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Trying to ascertain whether anxiety is psychologically-based or due to diabetes can be difficult as diabetes and anxiety symptoms are very similar. Diabetes and anxiety are associated and so specialist care is needed to identify and manage both conditions
Trying to work out whether anxiety is psychologically-based or down to blood sugar can be tricky as both hypoglycemia and hyperglycemia symptoms are very similar to symptoms of anxiety.

Anxiety and diabetes 

Emotions such as fear and anger are regulated by our limbic system which includes several structures in our brain which act as a guard, continually looking out for possible danger. When a potential threat is detected we go into the fight, flight, or freeze mode. Our bodies release stress hormones (primarily adrenaline and cortisol) into the bloodstream which kick-start biological processes and responses to enable us to avoid danger. These mean we can be ready for action and respond quickly. There are a number of physical sensations which arise as a consequence of our body's natural 'flight or fight' response to a challenge:

  • Shortness of breath.

  • Tightness in the chest

  • Feeling dizzy or light-headed

  • Palpitations (thumping in the chest)

  • Muscle pain, such as head and neck pain

  • Needing to urinate/defecate

  • Shaking

  • Perspiring

  • Dryness in the mouth

  • Feeling unable to swallow

  • Visual disturbances such as blurred vision

  • 'Butterflies' in the stomach or feeling nauseous

  • Gastrointestinal symptoms commonly associated with irritable bowel syndrome.

Over the longer term, when people have an anxiety disorder they may have the following issues:

  • Weight loss (generally owing to loss of appetite but on occasion, it can be due to increased metabolism)

  • Changes in appetite – reduced or increased appetite

  • Feeling extremely tired or lethargic

  • Poor physical health (as severe, chronic stress impacts upon the immune system's ability to function)

  • gastrointestinal issues

Symptoms of diabetes include:

  • Frequent need to urinate

  • Feeling very thirsty or having dryness in the mouth

  • Feeling perpetually hungry despite eating

  • Overwhelming fatigue

  • Blurred vision

  • Difficulties with healing

  • Weight loss

  • Tingling, pain, or numbness in extremities

  • gastrointestinal problems such as irritable bowel symptoms and diarrhea.

Therefore we can see the overlap between the conditions can be quite considerable and lead to confusion not only with an initial diagnosis but also in terms of subsequent events.

Living with diabetes

Diabetes impacts upon your body’s ability to produce and use insulin. People with the condition use a variety of treatments to enable their bodies to process the glucose in their blood and turn it into energy. Type 2 and type 1 diabetes are a markedly different condition with varying etiology (causes) and different treatment approaches.

Whilst nowadays living with diabetes is a manageable state of affairs, the nature of the condition and process of managing it can be stressful. For many, this stress is part of their condition and does not become pathological; however, for some, it becomes sufficiently severe that it has a significant impact on their day-to-day living. With diabetes, people may worry about a multitude of things that can lead to anxiety; both short and long-term. For example, the risk of renal failure and heart disease are increased in those with diabetes as is neuropathy or nerve damage which generally affects the extremities. Poorly managed diabetes can, long term, lead to necrotic digits/toes and amputations, for example.

Emotional stress or anxiety and physiological stress such as from illness or injury cause the body to release stress hormones into the blood which cause blood sugar to rise. For those without diabetes, this is followed by an increase in insulin secretion so that it is managed. For those with diabetes, where there is insulin insufficiency or indeed lack of insulin production, stress can, therefore, lead to difficulties with blood sugar level management.

Stress can, however, affect people differently, dependent on the form of diabetes. The form of stress experienced will also determine your body's physical reaction. For example, in type 2 diabetes mental stress, typically leads to an increase in blood sugar levels; whereas those with type 1 diabetes may experience either an increase or a decrease. Physical illness can lead to rises in blood sugar levels and research has shown a strong link between chronic stress and systemic inflammation, which in turn can lead to ill health.

Incidence: people with type 2 diabetes are more likely to be diagnosed with anxiety and depression

Studies show that people with type 2 diabetes are as much as four times more likely to be diagnosed with anxiety and depression. Studies indicate levels of 20 to 40 percent of people with type 2 diabetes have anxiety specifically and this is also more common in women.

Research also indicates that anxiety may influence type 2 diabetes risk. According to a study measuring levels of blood glucose and an immune response protein (IL-6), high anxiety is associated with increased inflammation in the body; and over the long term, inflammation increases the risk of developing type 2 diabetes.

Panic disorder and anxiety

A specific anxiety disorder, panic disorder, has been shown to negatively impact people’s diabetes control. The symptoms that indicate panic disorder -unpredictable, excessive fear, alongside specific physical sensations – are also similar to symptoms of hypoglycemia (low blood sugar). Symptoms may include palpitations, perspiring, breathing difficulties such as shallow or rapid breathing, numbness or tingling, chest discomfort, dizziness or lightheadedness, nausea, trembling or shaking, and feeling hot and/or cold. Many of these could also resemble a heart attack and so can also lead to misattribution of symptoms: for example, someone may check blood sugar believing their diabetes to be the cause but then feel concerned if they test as normal; they may then start to worry as symptoms persist that another medical emergency is at play.

A recent study showed that people with diabetes who also have panic disorder have higher measures of blood glucose over time (HBA1C) than those who don't. This suggests that panic attacks may interfere with people’s ability to manage their diabetes.

Diabetes-related anxiety and management strategies

Another problem people experience is known as “hypo anxiety” which is where a person becomes preoccupied with their blood glucose levels dropping too low, This is a common complaint – one study found that one-quarter of people with diabetes reported a serious issue with worrying about “hypos”. When people have both anxiety and diabetes, they need to work with their specialist clinician to enable them to work out the most appropriate approach to managing their co-morbid conditions effectively and safely.  

Relaxation techniques such as deep progressive muscle relaxation and mindfulness-based approaches can be useful strategies to manage anxieties; as can arming yourself with knowledge about your condition as it can significantly reduce worries and fears.

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