If you have a high level of interaction with patients, students, clients or the general public in your chosen work, you might be putting yourself at significant risk of developing type 2 diabetes, according to a large new study. And, if you also have a poor support network among your peers, it could worsen your odds.
"People person" red flag: Study draws link between some workplaces and an elevated risk of developing type 2 diabetes
Researchers from Karolinska Institutet in Sweden used data from the Swedish Work, Illness, and labour-market Participation (SWIP) cohort, looking specifically at people aged 30-60 and the job they had in 2005. They only included those who had no history of any diabetes nor had ever used an anti-diabetic drug before 2005.
In total, this left around three million Swedes.
Of these, the scientists looked at three aspects of jobs that involved contact with other people: general contact with other humans, the emotional demands caused by dealing with people that involved health or other problems, and confrontation in the workplace with other people. Then they also looked at the social support structure of those workplaces, based on Swedish Work Environment Surveys (1997-2013).
"Contact with other people" included interacting regularly with patients, customers, clients, passengers, students – everything from healthcare to customer service and teaching. In terms of contact with other people, the scientists included those who had responded to workplace surveys with the answer "roughly three-quarters of the time at work" and "almost all the time." To gauge personal demands and instances of confrontation, they calculated the proportion of respondents who said their job was emotionally taxing "a few days a week" or "every day."
Overall, 20 roles in sectors with the highest amount of contact with others – as well as being the most emotionally demanding and conflict-plagued – were singled out by the scientists. These included roles in healthcare, education, service industries, hospitality, social work, law, security and transport.
In 2019,Karolinska Institutet researchersconducted a similar study of diabetes prevalence, but instead looked at more than 200,000 Swedes with type 2 diabetes who were of working age during 2006-2015. They found that those at highest risk of developing diabetes were professional drivers, factory workers and cleaners – three times more likely to develop the condition than, for example, physiotherapists and teachers.
The new paper has some distinct differences in design – and now includes physiotherapists and teachers in the high-risk group. That earlier study has some clear flaws – particularly that lifestyle factors (smoking, obesity, diet) were not accounted for. The jobs the team identified with diabetes risk are typically overrepresented by people from low socio-economic backgrounds, who in turn already have a higher risk of chronic disease. So, while interesting, the link was a little tenuous.
The new study also sidesteps lifestyle factors, but it does cross broader economic lines and focuses instead on emotional demands and confrontation on the job. In 2006-2020, 216,640 people (60% men) developed type 2 diabetes – and once again there were certainly some lifestyle factors likely at play (they were most likely to have a lower level of education and low job security than those who did not develop the condition).
And in both men and women, participants working in high-people/highly taxing roles had a significant higher risk of going on to develop type 2 diabetes. It was 20% for men and 24% for women.
Higher and more stressful interactions with other people boosted the risk of diabetes in both men and women
Adding on regular conflict and confrontation, that risk jumped another 15% for men and 20% for women. And then, looking at how these respondents fared in workplace support systems, the data showed that women in emotionally demanding jobs that required a high level of interaction with others, with low social support in the workplace, had a 47% higher risk of developing diabetes compared to women with low demands on the job and a robust support network among their team.
“With regards to having contact with people at work, there are expectations for emotional management where workers are required to express or hide emotions according to societal, occupational and organisational norms," the researchers noted. "It is especially stressful when the displayed emotion and the genuinely felt emotion are not aligned."
So what does this mean? While the study has its limitations, it does highlight that the workplace – and the support system that employees in people-facing jobs have – is linked to poor metabolic health outcomes. However, it must be said that the study is a generalized one that discounts the individual experience, and it's just a snapshot of someone's working life – where they were working in 2005.
"The biological mechanisms underlying the association between person-related work and type 2 diabetes may involve biological responses to repeated and chronic stress that affects the neuroendocrine system by activation of the central sympathetic nervous system and hypothalamus–pituitary–adrenal axis, leading to excessive cortisol production, increased insulin resistance, and decreased insulin secretion and sensitivity," wrote the researchers. "In addition, chronic stress can increase pro-inflammatory cytokines, which impair insulin signaling and functioning. With insufficient social support at work, stress in person-related work may worsen and exert a greater impact on these biological alterations."
Despite its limitations, the study is a fascinating insight into the often unseen and unappreciated stressors in roles like teaching, nursing and social work – which are associated with high burnout, high staff turnover and, in many regions, are chronically understaffed.
"Person-related work is associated with an increased risk of type 2 diabetes, and lacking social support at work may further amplify the association," the researchers concluded. "Our findings highlight the impact of demands and challenges in person-related work on workers’ metabolic health. Future studies are warranted to explore mechanisms (eg, biological or behavioural mechanisms) underlying the associations and develop preventive strategies aiming to lower health hazards in person-related work."
Replacing one diet soda per day with water was linked to increased weight loss.
Many women who swapped diet beverages for water also achieved type 2 diabetes remission.
