The relationship between metabolism and mental-emotional wellbeing is a complex and often unrecognized aspect of psychiatric treatment, yet it is known that metabolic dysregulation is a key feature of, and clinical predictor of, stress- and trauma-related disorders like depression, anxiety, and posttraumatic stress disorder (PTSD). There is evidence that fluctuations in blood sugar levels may be associated with specific psychiatric symptoms and thus may be helpful data in exploring the mind-body connection. Among individuals with diabetes, continuous glucose monitoring is a valuable tool for making informed decisions to manage health; in addition, continuous glucose monitors (CGMs) are being employed as part of lifestyle medicine plans within the general population, acting as an instrument for personalized data collection. CGM data may be analyzed alongside other measurements to examine medical trends in both physical and psychological health.
Comorbidity in Diabetes
Individuals with diabetes are at an increased risk of worsening mental health, including the development of depression and anxiety, compared to the general population. Comorbidity of diabetes and psychiatric diagnoses seems to correspond with more negative clinical outcomes. Possible reasons for comorbidity are multilayered: underlying lifestyle factors, stress from managing a chronic illness, impacts of diabetes-related complications, medications, and physiological effects of fluctuating blood sugar levels. Likewise, individuals with a stress- or trauma-related disorder are more likely to develop type 2 diabetes, pointing to overlapping biological mechanisms underlying dis-ease.
Metabolic disorders share biological pathways with depression and anxiety. For example, both diabetes and depression are associated with altered hormonal signaling, autonomic nervous system activation, inflammation, dysbiosis of the gut microbiome, oxidative stress, and cardiovascular complications. From an integrative perspective, it can be challenging to isolate each of these processes and analyze them one at a time. To say one system gets perturbed before another would be too simplistic, and it might be helpful to conceptualize the interaction between physiological systems from a bidirectional approach. For example, dysregulated blood sugar levels (either too high or too low) can trigger pro-inflammatory states that lead to oxidative stress in the body, affecting brain function and emotional regulation. On the other hand, long-term psychological stress and dis-ease can activate fight or flight pathways that disrupt immune function and the gut microbiome, altering glucose regulation.
Dementia: Type 3 Diabetes?
Dysregulated glucose levels can also have long-term effects on cognitive function. A leaky blood-brain barrier, coupled with neuroinflammation, altered bioenergetics, and impaired brain signaling impacts how efficiently information is processed. Uncontrolled and fluctuating blood sugar may lead to difficulties with memory, concentration, and decision-making, all of which can contribute to feelings of frustration and stress. In a chronic state, brain cells may take on an insulin resistance phenotype that is associated with neurodegenerative diseases such as vascular and Alzheimer’s dementia.
CGMs have advantages over other glucose monitoring devices; GCMs provide real-time feedback on how diet, physical activity, sleep, stress, and insulin dosages impact blood sugar levels. This information supports individuals in adapting to fluctuating values and regulating their blood sugar, which may help stabilize mood and reduce the risk of psychiatric symptoms. While CGMs are commonly used by persons with diabetes, continuous glucose monitoring might be of equal benefit for those without diabetes who are interested in taking a personalized medicine approach to wellness. For example, metabolic profiles are highly divergent between people, even after eating the same foods, and fasting glucose ranges are not always representative of a single person’s metabolic status. CGMs offer insight into a person’s very unique inner world, providing acute responses to lifestyle choices and longer-term observations of blood sugar variability. These data may be used to inform customized dietary or other lifestyle changes.
CGMs may be useful for recognizing patterns between physiology, perceived experience (what does my body feel like during periods of high vs low blood sugar?), and psychological wellbeing. By tracking fluctuations in blood sugar levels, these devices offer opportunities for trend analysis, especially when combined with other metrics of health. Utilization of these data correlated with mood or cognitive difficulties may promote feelings of self-efficacy, supporting patients to take preventive measures in managing both metabolic and mental health.
Currently, prescriptions are required to obtain a CGM, and the cost per month is not cheap. While the cost of CGMs is covered by insurance for individuals with diabetes, it is often not covered for prediabetes and not for general wellness. CGMs are not accessible to everybody, with data showing disparities in obtaining a CGM based on social demographics. In order for CGMs to be used effectively outside of a diabetes context, more research is needed to understand the blood sugar target ranges for healthy individuals.
The correlation between diabetes and psychiatric disorders highlights the significance of metabolics in mental health. Assessing bidirectional relationships between glucose metabolism and psychiatry is one way to approach diabetes and prediabetes care holistically. Continuous glucose monitoring offers a powerful tool to bridge the gap between physical and mental health in the context of diabetes as well as the general population. CGM technology can empower individuals to take proactive steps to manage their overall health, wellbeing, and longevity.