The Emotional Side of Complications


We have been educated, maybe warned, or even “threatened” with diabetes complications since we’ve been diagnosed. Many of us have been made to think that if we develop any complication (let alone more than one) that it is our sign of failure—failure to take care of our diabetes, failure to follow what our doctor told us and that we are “bad diabetics” that didn’t take care of ourselves. The stigma attached to diabetes complications is still prevalent today even though we know a lot more about them (e.g., genetics plays a role) than 30 years ago.

Many people with diabetes have been educated to keep their blood glucose as close to their target range as possible in order to avoid and/or delay developing complications. But we are cautioned that even if we do take diligent care of our diabetes, we can develop complications anyway—there are no guarantees. This makes many people feel hopeless and helpless because they lack control over the development of complications.

Diabetes + Everyday Life

This burden and worry of developing diabetes-related complications, in addition to the already overwhelming, unending demands of diabetes—multiple doses of medication(s) and/or insulin; self-blood glucose monitoring or continuous glucose monitor (CGM); managing other health conditions, pregnancy, colds/flu, or diabetes-related complications; eating healthy and/or counting carbs; getting regular physical activity; managing our stress so it doesn’t affect our blood glucose; keeping up with all of our recommended doctor appointments and screenings; added medical bills; not to mention the responsibilities of normal life (i.e., working, paying bills, a love life, family, friends, etc.), leaves many people burned out and unmotivated to take care of their diabetes.

So, it’s not surprising that people with diabetes are twice as likely to have serious psychological distress compared to people without diabetes.1 Depression has been found to be significantly associated with diabetes complications including eye, kidney and nerve diseases as well as macrovascular complications and sexual dysfunction.2 Depression, anxiety and other disorders causing serious psychological distress are associated with poor quality of life (QOL) and physical functioning. In addition, these psychological and emotional factors can also impact glycemic management and diabetes self-care behaviors (adhering to a diabetes regimen).2,3,4,5 This can further increase a person’s risk of developing complications and/or contribute to the progression of existing complications (because of higher blood glucose).

Developing a complication may impact a person’s ability to be independent and they worry about being a burden to their family. They may also be in pain and their self-image may change because of their new limitations. People worry about being treated differently, about the loss of or change in relationships, worry about the cost of additional medications or treatments, worry about job security or prospective jobs. There is also a judgment and stigma surrounding diabetes complications that make people embarrassed, shameful, or feel guilty. They may also experience blame associated with having complications—blame from family, blame from their healthcare providers and they blame themselves, which further feeds into the psychological distress.6

The emotional toll and physical consequences of complications impact every aspect of a person’s life. The emotional and psychological experiences previously described are very common—these feelings, worries and reactions are very normal. In fact, if a person didn’t have any of these reactions that would be out of the norm. Because complications pose an enormous impact on a person’s life, individuals may need extra support and understanding.

Mental Health as an Essential Part of Diabetes Care

Addressing the social, emotional and psychological aspects of diabetes and complications has been found to play such an important role in the health and quality of life for people with diabetes, that the American Diabetes Association (ADA) has made it a Standard of Care that all clinicians should follow. They recommend that, “Psychosocial care should be integrated with collaborative, patient-centered medical care and provided to all people with diabetes…” In addition, the ADA specifically highlights that healthcare providers should talk to their patients to see if they are experiencing any symptoms of depression, anxiety, or diabetes distress at the onset of complications and/or progression of them. They recommend that clinicians continue to monitor their patients and offer help when needed.6

Having diabetes is overwhelming and the added stress and worry of developing complications or discouragement of complications progressing should not be overlooked. Reaching out to family and friends that are understanding, talking to your healthcare providers about how you are feeling and your worries and seeing a mental health care provider are all important. Although in many cultures reaching out for support or seeing a mental health provider is seen as “weak” and often taboo. However, during times of stress and when people are having a difficult time coping, they need additional help and support. People with diabetes who are suffering from emotional and psychological distress have poorer outcomes—they have more difficulty taking care of themselves, they have more hospitalizations, higher health care costs, poorer quality of life and even premature death. Therefore, it is of utmost importance to not only take care of your physical health but also your emotional and mental health as well.

 1. Centers for Disease Control and Prevention. Serious psychological distress among persons with diabetes–New York City, 2003. MMWR. Morbidity and mortality weekly report. 2004, 53(46): 1089.
2. Polonsky, W. H. Emotional and quality-of-life aspects of diabetes management. Current diabetes reports. 2002, 2(2): 153-159.
3. De Groot, M. Anderson, R., Freeland, K.E., Clouse, R.E., & Lustman, P.J. Association of depression and diabetes complications: A meta-analysis. Psychosomatic Medicine. 2001; 63: 9-630.
4. Gonzalez, J. S., Peyrot, M., McCarl, L. A., Collins, E. M., Serpa, L., Mimiaga, M. J., & Safren, S. A. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes care. 2008, 31(12): 2398-2403.
5. Hendriks, S.M., Spijker, J., Licht, C.M. et al. Disability in Anxiety Disorders. Journal of Affective Disorders. 2014; 166: 227-233.
6. Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2016 Dec; 39(12):2126-2140. doi: 10.2337/dc16-2053.

Educational content related to diabetes complications is made possible with support from Allergan, an active partner of Beyond Type 1 at the time of publication. Editorial control rests solely on Beyond Type 1.

WRITTEN BY Alicia McAuliffe-Fogarty, PhD, CPsychol, POSTED 12/13/20, UPDATED 01/04/23

Dr. Alicia McAuliffe-Fogarty was diagnosed with type 1 diabetes in 1987. She is a clinical health psychologist specializing in diabetes, completing her fellowships at the Yale University School of Medicine. Dr. McAuliffe-Fogarty founded the Circle of Life Camp for children with diabetes, was vice president of the Lifestyle Management Team at the American Diabetes Association and vice president of patient-centered research at the T1D Exchange. She is a clinical and scientific consultant to nonprofit and biotech/pharmaceutical companies leading research, strategy, content creation and program development.