CHICAGO — Women who replaced their lunchtime diet beverage with water had greater weight loss and achieved diabetes remission compared with women who continued drinking diet beverages, according to new research.
Hamid R. Farshchi, MD, PhD, CEO of D2Type and former associate professor at the University of Nottingham School of Life Sciences, U.K., presented a randomized study at the American Diabetes Association Scientific Sessions evaluating the metabolic benefit of substituting water for diet beverages among women with type 2 diabetes and overweight or obesity.
Drinking water at lunch was tied with greater weight loss and higher odds for diabetes remission vs. drinking a diet beverage. Image: Adobe Stock “Patients often assume diet sodas are a ‘free pass’ because they contain no calories. Yet evidence on weight and glycaemic control is inconsistent. We wanted a clear, long-term test of whether simply swapping diet beverages for water could shift the needle in everyday practice,” Farshchi told Healio.
The researchers enrolled 81 women in an 18-month weight management program who reported regular intake of diet beverages. The women were randomly assigned to replace the diet beverages with water or continue usual intake of five diet beverages per week after lunch.
“Women make up the majority of commercial weight-loss program participants and show distinct hormonal and behavioural responses to sweet tastes,” Farshchi told Healio. “Keeping the cohort single-sex reduced variability and let us achieve adequate power with our resources.”
The 18-month weight program consisted of a 6-month weight-loss program followed by a 12-month weight-maintenance program.
By the end of the 18-month weight program, women assigned to water had greater mean weight loss compared with the diet beverage group (6.82 kg vs. 4.85 kg; P < .001).
“The open question was, would people with type 2 diabetes — who often have stronger sweet cravings and insulin resistance — stick with plain water for 18 months? We expected some benefit, but the extra [approximately] 2 kg weight loss and higher remission signal in the water group were larger and more durable than we dared hope,” Farshchi said.
Ninety percent of women assigned to drink water achieved diabetes remission compared with 45% in the diet beverage group (P < .0001), according to the study.
The researchers also observed improvement in BMI, fasting glucose, insulin levels, insulin resistance, postprandial glucose and triglycerides among women assigned to drinking water.
“The advice is refreshingly simple: Encourage patients who lean on diet sodas to try water instead,” Farshchi told Healio. “It’s free, improves overall calorie control and may boost diabetes-remission odds. Embedding ‘water first’ into lifestyle counselling could be low-hanging fruit for better outcomes.”
Many people with diabetes also have high blood pressure, as well as unique nutritional needs.
One study found that reducing sodium intake and following a modified version of the DASH diet helped to decrease blood pressure in participants with type 2 diabetes.
The main reason for the observed decrease in blood pressure was the decreased sodium intake.
It is commonTrusted Source for people with diabetes to also experience high blood pressure. A study tested how a modified version of the DASH diet that focused on the nutritional needs of people with type 2 diabetes, combined with minimizing sodium intake, affected blood pressure levels.
The dietary combination lowered systolic blood pressure among participants by around five points and diastolic blood pressure by around two points compared to the comparison diet with more sodium. This result was mainly from the decreased sodium consumption.
The dietary approaches to stop hypertension (DASH)Trusted Source diet is a diet for heart health. Study author Scott J. Pilla, MD, MHS, explained to Medical News Today that “The DASH diet is a healthy diet that is rich in fruits, vegetables and low-fat dairy products, and is lower in saturated fat and cholesterol.”
However, the study notes that the DASH diet doesn’t consider the unique dietary needs of people with type 2 diabetes. So, researchers created the “Dietary Approaches to Stop Hypertension for Diabetes (DASH4D) diet,” which is similar to the DASH diet but considers what adults with type 2 diabetes need. For example, this diet was lower in carbohydrates than the typical DASH diet. Researchers tested how this diet, combined with decreased sodium intake, affected participants’ blood pressure.
This randomized clinical trial included 102 adults with type 2 diabetes whose systolic blood pressure was between 120 and 159 mmHg. Participants were designated as having type 2 diabetes if they had a haemoglobin A1C of 6.5% or greater, were taking medications for diabetes treatment, or both.
People were ineligible to participate in the study for a number of reasons, including having type 1 diabetes, if their A1C was over 9%, or if they were taking weight loss medications.
The average age of participants was 66 years. About two-thirds of participants used at least two medications to help lower blood pressure, and a little over half used at least two medications to lower blood sugar.
Researchers assigned participants to receive four diets in varying orders, each for five weeks. One was a DASH4D diet with low sodium, and another was the DASH4D diet but with higher sodium intake. The other two were comparison diets: one with lower sodium and one with higher sodium, and these diets were similar to the intake of adults with diabetes living in the United States. The participants were provided with the food for their assigned diets, and aside from allowed beverages, they were not supposed to eat food from other sources outside the study.
Participants did not lose weight throughout the study. Researchers measured systolic blood pressure during the last two weeks of each diet intervention. They kept track of adverse events among participants, such as any very high blood pressure levels.
