Anxiety + Type 1 Diabetes: What’s The Connection?

When you live with a condition like type 1 diabetes (T1D) that never lets up or allows for any breaks, it’s understandable how that could lead to anxiety. One quick way to know if you’re experiencing anxiety is if your stress levels feel abnormally high or if your stress response feels greater than what triggered it.

In this guide, we elaborate on the differences between feeling anxious and living with anxiety or another mental health condition, how to manage symptoms and how to find help from someone who truly understands this intersection.

Is it anxiety or a state of anxiousness?

Anxiety has become one of the most commonly diagnosed mental illnesses among adults in the United States. It seems like everywhere you turn, someone is talking about it—everyone and their mother, as the saying goes, seems to suffer. But there’s a difference between feeling anxious and living with an anxiety disorder.

In the U.S., anxiety diagnoses are far from unheard of:

• According to UAB Medical West, 40 million U.S. adults have been diagnosed with anxiety. 
• According to the National Institute of Mental Health, about 31.1% of U.S. adults will experience any anxiety disorder at some point in their lives—prevalence was higher among females than males.
• According to a 2023 report by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB), which featured a national survey of children’s health, more than 5.3 million adolescents ages 12-17 (20.3% of adolescents) had a current, diagnosed mental or behavioral health condition (anxiety, depression or behavior/conduct problems).

Studies vary slightly in exact data points and measurements, but they trend the same—anxiety is growing in the nation. So why are U.S. citizens so anxious? It could point to several factors.

Factors contributing to an uptick in anxiety diagnoses among U.S. adults and children may include:

• Social media engagement/All day digital connectivity
• Post-COVID-19 pandemic stress
• Academic pressure
• Economic/financial stress
• Heightened awareness of the geopolitical climate
• And more
  

What is anxiety, exactly?

Anxiety is brutal. To understand why it’s happening and how it connects to life with chronic illness, it’s important to first distinguish between anxiety and a state of anxiousness. A certain level of anxiety is healthy—necessary, even. It’s part of human survival! It keeps us from engaging in dangerous behaviors and motivates us to accomplish what we need to do. Everyone has a little bit of anxiousness, but an anxiety disorder goes beyond the baseline.

The main difference between feeling anxious and having an anxiety disorder is:

• Feeling anxious: is a normal, short-lived reaction to a specific situation that passes once the situation does. Feeling anxious doesn’t mean you have anxiety.
  

• Anxiety: is a persistent pattern that outlasts the trigger (or has none) and interferes with daily life. 

When this distress becomes too high or is disproportionate to the situation provoking it, the person tends to suffer from anxiety instead of benefiting from it. This is where feelings of anxiousness point to an anxiety disorder. Everyone has a standard amount of anxiety that serves them. The true difference is when it starts hurting you. That’s where the signs point to more than just a passing feeling.

An anxiety disorder should be diagnosed by a mental health professional so that you can get proper treatment. Treating the “wrong” condition may mean no relief of symptoms, so it’s best not to assume you’re living with one thing when you could be living with another. For example, anxiety can be a byproduct of conditions like attention-deficit/hyperactivity disorder (ADHD).

4 common anxiety and related disorders

There are many types of anxiety disorders. 

Some of the most common include:

• Generalized anxiety disorder (GAD): this reflects a prolonged state of worry or tendency to worry about any and everything. GAD can have physical manifestations, such as gastrointestinal (GI) problems and difficulty sleeping. Someone living with GAD will tend to view everything through a lens of anxiety and feel bombarded by “what-ifs?”.
• Panic disorder: panic disorders can occur when a person experiences multiple panic attacks and lives in constant fear of the next one occurring. Everyone experiences panic attacks in different ways, but the most common symptoms are shortness of breath, feelings of impending doom, depersonalization (when you feel like you are floating outside of your body) and heart palpitations, to name a few.
  
• Social anxiety disorder: this is basically what it sounds like—social anxiety disorder is when people experience extreme discomfort and anxiety around other people. This type of anxiety is rooted in the fear of what others think of you, embarrassing yourself or looking foolish in a social setting.
  
• Obsessive-compulsive disorder (OCD): checking is essential in life with diabetes—checking your blood sugar, insulin on board (IOB), low blood sugar supply stash, etc. But for someone with anxiety, checking can spiral into an obsessive ritual, sometimes manifesting as obsessive-compulsive disorder (OCD). People with OCD perform certain rituals to quiet obsessive thoughts that repeatedly run through their minds. With all the checking diabetes requires, you can imagine how this can fall into a negative thought-behavior cycle.
  

Diabetes and anxiety: what’s the intersection?

Anxiety can make diabetes management more challenging and may affect your blood sugars indirectly—it’s unfair, we know. T1D gives anxiety a lot of fuel, so it may be easy to confuse the T1D part of you with the anxious part. Just remember, you live with these conditions; they aren’t your identity—at least, they don’t have to be the things you define yourself by.

