Diabetes is usually discussed in terms of numbers: fasting glucose, HbA1c and insulin units. What rarely makes it into that conversation is how exhausting the disease can be to simply live with, day after day, especially for women. Behind the glucose checks, the medicine reminders, the careful meal planning and the endless appointments lie a mental burden that often goes unnoticed, even by the women carrying it.
Dr Durva Dharmesh Shah, a psychiatrist, has observed this pattern closely in her practice. “The constant vigilance diabetes demands can wear a person down over time, and that chronic stress does not simply sit in the background, it actively disrupts sleep, eating patterns, physical activity and even how the body responds to insulin. This creates what she describes as a frustrating loop: poor sugar control adds to stress, and that stress, in turn, makes the itself harder to manage,” says she and adds that layer in hormonal shifts from menstruation, pregnancy or menopause, and a woman’s exhaustion may run far deeper than anything a routine blood test would reveal.
This is where a common myth deserves to be challenged. Many people still assume that if the numbers on a glucose meter look fine, everything must be fine.
Dr Shah’s clinical experience suggests otherwise, and she points families towards subtler signs instead.
“A woman withdrawing from family meals, becoming irritable over small things, checking her sugar obsessively or, just as tellingly, avoiding checks and follow-ups altogether, disrupted sleep, a fading interest in things she once enjoyed, or simply going quiet about how she feels, these are the signals that something beneath the surface needs attention,” she says.
What makes this connection between diabetes and mood more than an emotional coincidence is the biology underpinning it. Dr Paras Agarwal, Director of the Diabetes, Obesity and Metabolic Clinic, explains that oestrogen levels in women shift constantly, across the menstrual cycle, through pregnancy and into perimenopause, and each shift changes how sensitive the body is to insulin.
“When blood sugar swings, mood often swings with it, not by chance but because the same hormonal system is misfiring in two places simultaneously. Add cortisol into the mix, and the cycle deepens: prolonged high or unpredictable glucose keeps cortisol elevated, which blunts insulin’s effectiveness further, feeding the loop from both directions,” says Dr Shah.
The warning signs of this struggle rarely resemble textbook diabetes symptoms. According to Dr Agarwal, a woman might simply seem persistently tired despite sleeping well, or quietly skip insulin doses because she has noticed it helps keep her weight down. Irritability might have nothing to do with her day and everything to do with a glucose crash an hour earlier.
“Some women stop checking their blood sugar entirely, not out of neglect, but because they are simply worn out from tracking it constantly,” says the doctor.
Both doctors agree that waiting until a crisis to address any of this is the costliest approach. Dr Shah believes mental health should be built into diabetes care from the point of diagnosis, with simple screening for anxiety, and sleep problems, and family involvement from the very first conversation, so long as that support never tips into constant monitoring or criticism.
Dr Agarwal echoes this, arguing that every diabetes check-up should leave space for an honest conversation about how someone is coping, not just what their numbers say, with dietitians and mental health support woven in early rather than summoned only once things have unravelled.