Participants self-reported how well they stuck to their assigned diets, but researchers also did a 24-hour urine excretion test during the fourth or fifth weeks to look at sodium, creatinine, and potassium levels, which also was a way to test how well participants were following diet assignments.
The findings showed that the lowering of blood pressure mostly occurred during the first three weeks of participants following a diet.
The researchers found that the DASH4D diet with reduced sodium showed a better overall decrease in blood pressure versus the comparison diet that had higher sodium intake. The average difference in systolic blood pressure between these two groups was 4.6 mmHg, and the average difference in diastolic blood pressure was 2.3 mmHg.
“The main finding was that a low-sodium DASH4D diet (compared to a higher sodium typical American diet) caused a statistically and clinically significant reduction in blood pressure. Sodium reduction appeared to contribute more strongly to reducing blood pressure than the DASH4D diet.” — Scott J. Pilla, MD
Jennifer Wong, MD, a board-certified cardiologist and medical director of Non-Invasive Cardiology at Memorial Care Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, also noted that “Studies like these remind us of the beneficial impact of a heart-healthy diet, especially a low salt diet designed to modify blood pressure.”
This research only included a small number of participants and focused on a niche subgroup of individuals, limiting generalizability. The majority of participants were Black, which provided important information about this at-risk group. Two-thirds of the participants were women. However, research in other groups may also be helpful.
The dietary interventions for this study each only lasted five weeks, so long-term follow-up may be helpful with further research.
Some data, such as following the assigned diet and health history, was self-reported by participants, so inaccuracies are possible.
While adverse events on the DASH4D diet with low sodium were low, more research into the potential risks may be helpful. Researchers also suggest the need for more research in people with a higher level of risk. The amount that blood pressure was lowered by could have been less in this study for many reasons, such as the high number of participants taking diuretics and the number of participants who experienced changes to their blood pressure medications during the study.
Researchers acknowledge that they weren’t able to detect the separate impact of the DASH4D diet and decreased sodium intake. Another struggle was the COVID-19 pandemic. The authors explain that this “interrupted participant feeding at several points.” It was also only a single-site study.
Pilla also noted that “More work is needed on how to make healthy, low sodium diets accessible. Following a healthy diet can be challenging and costly, and we would like to design diets that meet the DASH4D nutrient targets that are more affordable and tailored to different cultures.”
Researchers note that it may be hard to decrease sodium intake to only 1,500 mg a day, and future research in this area will be helpful. The authors say this research should include “implementation research in community settings.”
The result suggests that the DASH4D eating plan combined with lower sodium intake helps with blood pressure reduction in people with type 2 diabetes. Researchers note that a five mmHg reduction in systolic blood pressure can decrease the risk of stroke, heart failure, and cardiovascular events. It can also help with kidney outcomes.
Pilla noted the following regarding the clinical implications of the study:
“Diet change can effectively improve blood pressure in people with diabetes, even those on multiple antihypertensive medications, so clinicians should still focus on diet even in these individuals.”
“Dietary sodium reduction is an important part of dietary change in people with diabetes to achieve better blood pressure control. Our specific DASH4D diet with lower sodium now has strong evidence for benefiting people with diabetes, so it should be strongly considered as a recommended diet in this population.” — Scott J. Pilla, MD
Even though there may be a need for more research, Patrick Kee, MD, PhD, a cardiologist at Vital Heart & Vein, noted the following about the study’s results:
“The acceptability and adherence to the lower sodium intake (~1500 mg/day) was high among participants, suggesting that with proper guidance and access to prepared meals or education, such dietary targets are feasible in practice. This finding counters a long-standing belief that stringent sodium targets may be unrealistic for patients.”
Diabetes technologies have been evolving rapidly in recent years and now serve a wide range of patients.
Usage is up for technologies such as automated insulin delivery and continuous glucose monitoring.
The evolution of diabetes technologies has led to the expansion of automated insulin delivery for type 2 diabetes, continuous glucose monitoring for people without diabetes and calls for a higher standard of care in type 1 diabetes.
The American Diabetes Association Standards of Care for 2025 states CGM should be offered to all people with diabetes who use any insulin therapy. Now, diabetes technology for insulin-treated diabetes is going beyond CGM. The FDA cleared the Omnipod 5 automated insulin delivery system (Insulet) in August and the Control IQ+ (Tandem) in March for adults with type 2 diabetes based on data that show the devices could provide glycaemic benefits.
“Unfortunately, with the natural progression of type 2 diabetes, many end up needing insulin,” Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES, FCCP, endocrine clinical pharmacy specialist and co-director of endocrine disorders in pregnancy at Cleveland Clinic Endocrinology & Metabolism Institute and a Healio | Endocrine Today Editorial Board Member, said in an interview. “Asking someone to take multiple [insulin] injections per day is really challenging, so being able to offer an insulin pump and, specifically, an automated insulin delivery system that really improves time in range and reduces HbA1c similar to what we see in type 1 diabetes ... is a big deal.”
