How Do Glucose Levels Impact Depression & Anxiety?

What does research show about glucose and mood?

It has been well-documented in research that diabetic individuals – a population that has uncontrolled glucose typically illustrated with frequent bouts of hyperglycemia or high blood sugar levels – are twice as likely to have depression as healthy individuals are.  Approximately 25% of diabetics have been diagnosed with depression, and nearly 20% experience anxiety.  

Uncontrolled glucose have been shown to increase the risk of mood disorders like anxiety and depression in both diabetic and non-diabetic populations. Utilizing a CGM without diabetes may help you notice patterns in glucose swings and decrease the risk of undesirable mood changes. 

Who is at risk for mood changes from glucose swings?

We also see a correlation between the risk of mood disorder development and frequent high and low glucose in a healthy population as well. These relationships are proving to be more important now than ever, as the rate of diabetes, glucose dysregulation, insulin resistance and obesity are on the rise.

What symptoms link glucose swings and mood?

Relationships between blood sugar levels and overall mood are well-established, especially when looking at continuous highs and lows, otherwise known as poor glycemic regulation. This poor regulation overtime can reflect certain mental health symptoms such as irritability, anxiety, increased worry, and possibly the brain’s desire to run primarily on glucose as its fuel source. 

Who may benefit from 24/7 glucose insights?

Comprehensive programs that utilize continuous glucose monitors and nutrition experts can provide 24/7 feedback on trends measured in interstitial fluid. This can help you spot patterns that may relate to feelings of anxiety or changes in mood. Identifying patterns in glucose dysregulation can lead to lifestyle changes that may prevent the development of depression and anxiety.

How can glucose levels influence depression?

There are a few reasons for poor glucose control resulting in higher prevalence of depression in both diabetic and healthy populations. Research has shown that diets high in added sugars or foods that ultimately raise your glucose are linked to depression and adverse mental health symptoms after several years. This informs us that diets high in added sugar impacts mental health on a long-term basis.

High dietary intake of added sugar has impacts on various metabolic processes that may result in the development of depression

Added sugar and mood

Excessive sugar intake can lead to inflammation in the body, which is correlated with higher risks of depression, along with varied high and low glucose levels (or dysregulation) that impacts fluctuations in our hormones. Hormone dysregulation can often have a negative effect on our moods and is linked to greater risk for depression over time.

Addictive sugar effects

Diets high in added sugar can often impact our pleasure / reward chemical, and dopamine, in the brain – resulting in an addictive effect that feeds a cycle of poor mood, depression, and desire for more sugar to improve those feelings.

 Diagnosis stress

This is the most conventional theory related to glucose management and depression rates. The overwhelming concern and associated responsibilities (tracking glucose levels, managing medications and/or insulin therapy, lifestyle changes) after a diabetic diagnosis has been associated with increased rates of depression within this population. 

Research has shown a positive correlation between increased fasting glucose and an increased score on PHQ-9 depression scale, illustrating the added pressure newly diagnosed diabetics feel to manage their glucose levels, with little to no understanding of how to do that at times.

Brain connectivity changes

There is MRI data that shows increased glucose can decrease the strength of connections in a region of the brain that involves emotions and self-perception which will impact mood and may lead to development of depression. These connections are shown to worsen in diabetics that have poor long term glucose control.

Glutamate and mood

Diabetics with continuous elevated glucose levels can have glutamate dysregulation, which is consistently implicated in mood disorders including major depressive disorder and bipolar disorder. This again illustrates how widespread the impact of glucose dysregulation is on other metabolic processes in our body. 

How can glucose levels influence anxiety and mood disorders?

A recent study showed that women with diabetes who had poorly managed or inconsistent glucose levels were associated with a decreased quality of life and reported more negative moods. These moods differed depending on glucose levels. For example, high glucose levels or hyperglycemia was associated with feelings of anger and sadness, while hypoglycemia or low glucose was associated with nervousness.

That Mid-Afternoon Mood Swing

It’s 2 p.m., and that familiar wave of anxiety washes over you, making it hard to focus on your screen. You had a "healthy" salad for lunch, so you can’t understand why you feel so irritable and on edge. You start to second-guess your food choices, wondering if the post-lunch energy slump is also tanking your mood and bringing on this feeling of unease.

That being said, it is not just diabetics that are susceptible to blood sugar fluctuations. Non-diabetic populations that consume high amounts of refined carbohydrates and added sugars are also at risk for this dysregulation. A study showed a positive association between increased sugar consumption and common mental disorders within an otherwise healthy population. 

Diet and lifestyle steps

Some of the best ways to address these issues are through diet and lifestyle changes such as:

• Managing and reducing overall stress using the strategies in our three-step cortisol guide. 
• Increasing macronutrients and micronutrients that support glucose regulation, especially protein, fat, and fiber. 
• Decreasing refined carbohydrates and added sugars.

Other well-documented reasons glucose levels can influence anxiety and mood are:

 Hypoglycemia and anxiety

Poor glucose regulation can alter our hormonal responses such as: 

• Adrenaline
• Cortisol
• Epinephrine

This can cause physical anxiety-inducing symptoms like sweating, shaking, blurred vision, mood swings, and crankiness.

Diabetes distress and hypo anxiety

Diabetes distress and hypo anxiety describe the emotional strain of day-to-day glucose management and worry about low readings. 

Major guidelines advise routine mental health screening for diabetes distress, depression, and fear of hypoglycemia during care, since these factors can affect self-care and quality of life. To ease the load, focus on a few practical habits you can take today:

• Ask your clinician about brief screening tools such as the Diabetes Distress Scale and the Hypoglycemia Fear Survey, and share any concerns about lows or alarms.
• Keep short notes on situations that raise worry like overnight dips or after-exercise patterns, then review them with your care team and dietitian to adjust routines.

Sugar intake and mood

Research shows that increased added sugar intake over time will impact mental health even in healthy individuals long term.

Gut microbiome links

Inflammation and poor glucose control may be major factors at play in this correlation. Diets high in added sugar result in inflammation in the body, glucose dysregulation, and insulin resistance over time. These can all be contributors to the development of obesity and type 2 diabetes, which can worsen the gut microbiome.

Epidemiological studies indicate that more than 2.5 billion people are currently overweight or obese worldwide. If current trends continue, estimations show that [addition] by 2035, 25% of the world’s population will be affected, and approximately 3.80 billion adults will be living with overweight or obesity by 2050. [/addition] 

Many publications over the last decade have shown evidence that suggest an association between a dysregulated gut microbiome and obesity, insulin resistance, and type 2 diabetes. These conditions have a higher susceptibility for associated mood issues and anxiety, as well as the possible development of depression over time.