Mental health in diabetes: The battle beyond blood sugar

When we talk about diabetes, the first thing people think of is blood sugar: fasting levels, HbA1c, insulin and so on. But rarely do we speak about what diabetes does to the mind: the emotional wear and tear, the constant mental juggling act that never seems to end.

Depression 

Ade, a 52-year-old businessman, was diagnosed with Type 2 diabetes over a decade ago. Once disciplined about his health, he gradually lost interest in self-care, missing doctor’s appointments and was skipping medications. His family noticed his withdrawal and irritability, but they attributed it to work stress. When he was hospitalised for severe diabetic complications, doctors uncovered an underlying major depressive disorder. Ade was depressed! By the time he was rushed to hospital, he had hit rock bottom. Not only was his body crashing, but so was his mind. Depression had crept in quietly and dismantled his self-care one piece at a time. Ade’s case highlights how untreated mental health issues can silently deteriorate physical health, leading to a dangerous cycle of neglect.

Ade’s story is not unique. Studies show that people with diabetes are twice as likely to experience depression—but nearly 75 percent of cases go undiagnosed. And untreated depression in diabetes is not just a mental health issue—it’s a medical risk factor that can significantly worsen outcomes.

Distress and burnout

Aisha, a 40-year-old teacher, struggled with the reality of managing Type 1 diabetes. Living with diabetes is like having a full-time job you never applied for. There are no days off. No holidays. No “I’ll deal with it later”, constant blood sugar checks, strict dietary restrictions, and the fear of long-term complications overwhelmed her. She found herself resenting her condition, frequently skipping insulin doses and indulging in comfort foods. When her sugar levels spiked dangerously, she was diagnosed with diabetes distress, a psychological condition where frustration and exhaustion lead to self-sabotage.

Aisha wasn’t being careless—she was emotionally burnt out. Diabetes distress is a psychological state caused by the relentless demands of diabetes self-care. It’s not depression, but it feels close. It’s the constant worry, the frustration, the guilt, and the feeling that no matter how hard you try, it’s never enough. Up to 36 percent of people with diabetes experience this distress, which often goes unspoken—until it leads to poor glycaemic control and serious health risks.

Anxiety

Chike, a 28-year-old software engineer, developed an intense fear of low blood sugar episodes after a near-fatal hypoglycaemic attack. The incident left him traumatised and feeling vulnerable that he could just die at any time from the condition. He became overly cautious and started consuming excessive carbohydrates to “stay safe.” This unintended coping mechanism caused persistent high blood sugar levels, worsening his overall health.

Chike’s story illustrates how anxiety can dominate the diabetic experience. Hypoglycaemia-related anxiety is real and common, especially in those who have had close calls. But anxiety doesn’t just affect emotional well-being—it leads to behaviours that paradoxically worsen diabetes control, such as overeating or avoiding insulin. It turns survival strategies into self-sabotage.

Discussion: Diabetes doesn’t just affect the body, it drains the mind

Diabetes affects over 422 million people worldwide, with Nigeria alone accounting for over 3.6 million cases. While its physical complications—blindness, kidney failure, and amputations—are well-known, its mental health impact remains dangerously neglected. Studies show that people with diabetes are twice as likely to experience depression. Sadly, nearly three-quarters go undiagnosed. And that’s just depression. Anxiety, burnout, diabetes distress, even disordered eating patterns—these are part of the diabetic experience too. They affect how people take their meds, what they eat, how they feel about their bodies, and whether they even feel like fighting anymore.

Diabetes is demanding. It requires constant attention—blood sugar checks, diet choices, physical activity, medication timing. There’s no off switch. And when the numbers fluctuate, they can hijack your emotions—irritability, confusion, brain fog. Over time, this rollercoaster can take a serious toll on mental clarity and mood stability.

Emerging research also links chronic high blood sugar (hyperglycaemia) to cognitive decline and dementia, especially in people with Type 2 diabetes. So yes, diabetes doesn’t just affect your feet, eyes, or kidneys. It affects your brain too.

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Let’s talk about it

We need to stop treating mental health symptoms in diabetes like background noise. Depression isn’t laziness. Burnout isn’t indiscipline. Anxiety isn’t overreacting. These are real, diagnosable, treatable conditions. And they matter, because when the mind breaks down, the body soon follows.

So the next time we talk about diabetes, let’s not stop at sugar levels. Let’s ask:

How are you coping? Are you sleeping well? Are you still motivated to take care of yourself? Do you sometimes feel overwhelmed or helpless?

Because the true battle in diabetes isn’t just about controlling blood sugar, it’s about protecting the person who’s living with it, body and mind.