jan, 2003) in Gulfport, Florida. I came with the plan to stay long enough to decide if I wanted to live in Gulfport, Florida. I decided that Gulfport would be a good place for me to live. I returned in January 2003 to Australia, gave my housemates there two months notice of my move, started packing, shipping, and flew in April, 2004 to return to Gulfport, Florida. While living in Melbourn, Australia, I was under the care of a wonderful endocrinologist, Dr. Allison Nankervis. Every visit with her was a pleasure. Everything about my attention from her, reports from her …all was good news, positive reports. Now… in recent years ….in my diabetes care experiences……I feel estranged…..First of all, I have not been able to locate a “Diabetes Support Group” for type 1 diabetics (like I had in Ann Arbor in the 1970(s). Without this kind of resource in support for type 1 diabetes anywhere in the St. Petersburg, Florida area …we are in diabetes type 1 wind without sail. As we age, it becomes increasingly challenging to live and manage with type 1 diabetes. I want to have hope for all of us now…and in years to come…Where are we to find resources between our once every three months appointment for 15 minutes with our doctor?

  19. Nancy Adams Armendariz says:

    I meant to write that I had worked for Electronic Data Systems…..not Electronic Diabetes Systems….Just goes to show how living long in self-care with type 1, can lead to obsession! Nancy Adams Armendariz

  20. Cindy says:

    I have had type 1 diabetes now for 61 years and have no complications, for which I am extremely grateful–mostly to my parents, who took very good care of me when I was a small child, and to Dr. Priscilla White, late of the Joslin Clinic in Boston. But I also had a very fine psychiatrist in my late 30s/early 40s who taught me that I should be proud of my accomplishments in life, that I have no need to compare myself to others (especially negatively), and that each individual is really quite remarkable. He helped me dig myself out of a depression that I’d been constructing since my early teens. He also put me on a low dose of an antidepressant medication that I still take. If you have managed to survive with this disease–for any length of time–you are to be congratulated! Please don’t give up. I, too, get frustrated and tell my husband of 20 years that I’m tired of having diabetes, tired of being on the roller coaster and want to get off. He’s very sympathetic, but of course can’t do anything about it. And then I realize that I can simply focus on something else for a while and the frustration will pass. On to more interesting topics than my own problems! That’s not to say I will stop taking good care of myself: cooking and eating delicious, healthy food; exercising (well, most of the time); checking my glucose levels 5 or 6 times a day; and using my OmniPod pump and DexCom continuous glucose monitor carefully. That goes without saying! I plan to live to 95 at least.

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  23. kjersti says:

    So im diabetic, type 1. 28 years. Ive struggled with diabetes alone almost all my life. Now my boyfriend cant understand the mood swings. I try to explain its not my fault but he thinks im using that as an excuse for a bad attitude. I try to tell him i need support and understanding. That that will help. Instead he blames which stresses me out and just makes my sugars worse overall. Any advice how to make him understand?

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