Diabetes and Mental Health

Checking sugar, taking pills or insulin, watching food, and worrying about complications, every single day. It is no surprise that many people with diabetes feel tired, frustrated or low. This is common, and it helps to talk.

What is happening

Diabetes means your body cannot manage blood sugar (glucose) properly. Type 2 diabetes is very common in South Africa, and many people have it without knowing. Type 1 usually starts younger and always needs insulin.

Mind and blood sugar are linked both ways. High and low sugar can cause irritability, anxiety, poor concentration and tiredness that feel like mood problems. At the same time, stress hormones raise blood sugar, and depression makes it harder to eat well, move and take medicine. People with diabetes are more likely than others to experience depression.

There is also "diabetes distress" or burnout: feeling overwhelmed, guilty or fed up with managing it. Some people stop checking or skip medicine, not because they do not care, but because they are exhausted. Shame and blame from others, including comments about weight or food, make this worse.

Signs to notice

• Feeling fed up, defeated or guilty about your diabetes
• Skipping medicine, insulin or clinic visits
• Avoiding checking your sugar because you fear the number
• Mood swings that seem linked to highs and lows
• Poor sleep and low energy most days
• Hiding what you eat from family

30-second self-check

Answer yes or no to each question.

• Do you often feel overwhelmed by managing your diabetes?
• Have you missed medicine or insulin more than twice in the last two weeks?
• Have you felt low or lost interest in things for two weeks or more?
• Do you avoid checking your sugar or going to the clinic?
• Have you had a low sugar episode (shaky, sweaty, confused) recently?
• Do you feel judged or blamed about your diabetes?
• Is money making it hard to buy food or get to the clinic?

0-1 yes: You are coping well. Keep your routines and check-ups going.
2-3 yes: Diabetes is taking a toll. Share this with your nurse or doctor and consider support.
4 or more yes: You deserve more support. Speak to your clinic this week and ask about counselling.

What you can do next

• Today: Know the signs of low sugar (shaking, sweating, confusion, fast heartbeat) and keep sugar sweets or juice with you if you use insulin or certain tablets.
• This week: Pick one small change: a 15 to 20 minute walk after supper, or swapping sugary cold drinks for water. Walk with a friend in a safe, well-lit area.
• This month: Ask your clinic for your HbA1c (three-month sugar average), blood pressure, eye, kidney and foot checks.
• Affordable food works: pap made with less, beans, lentils, eggs, pilchards, cabbage, spinach and pumpkin. A dietitian can help plan meals on a budget.
• Tell your family what helps and what does not. Food policing rarely helps; support does.

Your tool

Lifestyle Health Check - a two-minute private check of your sleep, movement, food, alcohol, smoking and stress habits, showing which small change would help your sugar and mood most.

When to get professional help

Get help if you feel low or burnt out for more than two weeks or are struggling to take your treatment. Call 10177, or 112 from a mobile, if someone with diabetes is confused, very drowsy or cannot be woken, is having a fit, or has very high sugar with vomiting, deep fast breathing or a fruity smell on the breath. If low sugar does not improve after sugar, get emergency help. See a doctor today for a foot wound that is red, hot or smelly. If you have thoughts of ending your life, call 0800 567 567.
Who can help: doctor, nurse, dietitian, biokineticist, psychologist, counsellor, emergency services

Getting help in South Africa

Public clinics provide free diabetes care, medicine and regular check-ups. Many pharmacies do low-cost sugar tests. For emotional support, call the Cleared Mind 24-hour Careline on 0800 212 146 or SADAG on 011 234 4837.