Does T2D Cause Anxiety?

adrenaline anxiety anxiety disorder blood glucose brain cortisol cytokines elimination diet fight-or-flight response hpa axis hyperglycemia hypoglycemia inflammation insulin insulin resistance mitochondrial dysfunction stress sympathetic nervous system type-2 diabetes Jul 20, 2024

Depressed woman with a diabetes testing kit

Diabetic and anxious all the time? That’s not just a coincidence.

Studies show that around 40 percent of people with diabetes suffer from anxiety.¹

One in six people with type-2 diabetes (T2D) experience moderate to severe anxiety symptoms — a sign of an anxiety disorder.²

In this article, we’ll explore the link between T2D and anxiety as we cover:

Anxiety vs. anxiety disorder
Physiological changes in anxiety
Abnormal blood sugar levels and anxiety
Insulin resistance and anxiety

But first, when does ordinary anxiety become an anxiety disorder? Read on to find out.

Anxiety vs. anxiety disorder

The National Library of Medicine defines anxiety as “a feeling of fear, dread, and uneasiness.”³

Anxiety is a normal emotion. It can be your body’s response to stressful situations, such as taking a test or driving in heavy traffic. In such cases, anxiety can help you cope or focus. It can give you an energy boost too.^3,4

When you’re anxious, your heart might beat fast, and your blood pressure might increase. These physical changes might make you shake and sweat.^3,4

But if you have persistent and excessive fear or worry in non-threatening situations, you may have an anxiety disorder.^2,5

Physical symptoms of an anxiety disorder include not just sweating and shaking, but also palpitations, shortness of breath, nausea, and abdominal discomfort.⁵

You’re likely to feel irritable, tense, or restless. You may find it hard to concentrate or sleep. You may have an impending sense of danger or doom as well.⁵

Simply put, an anxiety disorder impairs your day-to-day functioning, interfering with work or school performance and also disrupting your relationships.³

Physiological changes in anxiety

Stressful situations trigger a cascade of hormones that produce well-coordinated yet almost instant changes in your body. This combination of reactions make up your “fight-or-flight” response — a survival mechanism that allows you to react quickly to dangerous situations, either by fighting off the threat or fleeing to safety.⁶

The stress response starts in a part of your brain called the amygdala. When your amygdala perceives danger in your surroundings, it sends a signal to your hypothalamus.⁶

Your hypothalamus, which acts like a command center, then activates your sympathetic nervous system (SNS). Your SNS is the network of nerves responsible for your fight-or-flight response.^6,7

To activate your SNS, your hypothalamus sends signals to your adrenal glands. In response, your adrenal glands — located above your kidneys — release the hormone adrenaline (sometimes called epinephrine) into your bloodstream.⁶

As adrenaline moves throughout your body, it causes various physiological changes — the same changes that are associated with anxiety. Your heart beats faster, pushing blood to your muscles and other organs. Your pulse rate and blood pressure rise. Your muscle cells below your skin surface contract, making you sweat. You start to breathe more quickly too, as the small airways in your lungs dilate to be able take in more oxygen. This extra oxygen goes to your brain, which makes you more alert. Your sight, hearing, and other senses get sharper.⁶

At the same time, adrenaline stimulates the release of blood sugar (glucose) and fats from their storage sites. These nutrients go to your bloodstream, providing your whole body with energy.⁶

The effects of adrenaline are short-lived though. They can only last for up to an hour after the stressful situation ends.⁸

Once the adrenaline surge wanes, your hypothalamus activates your HPA axis — the second component of your stress-response system. This network is made up of your Hypothalamus, Pituitary gland, and Adrenal glands.⁶

Your HPA axis depends on hormonal signals to keep your SNS activated. If your brain continues to perceive danger, your hypothalamus and pituitary glands will secrete certain hormones. Ultimately, these hormones will prompt your adrenal glands to release cortisol.⁶

Unlike adrenaline, cortisol can stick around for several hours. This keeps you energized and alert in case another stressful situation comes along.⁸

If your HPA axis remains activated, you can have high cortisol for months or longer. Long-term elevated cortisol is linked to anxiety disorders.^9,10

Abnormal blood sugar levels and anxiety

Having T2D means you need to manage your blood sugar levels and make sure they’re within a healthy range. But this task can be difficult and stressful.¹¹

Your daily routine may include checking food ingredients and perhaps avoiding certain foods. Also, you may need to check your blood sugar several times a day. Plus, if you use insulin, you’ll need to pay attention to the timing of your doses. Dealing with all these concerns may trigger anxiety.¹¹

Persistently high blood sugar levels — also called hyperglycemia — are the hallmark of T2D. But if you’re diabetic and you have trouble keeping your blood sugar levels stable, your blood sugar may sometimes drop below normal too. This condition is known as hypoglycemia.^12,13

In response to hypoglycemia, your body quickly releases adrenaline and slowly releases cortisol. As described earlier, these hormones drive anxiety symptoms.¹⁴

Insulin resistance and anxiety

Insulin resistance is the precursor to T2D. It happens when your muscle, fat, and liver cells don’t seem to respond well to insulin. Insulin helps your cells take up glucose from your blood for energy use. It also signals your muscles and liver to store glucose as glycogen. If you have insulin resistance though, over time your blood sugar levels will be persistently high.^15,16

Within your cells, your mitochondria produce 90 percent of the energy that your body needs to function. Insulin resistance in your brain prevents your mitochondria from working properly. Such mitochondrial dysfunction is connected with anxiety and other mental disorders.^17,18,19

What’s more, studies show that insulin resistance leads to disruptions to your HPA axis. A dysfunctional HPA axis may impair your body’s ability to deal with stress, putting you at risk of chronic anxiety.²⁰

Specifically, insulin resistance is associated with elevated cortisol levels. In addition to directly producing feelings of anxiety, long-term excess cortisol in your blood promotes inflammation. Inflammation is another normal biological function. It’s part of your immune system’s reaction to harmful stimuli. But like your fight-or-flight response, it’s meant to be used short-term. If it persists, inflammation can damage your cortisol receptors, further disrupting your HPA axis.^18,19,20,21

Too much cortisol raises your levels of cytokines too. These are inflammatory proteins that alter the structure and function of your brain. The changes, which mainly affect your brain’s prefrontal cortex and limbic system, are tied to anxiety disorders.^18,19

Conclusion

T2D can lead to anxiety in several different ways.

Having T2D requires ongoing blood-sugar management, a challenging task that can make you anxious.

Insulin resistance, the precursor to T2D, can also result in anxiety by impairing your mitochondrial function and disrupting your HPA axis.

Plus, insulin resistance is linked to high cortisol levels. In the long term, too much cortisol can alter your brain in ways that are associated with anxiety disorders.

You can fight anxiety along with T2D by managing — or even better, reversing — insulin resistance. Doing that is easier than you may think — in fact, you don’t need to look any further than your diet. Discover the number one dietary change you’ll need to fight insulin resistance when you sign up for the Diabetes Diet Solution now.

Does T2D Cause Anxiety?

Anxiety vs. anxiety disorder

Physiological changes in anxiety

Abnormal blood sugar levels and anxiety

Insulin resistance and anxiety

Conclusion

References

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