Type 1 diabetes (T1D) may be a physiological condition, but it comes with an emotional impact that should never be underestimated. Daily regimens, lifestyle changes, worries about complications, and other significant anxieties can cause emotional stress — also known as diabetes distress. Diabetes distress can reveal itself in feelings of anger, resentment, guilt and irritability.
It is easy to see how these psychological aspects of managing T1D can affect you emotionally, but there is more to bad moods than psychological stress; in T1D, these moods also have a physiological basis.
Blood glucose fluctuations
When not effectively regulated, fluctuations in blood glucose levels can have a significant effect on emotions. You may already be aware of feeling tense and angry when your blood sugar is high and nervous and tearful when your sugars are low. These emotions tend to resolve when you manage to stabilize your glucose levels. Sometimes, it’s not even the blood glucose levels, but rather the rapidness of fluctuations that may cause a sudden rise in certain emotions.
Although studies have confirmed that fluctuations in blood sugar usually have an impact on moods, the specific emotions evoked by either hyperglycemia or hypoglycemia have been found to be rather idiosyncratic. This means that even within the same person, low or high blood sugar may cause different mood changes at different times. However, the most common emotions associated with high blood sugar are anger and sadness, while with low blood sugar, nervousness and irritability are more common.
So, what exactly is happening in the body to cause these mood changes?
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Type 1 diabetes and mood: the highs and lows
The human brain requires glucose to function, and when the glucose in your blood is insufficient, your brain tends to become “weak.” The resulting mood changes are due to the lethargy that comes from your brain not getting the energy it needs; you simply lack the brain power to manage your moods. Furthermore, hypoglycemia can affect levels of acetylcholine, a neurotransmitter responsible for transmitting signals between brain cells, specifically signals that control psychological and physical functions like breathing, heart rate and muscles. This may explain why some people report experiencing a slightly euphoric feeling, similar to being mildly drunk, when their blood sugar drops.
Conversely, too much sugar in the blood has the adverse effect of putting your brain on very high alert. In people with T1D, a rise in sugar levels also increases the chemical glutamate in the region of the brain that controls emotions. Glutamate has been linked to depression, and this response to increased sugar levels only occurs in people with T1D. This explains why many people report being in a very low mood akin to depression when their blood sugar rises. If it persists over a long period of time or happens frequently, high blood sugar can lead to depression.
Managing your moods
The emotional impact of T1D can significantly affect your quality of life and even your physical safety in certain situations. Managing your emotional health is therefore as important as managing your diabetes. Considering that your mood can be influenced by both the psychological or physiological effects of T1D, or sometimes by both, it is necessary to guard against both.
The mood management strategies that will work for you may change as rapidly as your emotions, so have several options at hand. Some examples include:
• Develop an extended support system. This could include diabetes support groups, family members, friends, your doctor or a diabetes coach.
• Journal or blog about your daily struggles as an outlet for negative moods.
• Meditate and find time to relax.
• Infuse an abundance of humor into your life.
• Volunteer at your favorite charity.
• Follow your diabetes management plan carefully and avoid sudden spikes or dips in blood sugar.
• Keep a mood diary to record when you have mood swings to determine what your key triggers are.
• Use the kind of continuous glucose monitoring (CGM) system that shows how fast your blood sugar is rising or falling, such as the Dexcom G6 CGM.
• Educate the people around you about your potential for mood swings due to fluctuating blood glucose levels.
• Be armed with a generous dose of self-forgiveness.
T1D and moods are interwoven in many ways, but that doesn’t mean you are completely out of control of your emotions. Know how your glucose highs and lows impact you and prepare in advance for dealing with these fluctuations. In other words, put yourself in the driver’s seat!
Want to learn more about diabetes and mood? Read “Beating the Winter Blues,” “Snap Out of It: Using Food to Boost Your Mood” part 1 and part 2 and “Reducing Diabetes Stress.”