Diana Isaacs
In the past year, several over-the-counter CGMs have been approved, some of which are available for people without diabetes. Carol J. Levy, MD, CDCES, professor in the department of medicine and department of obstetrics, gynecology and reproductive science and director of the Mount Sinai Diabetes Center and associate system chief of endocrine clinical research, said OTC CGMs may fill a niche by providing access to diabetes technology for people lacking insurance coverage.
“These provide an option for those individuals who wish to have some feedback and can afford them,” Levy told Healio | Endocrine Today.
Progress is also being made with automated insulin delivery systems in type 1 diabetes. Viral N. Shah, MD, professor of medicine in the division of endocrinology and metabolism and director of diabetes clinical research at Indiana University Center for Diabetes and Metabolic Diseases, said many health care professionals are excited for the launch of the twiist automated insulin delivery system (Sequel), which will be the first system in the U.S. using the algorithm that was developed by the open-source community and later commercialized by Tidepool.
Viral N. Shah
“The algorithm is different compared to other automated insulin delivery systems,” Shah told Healio | Endocrine Today. “Having a lot of options would be good for people to select the appropriate technology for them.”
Advances in automated insulin delivery have led some researchers to issue a call to action for people with type 1 diabetes. A commentary published in Diabetes Technology & Therapeutics in February stated, “All people with type 1 diabetes and other patients with insulin-dependent diabetes must be given a choice to use an automated insulin delivery system at the time of diagnosis or as soon after diagnosis as possible.”
“Algorithms have come a long way. Sensors have come a long way,” Satish K. Garg, MD, professor of medicine and pediatrics at the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus and an author on the report, told Healio | Endocrine Today. “[The commentary was intended] to bring people up to date with where we have come in the past 15 to 20 years in this whole pathway of CGMs and [insulin] pumps, and integrating the two.”
Satish K. Garg
Advances for type 2 diabetes
Two trials published earlier this year showed automated insulin delivery can not only benefit people with type 1 diabetes, but also those with insulin-treated type 2 diabetes.
In the single-arm SECURE-T2D trial, adults with type 2 diabetes on insulin therapy used the Omnipod 5 automated insulin delivery system for 13 weeks. This group had a decline in HbA1c from 8.2% at baseline to 7.4% at 13 weeks.
Automated insulin delivery also improved glycemic control in the 2IQP trial. Investigators randomly assigned adults with type 2 diabetes 2:1 to use the t:slim X2 insulin pump (Tandem) with Control-IQ+ automated insulin delivery system with the Dexcom G6 CGM or the Dexcom G6 alone for 13 weeks.
Adults who used automated insulin delivery had a 0.9 percentage point decline in HbA1c from baseline to 13 weeks vs. a 0.3 percentage point decline for those who used CGM alone (P < .001). Time in range increased from 48% at baseline to 64% at 13 weeks with automated insulin delivery.
Based on findings from both trials, the Omnipod 5 and Control IQ+ were cleared by the FDA for use by adults with type 2 diabetes.
Shah, who was an investigator on the SECURE-T2D trial, said the recent approvals have already made an impact on clinical practice.
“A lot of people with type 2 diabetes, particularly on basal insulin only, are seen by primary care,” Shah said. “I doubt the use of automated insulin delivery systems is high in primary care practice. These studies and FDA approval will help train primary care physicians and hopefully encourage them to use this technology more.”
Levy said the availability of multiple systems will allow health care professionals to prescribe a device that works best for each individual’s needs.
“These are two different systems that both have different, unique niches for patients: one is tubeless and one provides autocorrection boluses,” Levy said. “Each has unique advantages and opportunities for people with type 2 diabetes.”
A role for OTC devices
Several OTC CGMs have earned FDA clearance since the beginning of 2024. In March 2024, FDA cleared a glucose biosensor system (Stelo, Dexcom) for all adults who do not use insulin, including those without diabetes. In June 2024, the FreeStyle Libre Rio and Lingo (Abbott) were cleared by the FDA; Libre Rio is indicated for adults with type 2 diabetes and Lingo was cleared for those without diabetes looking to improve overall health and wellness.
Though OTC CGMs can help increase access to diabetes technology for people without insurance coverage, Levy said cost may still be a barrier for some. Lingo and Stelo are both offered at a price of $89 for two sensors, which would last for a combined 30 days, according to product information on both websites.
Shah said OTC CGMs offer valuable information, but there is limited data on whether the devices lead to improved outcomes in any populations.
“I have a lot of patients who have used an OTC CGM,” Shah said. “Either they have prediabetes or no diabetes. [In those populations], it is good to see that information and make some changes. But there are many questions that remain.”
Shah said research on whether OTC CGMs can benefit people with or at risk for prediabetes is needed, including how often they should wear the CGM, the optimal interval of wear time and whether adults should wear a sensor intermittently or continuously.
Despite including several interesting features, Isaacs said uptake of OTC CGMs appears to be slow.
“I don’t think it’s as high as the companies would have liked or expected, and in some ways, I’m not surprised,” Isaacs said. “I don’t think you need to wear [an OTC CGM] all the time to learn from it.”
