Since the discovery of insulin in 1921 by Canadian researchers Frederick Banting and Charles H. Best, Canada has remained a leader in diabetes research. 

Most of these advances have been in the form of new or modified treatments and practices but with increased understanding about how mental health affects whole health in general, a new focus on the relationship of diabetes and mental health is evolving.

Ross Chocolates wants to shine a light on some of the mental health issues that are difficult for those with diabetes. In addition to all the mental illnesses that can affect all people, those with diabetes may have other mental illnesses to deal with that others do not.

The most common mental illness in North America today is depression. Those with diabetes are two to three times more likely to suffer from depression than others and several of the symptoms of depression such as extreme fatigue, over- or undereating, and insomnia—or its opposite—trouble staying awake all affect blood sugar levels. In addition, those with diabetes may have to deal with other mental illnesses others do not.

Diabetes distress encompasses the emotional burden and stress that comes with constantly monitoring and dealing with diabetes. It includes:

• Worry
• Frustration
• Fear

Diabetes distress can lead to diabetes burnout, which includes:

• Physical and emotional exhaustion
• Disengagement from life and diabetes care
• Frustration, hopelessness and despair
• Neglect of self-care
• Irritability and stress

Diabetes burnout is a serious situation that needs to be addressed—request help with diabetes management and other tasks from family and friends, seek relaxing techniques and engage in relaxing activities such as exercise, laughter, meditation, and hobbies, seek help from diabetes and other medical professionals including nurses, nutritionists, psychologists, physicians, and counsellors

Loneliness is the feeling of being alone, regardless of the amount of social contact; social isolation is a lack of relationships, contact with, or support from others while wanting or needing it. While both loneliness and social isolation are more common amongst those with diabetes than others, social isolation is more serious. 

Always needing to be aware of how different foods affect one’s blood sugar levels can cause those with diabetes to avoid social activities that focus on food, eating, and drinking for fear of appearing different, not knowing how their blood sugars will act due to consuming foods with which they are unfamiliar, or encountering sauces and additives that include additional sugars or carbs that they aren’t aware of. Worrying about blood sugar levels, food intake, and exercise can also cause those with diabetes to shy away from social activities involving physical activities, extended periods without food, or requires one to keep up with a group as it moves or participates in an activity. 

Those with diabetes are often acutely aware that they are “different” than others and don’t want to draw attention to those differences so they avoid situations in which they may be revealed (for example, avoiding swimming or other activities because they don’t want others to see their insulin pump or CGM or be seen checking their blood sugar or injecting insulin). 

Those with diabetes who live alone can suffer low blood sugars more frequently and more severely than those with diabetes who live with others; the risk of death is higher for those with diabetes who live alone. Not only can social isolation from having diabetes be very psychologically damaging but social isolation has been shown to increase the incidence of heart disease, stroke, high blood pressure, weakened immunity, and reduced overall longevity, all conditions that diabetes may already worsen.

Psychological Insulin Resistance (PIR) is sometimes experienced by those with Type 2 Diabetes (T2D). PIR is psychological resistance (due to cognitive, emotional, relational, and/or cultural understandings or feelings) to beginning or continuing insulin injections or use. 

For years, T2D was mainly controlled by diet, exercise, weight loss and control, and behavioural changes and, initially, it is still often treated in these ways. The use of insulin, which is necessary when all the other treatment methods have not brought a person’s blood sugar levels to a safe level, is not usually deeply discussed early in the treatment of T2D. Thus, people with T2D who are told to start using insulin are reluctant to do so. 

 They feel various things such as that they have been “bad” and if they just watch their diet, exercise, or take cinnamon, or any other “magic” solutions they can avoid taking insulin. They also feel that starting insulin will lead them to be at risk for more serious complications down the road (they couldn’t be farther from the truth). Since their pancreas does still produce insulin (it either produces too little for their needs or it produces enough but their body is resistant to using what is produced), they can survive without taking insulin (unlike a T1D, who will become very ill very quickly because they don’t produce any insulin at all). What people with PIR don’t realize is resisting insulin use (or limiting it) leads to the complications they fear taking insulin will impose on them:  Circulation, nerve and eye damage, kidney disease, heart disease, etc. are MORE likely to occur if someone resists using insulin when prescribed by a healthcare professional. 

Overcoming PIR is a challenge for some patients and specialists to assist them with overcoming the resistance or refusal to take insulin as required are not widely available (a psychologist may be required rather than a medical doctor, nurse, or diabetes specialist). The problem with PIR is that long-term damage to the body can lead to blindness, infections, amputations, nerve damage, kidney disease, and shortened lives. 

Another factor that can be involved with social isolation is a strong fear of hypoglycemia. One in seven people with T1D suffer from this disorder but those with T2D and gestational diabetes who take insulin can also suffer from this mental disorder. FOH causes anxiety and stress, inhibits normal activities, and causes resistance to trying new things, and these, in turn, can cause blood sugar control to be more difficult.

Although a fear of hypoglycemia is important to survival and blood sugar control, when that fear becomes overwhelming, it is counterproductive. People with FOH allow their anxiety about having low blood sugar to affect their activities, often limiting them so they are always able to avoid a low. They may allow their blood sugar levels to run much higher than recommended for fear of having a low, which has negative impacts on long-term complications and health. As well, ironically, high levels of anxiety can mask the physical feelings of a low blood sugar episode, which may lead to suffering a lower blood sugar event than had the person sensed the low earlier.

Primary psychosis is a state in which a person has trouble determining what is real and what is not real and can include: hallucinations, delusions, disordered thinking, confusion, trouble focusing, and disorganized speech or behaviours. Secondary general psychosis is a state in which the same symptoms appear but they are those caused by a medical condition, of which diabetes is one.

Those suffering from ketoacidosis (extremely high blood sugars resulting in the production of ketones in the bloodstream) or severe hypoglycaemic events can suffer from secondary psychoses, which are evident as visual hallucinations, delusional thinking, and confusion.

It is important to note that those with diabetes do not suffer psychosis when their blood sugars are not extremely high or low—it is only at the two extremes of the blood sugar scale that psychosis may occur—and diabetes is not associated with primary psychosis, although research shows treatments for primary psychosis can lead to weight gain which, in turn, can lead to T2D.

At any time, hallucinations are serious but when someone with diabetes is suffering hallucinations during a low blood sugar episode, hallucinations are particularly dangerous as they may stop the person from treating their low blood sugar. Their focus may sway from getting sugar into their bloodstream which may lead to accidents, unintended injuries to themselves and others, or loss of consciousness before they can consume sugar or use nasal glucagon to raise their blood sugars.

 Dealing with chronic illness, such as diabetes, adds extra stress to a person’s life, as they must stay aware of their health and make treatment decisions 24 hours a day. The added stress of full-time self-care can wear people down. It can become overwhelming. 

Those with diabetes need to beware of the risks of poor mental health and should advise at least one person on their medical team (doctors, nurses, diabetes specialists, etc.) of their feelings, challenges, and thoughts as soon as they become aware of them..

Dark chocolate is good for those with diabetes and studies have shown that dark chocolate is good for mental health, particularly for reducing depression but also for treating stress and anxiety. Thus, the health benefits of Ross No Sugar Added (Sugar-free) Dark Chocolates for all types of diabetes are twofold: It’s good for your blood sugar levels and good for your mental health. 

Boost your mental health with the best no-sugar-added chocolate every day!