Many people with diabetes also experience anxiety, and they may wonder whether there is a link between the two conditions.

Diabetes and anxiety are both among the leading causes of disability in developed countries around the world.

In the United States alone, anxiety affects close to 40 million adults. Diabetes is also common, with about 30.3 million US adults living with this condition.

A 2013 meta-analysis revealed that people with diabetes face a higher likelihood than the general population of experiencing anxiety.

In this article, we outline the reasons for this association. We also describe the symptoms of both diabetes and anxiety, as well as how healthcare professionals diagnose each of these conditions.

How can diabetes cause or contribute to anxiety?

People with diabetes are responsible for managing their blood sugar levels and ensuring that these stay within a healthy range. This task can be challenging and stressful.

Doctors will ask people with diabetes to remain mindful of their blood sugar levels and to engage in routine behaviors, such as:

• paying particular attention to food ingredients
• avoiding certain foods
• tracking blood sugar levels regularly throughout the day
• timing insulin doses

Planning, checking, and being prepared for a wide range of challenges are all important for effective diabetes management. However, some people may worry excessively about their blood sugar levels or how their disease may progress. These concerns may trigger episodes of anxiety.

According to the National Library of Medicine, anxiety is "excessive worry or fear at real or imagined situations."

The emotional challenges of living with diabetes can also trigger anxiety.

What the research says

Researchers report that anxiety affects about 40% of people with diabetes. This prevalence is much higher than that in the general US population, where the condition affects 18.1% of people.

People with diabetes are at risk of developing low blood sugar, or hypoglycemia. Some of the symptoms of hypoglycemia are identical to those of anxiety.

Additionally, the results of a 2015 animal study suggest that experiencing several episodes of hypoglycemia can increase the likelihood of anxiety. The reason for this may be that hypoglycemic episodes trigger chemical and metabolic changes that physically affect the part of the brain that plays a role in processing anxiety.

Symptoms

Diabetes and anxiety share several symptoms. The American Diabetes Association and the National Institute of Mental Health both list the following symptoms for hypoglycemia and anxiety, respectively:

• feeling on edge or irritable
• difficulty focusing thoughts
• headaches
• lightheadedness
• fatigue
• rapid heartbeat

Diagnosis

The procedures that healthcare professionals use to diagnose diabetes and anxiety are quite different.

Diagnosing diabetes

According to the Centers for Disease Control and Prevention (CDC), doctors diagnose diabetes using one or more of the following blood tests:

• Fasting blood sugar: This test requires a person to fast overnight. A reading of 126 milligrams per deciliter (mg/dl) or higher indicates diabetes. Levels between 100 and 125 mg/dl indicate prediabetes.
• A1C: This test measures a person's average blood sugar level over a few months. An A1C of 6.5% or higher is a sign of diabetes. An A1C of 5.7–6.4% indicates prediabetes.
• Glucose tolerance: For this test, a person first tests their blood sugar after fasting and before drinking a glucose solution. After drinking the liquid, the person continues to test their blood sugar on an hourly basis for up to 3 hours. A result of 200 mg/dl or above at 2 hours suggests diabetes, while a result between 140 and 199 mg/dl may be due to prediabetes.
• Random blood sugar test: This test does not require fasting, meaning that a person can undergo it at any time. A reading of 200 mg/dl or above indicates diabetes.

Diagnosing anxiety

A person should see their doctor if they think that they have anxiety. The doctor may ask the person to fill in a questionnaire that asks about their psychological and physical symptoms.

In some cases, a doctor may refer the person for a mental health screening with a psychiatrist or psychotherapist. These mental health professionals will be able to carry out a more detailed assessment.

Treating diabetes and anxiety

People with diabetes and anxiety must learn to distinguish between rational concerns over diabetes management and irrational, anxious thinking.

The first step in this process is to work closely with healthcare professionals to develop a diabetes treatment plan. This plan should include information on the following:

• nutrition guidelines
• monitoring practices
• medication use
• weight loss tips, if necessary, and activity goals
• emotional support systems

For people with anxiety, many different treatment options are available. A doctor or mental health professional may recommend one or more of the following approaches:

• individual counseling
• group therapy
• cognitive behavioral therapy or other specific therapy techniques
• medication
• lifestyle changes
• complementary and alternative healthcare practices, such as yoga and meditation

The combination of diabetes and anxiety can create a vicious cycle of physical and emotional problems. However, people who learn to manage their anxiety may find themselves better able to manage their diabetes.

Certain lifestyle practices can be beneficial for people with diabetes, anxiety, or both. These include:

• exercising regularly and being physically active
• following a well-balanced, healthful diet
• establishing and maintaining a regular sleep schedule
• devoting time and energy to connecting with family and friends
• cutting back on caffeine
• limiting alcohol intake or avoiding it altogether
• avoiding using recreational drugs

Summary

Diabetes and anxiety are two serious yet common conditions, which can share some of the same symptoms.

People with diabetes are at increased risk of developing anxiety because they may experience excessive fear and worry about the management and possible progression of diabetes. Concerns over the physical symptoms themselves can also trigger anxiety.

Anxiety can, in turn, interfere with a person's ability to manage their blood sugar levels. Due to this, a person who has diabetes should see their doctor if they begin to experience symptoms of anxiety.

Many treatment options are available to help people deal with the symptoms of diabetes and anxiety. Certain lifestyle changes may also help with the management of both conditions.