Improvements in insurance coverage of prescription CGMs is one reason the OTC devices have not taken off, and another factor is access to devices, Isaacs added.
“Right now, [the OTC CGMs] are not available in pharmacies; you have to purchase them online,” Isaacs said. “They both have respective websites. I think if they were available in pharmacies, that would probably increase the access a little bit more.”
Limited options for type 1 diabetes in pregnancy
Managing type 1 diabetes during pregnancy requires target glucose ranges that are lower than most devices offer. In May 2024, the FDA approved the CamAPS FX closed-loop algorithm (CamDiab) as the first one for pregnant women with type 1 diabetes. However, the algorithm is still unavailable for use in the U.S. The CamAPS FX algorithm is compatible with the mylife YpsoPump (Ypsomed), which the FDA has not yet approved.
“It is very frustrating for those of us who work in the pregnancy space, because even our guidelines [state] you should use a pump that has an algorithm approved for use in pregnancy,” Issacs said. “We don’t have one, so it’s really tough.”
The CRISTAL trial showed that a currently available automated insulin delivery system could benefit pregnant women with type 1 diabetes. Researchers for this trial randomly assigned pregnant women with type 1 diabetes to use the Medtronic 780G automated insulin delivery system or receive standard of care with either multiple daily insulin injections or insulin pump therapy. Researchers found similar improvements in time in range between the two groups. The automated insulin delivery group had a significantly lower time below range compared with the standard of care group.
The Medtronic 780G was not designed with pregnancy in mind, as the lowest target glucose that can be set on the device is 100 mg/dL, Levy said. While this is a lower target than for other devices, the ADA Standards of Care recommends pregnant women with diabetes aim for a target glucose of less than 100 mg/dL before meals, as well as during bedtime and overnight.
Additionally, Levy said while the CRISTAL trial did not find the Medtronic 780G to be superior to standard of care for many it did reduce self-care burden.
“Many individuals, however, needed to use entry of fake carbohydrates and other assistive techniques to improve glucose control,” Levy said. “This type of off label use at present is the only option for those pregnant individuals using a commercially available automated insulin delivery system in the U.S. at present.”
A call to action
Diabetes technology continues to advance, but many people with type 1 diabetes still lack access to automated insulin delivery systems, Garg said. A call-to-action paper published in Diabetes Technology & Therapeutics listed four recommendations for future automated insulin delivery guidance. The recommendations stated all people with type 1 diabetes and insulin-treated diabetes should be given the choice to use automated insulin delivery, and the choice should be based on everyone’s situation and need. Additionally, there should be documentation in a patient’s medical record if they are not offered automated insulin delivery, and national health care systems should prioritize providing “unfettered access” to automated insulin delivery systems.
“Cost remains a barrier,” Garg said. “Resources remain a barrier, affordability [remains a barrier], and whether [health systems] have the infrastructure to support people going on automated insulin delivery.”
Garg said many people with type 1 diabetes also do not have access to an endocrinologist, and primary care physicians may lack adequate training to initiate and support patients who use automated insulin delivery systems.
“[Primary care providers] don’t have time to put [a patient] on a pump,” Garg said. “They may not have the capability of downloading data and putting it in the electronic medical record. All those things are very time-consuming. Resource utilization is not available in those practices, even in the U.S.”
Isaacs said the diabetes community generally needs to do a better job making sure all patients with insulin-treated diabetes are offered automated insulin delivery access.
“We are in a new era,” Isaacs said. “Years ago, we would make people prove that they could earn an insulin pump, prove that they had good carbohydrate counting, prove that they could get their HbA1c to a certain level prior to starting one. Now, the technology is so much better. It’s clear that the benefits far outweigh the risks, and we don’t want to put up unnecessary barriers to accessing these systems.”
Looking ahead
Health care professionals look forward to more novel diabetes devices in the coming year. Isaacs called attention to the launch of the twiist automated insulin delivery system, which is scheduled for the second quarter of 2025. The system received FDA clearance in March 2024. In April, Sequel Med Tech announced twiist would be compatible with the Eversense 365 integrated CGM (Senseonics), a CGM with an implantable sensor that lasts for up to 1 year.
The Omnipod is currently the only FDA-approved tubeless insulin pump, but Isaacs said she expects more companies to unveil tubeless insulin pumps in the coming years.
Continuous ketone monitoring is also on the horizon. Garg said companies are working on developing dual CGM and continuous ketone monitors that could give people with diabetes more data to manage their disease.
“Dual CGM and continuous ketone monitors are going to change the way we manage diabetes,” Garg said.
One area of research that will be spotlighted in the months ahead is the use of GLP-1 receptor agonists as adjunctive therapy for people with type 1 and type 2 diabetes. Shah was the lead author on a consensus report on GLP-1s as an adjunctive therapy for automated insulin delivery in type 1 diabetes. The report detailed 31 recommendations and concluded GLP-1s could have a role in improving glycemic control without increasing the risk for hypoglycemia or DKA.