The fears and thought patterns that fuel anxiety are inherent to managing diabetes. They can help or hurt you on any given day. When you struggle with anxiety, it can wreak havoc on your blood sugars. Diabetes management can be counterintuitive with anxiety levels, which makes treating anxiety almost as important as treating T1D itself.

T1D and anxiety can feel like toxic partners who can’t quit each other, but there are ways you can improve your relationship with these competing obstacles in your body—we’ll get to that in a bit!

How to manage a “what if?” mind with diabetes

• “What if I die?”

• “What if I embarrass myself?” 

• “What if I fail?” 

When you live with anxiety, questions like this can feel crippling, but when you live with T1D, they’re necessary for survival.

If you prebolus (meaning you take your insulin in advance of eating) your dinner at home before you leave for a restaurant, for example, you have to ask yourself:

• “What if I get stuck in traffic?”

• “What if the kitchen is 45 minutes behind?”

• “What if the chef messes up my order and has to remake it?”

• “What if we lose our reservation and have to go somewhere else miles away?”

With T1D, questions like these are helpful, but with anxiety, they can send you into full panic mode. Still, you can’t stop asking them because doing so could lead to dangerous situations. Diabetes requires planning and proactivity, but if you’re not careful, the questions you ask yourself around it could manifest into more fear and anxiety.

Planning your insulin dosage around exercise can be proactive and healthy. Anticipating you’ll go low during a workout and pass out isn’t. That’s the difference between a forward-thinking T1D brain and a T1D brain with anxiety.

There’s no shame in needing anxiety medication

Taking anxiety medication under a healthcare provider’s guidance can be helpful until you’ve had more time and practice retraining and reconditioning your mind so you can approach diabetes with silver linings instead of doomsdaying it. Just as there is no shame in taking medication for diabetes management, there certainly isn’t any for anxiety management either. 

Anxiety medication can help with symptom management—this is a psychological and neurological condition. While society might’ve tried to tell you it’s something you can control, if you’re still feeling anxious and you’re unmedicated, that’s not for lack of trying. Your head might be overfiring signals it shouldn’t. That’s not your fault. 

And even if it were on you, you still deserve grace and kindness. Shame never motivated anyone. It certainly shouldn’t self-motivate you to change your thinking! 

How to help yourself stay present with T1D and anxiety

While planning can help some people with diabetes (PWD), it can also take you out of the moment. You may find yourself struggling to be present, or even feeling like you’re missing your life, if you’re planning 12 steps ahead all the time. It’s valid if you are! It doesn’t mean anything is “wrong” with you or that you’re “weird.”

It is often difficult to be spontaneous in life with T1D when you’ve got IOB, sensors showing double downward-pointing arrows and a fixed amount of glucose gummies in your tote. Even nervous-system-regulating practices like yoga or meditation can be interrupted by insulin pump and continuous glucose monitor (CGM) alerts. It can be very taxing trying to “keep calm and carry on” in life with T1D. If only it were as easy as hanging up a motivational poster or spinning a fidget ring around your finger!

More seriously, if anxiety pills aren’t the route you’d like to explore to support your symptom management, there has also been growing evidence of the helpfulness of mindfulness-based stress reduction (MBSR) for treating anxiety in people with chronic illnesses like T1D. MBSR is a structured eight-week program combining education and experiential activities, including meditation, yoga and body awareness, designed to assist individuals in managing stress, pain and chronic illness.

How to manage your anxiety: put in the effort and get support

Fortunately, much like type 1 diabetes, anxiety disorders are manageable, but it takes work. Your mind is a muscle you must train and put effort into to be managed well, just like you do physically with your diabetes through insulin and with other diabetes devices and tools. 

If you feel like anxiety is interfering with your everyday life, consider seeing a therapist on top of the other recommended strategies mentioned within this guide. Therapists who have experience working with people with chronic illness can be especially helpful. 

If you would like to see a therapist to manage your anxiety and T1D, your healthcare provider may have referrals. If you have private health insurance, you can also call the “Member Services” number on the back of your insurance card and ask for referrals to local in-network behavioral health providers.

If you have Medicaid (or your state’s equivalent program), your state’s Division of Mental Health and Addiction Services should have resources for local community mental health centers that accept this insurance. Your therapist or primary care doctor can also advise whether you should consult a psychiatrist. A psychiatrist can prescribe medications for behavioral health concerns.

There are also many ways to find a therapist online:

• ADA Mental Health Provider Directory Listing
• Psychology Today
• NASW
• SAMHSA
• Insurance – Using a directory of covered Mental Health providers 

If you feel comfortable, ask around! The T1D community may know even better options. 

Anxiety is a manageable condition, just like T1D

While diabetes and anxiety may make a great pair, you don’t have to live at their mercy constantly. As you learn to accept and manage your anxiety, you’ll learn how to live well with it. It won’t be easy, and there will be a lot of trial and error. Of course, having type 1 means you’re used to that! And always remember, you’re not alone in this.

A community is waiting to support you! Many people have walked in your shoes before. Make connections and have meaningful conversations through our Community Apps. Join today!