Extreme blood sugar fluctuations are associated not only with physical symptoms, but emotional ones as well.

University of Virginia researchers assessed how self-reported mood related to blood sugar levels in 34 insulin-dependent diabetics.

They found that for most people, mood was related to blood glucose levels.

Low blood sugar was generally associated with negative mood states such as anxiety. High blood sugar was associated with positive mood states, as well as with some negative mood states such as anger and sadness.

When diabetics experience hypoglycemia, as they often do, anxiety is a common symptom. Another source of anxiety is worry about managing blood sugar levels.

The link between symptoms of depression and diabetes is well-established, but scientists are not certain if depression triggers diabetes or if depressive symptoms are an emotional or brain biological response to having diabetes.

Research on patients with Type 1 diabetes suggests that prolonged high glucose levels can lead to production of a hormone associated with depression.

Mental symptoms associated with hypoglycemic episodes, such as irritability and confusion, are also associated with depression.

Psychological stress can actually alter blood sugar levels. In a study published in the journal Diabetes Technology & Therapeutics, scientists monitored blood sugar levels of bungee jumpers who did not have diabetes.

They found that the stress of bungee jumping caused significant increases in blood sugar and stress hormone levels.

The latter response triggers the liver to release glucose to make more energy available to the body and the brain.

In patients with diabetes, inadequate insulin or insulin resistance inhibits the body’s ability to adjust to the buildup of sugar in the blood.

Because their illness is preventable, many diabetics also experience feelings of guilt. They blame themselves for not following a healthy diet, not exercising enough, and generally being unable to control their body weight.

Of course, genetics are an important factor in determining the risk for diabetes, but that knowledge may not assuage feelings of self-blame.

Diabetic patients with eating disorders often struggle with the same kinds of symptoms observed in non-diabetics with eating disorders.

They pursue an excessive body image, restrict calorie intake, engage in binge eating, and derive much of their self-worth from their shape and body weight.

They also often deny and hide their disturbed eating behaviors and experience symptoms of depression and anxiety.

Such patients may struggle with feeling out of control in their lives in general.