“It makes sense, both theoretically and scientifically, that GLP-1s would help people lose weight, improve the metabolic and glycemic outcomes, and could synergize the automated insulin delivery system,” Shah said.
Levy said large studies investigating GLP-1 use with automated insulin delivery are needed.
“As clinicians, we are struggling at times managing patients using algorithms without formal approval and formal data supporting methods to adapt and utilize these systems in situations with limited data,” Levy said.
Emotional well-being has been linked to improved disease management and longer life spans
THERE'S NO “RIGHT” way to react when a doctor tells you that something in your body has fundamentally shifted—and that life, from this point forward, is going to look different.
For men newly diagnosed with type 1 diabetes (T1D)—an autoimmune condition that affects your body’s ability to make insulin—the physical adjustments are only half the battle.
While the condition requires round-the-clock blood sugar monitoring, insulin injections, and a new level of vigilance, the mental health side of T1D is real, and for many men, it hits hard. Learning to manage the emotional aspects may be even more important than the physical—despite them being talked about less.
“Your mindset is what fuels your motivation to manage the physical side of things,” says William Haas, MD, board-certified integrative & family medicine doctor and founder of VYVE Wellness clinic who has male patients with type 1 diabetes. “If someone is emotionally overwhelmed or stuck in denial, it becomes a significant barrier to staying on top of glucose monitoring, insulin dosing, and lifestyle choices.”
There’s a robust body of research that supports the mind-body connection Dr. Haas is referring to. “Studies have found that when mental health issues (like depression or high distress) go unaddressed, patients often have worse healthcare outcomes,” says Cristina Del Toro Badessa, MD, a board-certified physician and director at Artisan Beaute with experience treating type 1 diabetic men.
“In diabetes specifically, research shows that conditions such as depression, anxiety, and diabetes distress (the overwhelm of managing diabetes) are associated with higher HbA1c levels (poorer blood sugar control), more complications, and generally harder-to-manage diabetes," Dr. Badessa says. "On the other hand, positive emotional well-being has been linked to improved disease management and even longer life spans."
It’s the thing that often goes unsaid: that chronic illness and mental health have a bidirectional relationship—and one affects the other constantly.
“Your mental state shapes how you experience life with type 1,” says Dr. Haas. “Two people can have the exact same A1C but drastically different qualities of life, and it often comes down to how they mentally and emotionally process their diagnosis.”
So, we asked doctors and therapists to share their best insights—what they want every man to know as he begins, or continues down, this journey. Consider this your guide to getting your mindset right, even if your body feels less in your control.
Seek support.
The best first step you can take is realizing you’re not meant to shoulder it all on your own. “I wish all male patients knew that acknowledging fear, sadness, or frustration doesn't make you less of a man—it makes you human, and it takes true courage and bravery,” Dr. Khan says. “You are not weak for needing support—you are strong for facing something difficult head-on.”
Dr. Khan encourages his newly-diagnosed patients to identify a few key people they trust—a partner, close friends—who they can lean on for emotional support or practical help. “I advise them to communicate their needs clearly, even scripting out language if necessary: ‘I don’t need fixing, but I do need someone to listen when this feels overwhelming.’ This shift from isolation to connection can dramatically change outcomes.”
If you don’t have a strong support system, ask your doctor for group therapy options. “For some, group therapy or peer support groups tailored to men with chronic illness can be transformative, offering both normalization and connection,” says Dr. Khan.
Reframe your definition of therapy.
Speaking of therapy: “Many men have internalized messages that seeking help is a sign of weakness,” says Dr. Khan. “To overcome this, I try to frame mental health as a component of physical health—not separate from, but essential to disease management.”
Rather than focusing on vulnerability—seeing therapy as some emotionally-fraught talk session—Dr. Khan suggests viewing it as a practical tool for mental resilience or performance optimization. Through that lens, going to therapy is no different than going to the gym.
All three experts agree: Whether it’s seeing a therapist who understands chronic illness, joining a peer support group, or connecting with a diabetes educator (your doctor should be able to help you find all three), these resources need to be seen as a core part of your ongoing treatment.
“I want to dispel the notion that you have to ‘man up’ by going it alone,” says Dr. Badessa. “In reality, talking to a professional or even a friend about your fears and frustrations can lighten that burden immensely and give you better strategies to cope.”
Own your diagnosis.
“The most challenging aspect for many is accepting that this is a lifelong condition,” says Dr. Haas. “It’s not something that goes away with a round of antibiotics or a diet change.”
But, those who accept their diagnosis earlier, rather than resist or minimize it, tend to manage the condition most effectively, Dr. Khan says. “They engage in their treatment proactively, ask questions, express fears, and use their medical and mental health team as collaborative partners.”
The mindset of these successful patients is key: “They tend to focus on what they can control rather than what they’ve lost,” he says. “I’ve noticed that successful patients are more willing to integrate diabetes into their identity without allowing it to define them entirely.”
For Dr. Badessa, too, the patients who do well are those who—after the initial shock—embrace the reality of their condition and decide to take charge. “Instead of staying in denial indefinitely, they pivot to ‘how can I manage this?’ They educate themselves about diabetes and tackle challenges head-on.”
For example, if they notice their blood sugar levels trending high, they’ll bring it up during their office visits and work with their provider to adjust their plan.
“This head-on approach of facing issues early and adapting helps prevent small problems from snowballing,” Dr. Badessa says. “In contrast, patients who struggle often avoid or ignore issues (understandably due to fear or burnout), which can allow difficulties to worsen.”
Focus on a healthy lifestyle overall.
Just like fitness is more about consistency than being "perfect," managing type 1 is about creating a healthy lifestyle you can sustain. The most successful patients are more forgiving of themselves when things don’t go perfectly, says Dr. Haas. “Blood sugar management isn’t a game of perfection,” he says. “It’s about consistency and resilience over time.”
It's true that you’ll need to pay attention to a few more details, especially around meals and exercise. "But in many ways, the healthy habits you’ll build to manage diabetes are the same ones every man should be doing anyway: eating a carb-conscious diet, staying active, and getting quality sleep," Dr. Haas says. "If anything, this diagnosis can be the catalyst for becoming the healthiest, most intentional version of yourself.”
Hidden symptoms appear before diagnosis reveals dangerous truth
The human body sends subtle distress signals long before diabetes officially develops, but millions of people miss these crucial warning signs until irreversible damage has already occurred. Understanding these early indicators can mean the difference between preventing diabetes altogether and managing a lifelong chronic condition that affects every aspect of daily life.
What makes these warning signs particularly dangerous is their deceptive nature. Many people dismiss these symptoms as normal signs of aging, stress, or busy lifestyles, allowing the underlying condition to progress unchecked. The body’s attempts to communicate its struggle with rising blood sugar levels often go unrecognized until a medical crisis forces the issue into the open.
The progression from normal blood sugar levels to full-blown diabetes doesn’t happen overnight. This gradual development creates a critical window of opportunity where intervention can prevent or delay the onset of diabetes. Recognizing the body’s early warning system becomes essential for anyone concerned about their long-term health and quality of life.
Photo credit: Shutterstock.com / Dmytro Zinkevych
1. Excessive thirst and frequent urination become constant companions
The first and most telling sign that the body is struggling with blood sugar regulation manifests through dramatic changes in thirst and urination patterns. This isn’t the mild thirst experienced after exercise or during hot weather, but an overwhelming, persistent need for fluids that never seems satisfied no matter how much water is consumed.
The mechanism behind this excessive thirst reveals the body’s desperate attempt to manage rising blood sugar levels. When glucose levels in the blood become elevated, the kidneys work overtime to filter and remove the excess sugar through urine. This process requires significant amounts of water, leading to increased urination frequency that can occur every hour or even more frequently.
The constant loss of fluids through frequent urination triggers intense thirst as the body attempts to replace lost water and maintain proper hydration levels. This creates a cycle where drinking more fluids leads to even more frequent urination, which in turn increases thirst. Many people find themselves waking multiple times during the night to urinate, disrupting sleep patterns and affecting overall energy levels.
What makes this symptom particularly concerning is its progressive nature. The thirst and urination frequency gradually increase over weeks or months, making it easy to adapt to the changes without recognizing them as warning signs. People often rationalize these symptoms by attributing them to drinking more coffee, consuming certain medications, or simply getting older.
The quality of thirst also differs from normal thirst experiences. Instead of being satisfied after drinking fluids, the thirst returns quickly and feels more urgent than typical thirst sensations. Some people describe it as having a constantly dry mouth or feeling like they can never drink enough water to feel satisfied.
2. Unexplained fatigue drains energy despite adequate rest
The second major warning sign appears as persistent, overwhelming fatigue that doesn’t improve with rest or sleep. This isn’t the normal tiredness experienced after a busy day or poor night’s sleep, but rather a profound exhaustion that affects the ability to perform routine daily activities and seems to have no identifiable cause.
The connection between developing diabetes and extreme fatigue lies in the body’s inability to properly utilize glucose for energy. As blood sugar levels rise and the body’s cells become resistant to insulin, glucose cannot enter cells efficiently to provide the energy needed for normal function. This leaves cells essentially starving for fuel despite having abundant glucose circulating in the bloodstream.
The fatigue associated with developing diabetes often comes with additional characteristics that distinguish it from normal tiredness. Many people experience a heavy, weighted feeling in their limbs that makes simple tasks like climbing stairs or carrying groceries feel extraordinarily difficult. Mental fatigue accompanies physical exhaustion, making concentration and decision-making more challenging than usual.
Sleep quality often deteriorates as blood sugar fluctuations disrupt normal sleep patterns. Even when people manage to get what seems like adequate sleep, they wake feeling unrefreshed and struggle to maintain energy throughout the day. Afternoon energy crashes become more frequent and severe, often requiring naps or caffeine to maintain basic functionality.
The unpredictable nature of this fatigue makes it particularly disruptive to daily life. Energy levels can fluctuate dramatically throughout the day, with periods of relative normalcy followed by sudden crashes that make it impossible to complete planned activities. This inconsistency often leads people to blame external factors like stress, weather, or busy schedules rather than recognizing it as a potential health warning.
3. Increased hunger paired with unexpected weight changes
The third critical warning sign manifests as dramatic changes in appetite and eating patterns, often accompanied by unexpected weight fluctuations that seem to defy logic. This isn’t simply increased appetite due to physical activity or growth spurts, but rather an intense, persistent hunger that feels impossible to satisfy regardless of how much food is consumed.
The physiological basis for this increased hunger stems from the body’s cells being unable to access glucose for energy despite elevated blood sugar levels. When cells cannot properly utilize available glucose due to insulin resistance or insufficient insulin production, they send hunger signals to the brain requesting more fuel. This creates a frustrating cycle where eating more food provides temporary satisfaction but fails to address the underlying cellular energy shortage.
The type of hunger experienced during diabetes development often focuses on specific cravings, particularly for sugary or carbohydrate-rich foods. The body instinctively seeks quick sources of energy, leading to intense cravings for sweets, bread, pasta, and other high-carbohydrate foods. These cravings can feel overwhelming and difficult to resist, even for people who previously had good control over their eating habits.
Weight changes during diabetes development can be confusing and seemingly contradictory. Some people experience unexpected weight loss despite eating more food than usual, while others gain weight rapidly even when trying to maintain their normal eating patterns. The weight loss occurs because the body cannot properly utilize consumed calories, leading to the breakdown of muscle and fat tissue for energy.
Alternatively, weight gain may result from the body’s attempts to store excess glucose as fat, combined with increased caloric intake from constant hunger. The distribution of weight gain often occurs around the midsection, creating the characteristic abdominal weight gain associated with insulin resistance and metabolic dysfunction.
The timing of hunger also becomes abnormal, with people experiencing intense cravings at unusual times or finding themselves unable to feel satisfied after meals that would normally provide adequate fullness. Night eating becomes more common as blood sugar fluctuations trigger hunger signals during hours when appetite would typically be suppressed.
Understanding the progression timeline
These three warning signs rarely appear simultaneously but tend to develop in a progressive pattern over months or years. The subtle onset makes it easy to dismiss individual symptoms as unrelated issues rather than recognizing them as components of a developing metabolic disorder.
The progression typically begins with mild increases in thirst and urination frequency that people often attribute to environmental factors, medication changes, or lifestyle modifications. As the underlying blood sugar regulation becomes more impaired, these symptoms intensify while fatigue begins to emerge as a noticeable problem.
The timeline for symptom development varies significantly among individuals, influenced by factors such as genetics, lifestyle, body weight, and overall health status. Some people may notice dramatic changes over a few months, while others experience gradual progression over several years before symptoms become impossible to ignore.
Age plays a significant role in both symptom recognition and progression speed. Younger individuals may experience more rapid symptom development but are also more likely to dismiss symptoms as temporary issues. Older adults may attribute symptoms to normal aging processes, delaying recognition of the underlying metabolic changes.
Risk factors amplify warning sign significance
Certain risk factors make the appearance of these warning signs more significant and concerning. Family history of diabetes increases the likelihood that these symptoms represent developing diabetes rather than other health issues. People with parents, siblings, or other close relatives with diabetes should pay particular attention to any combination of these warning signs.
Excess body weight, particularly abdominal weight gain, significantly increases the risk that these symptoms indicate developing diabetes. The distribution of body fat affects insulin sensitivity, with abdominal fat being particularly problematic for blood sugar regulation. Even modest weight gain in the abdominal area can contribute to insulin resistance and the development of these warning signs.
Sedentary lifestyle and poor dietary habits create additional risk factors that make these warning signs more concerning. Regular physical inactivity reduces the body’s ability to utilize glucose effectively, while diets high in processed foods and added sugars place additional stress on blood sugar regulation systems.
Age represents another significant risk factor, with diabetes risk increasing substantially after age 45. However, the condition is increasingly diagnosed in younger individuals, making age-related assumptions about symptom significance potentially dangerous for people in their twenties, thirties, and forties.
The hidden danger of symptom adaptation
One of the most dangerous aspects of these warning signs is the human body’s remarkable ability to adapt to gradual changes. As symptoms develop slowly over time, people unconsciously adjust their expectations and behaviours to accommodate the changes without recognising them as abnormal.
The gradual nature of symptom progression allows people to rationalize each change as they occur. Increased thirst gets attributed to weather changes or increased coffee consumption. Fatigue becomes explained by busy schedules or poor sleep habits. Increased hunger seems normal given stress levels or activity changes.
This adaptation process prevents many people from seeking medical evaluation until symptoms become severe enough to significantly impact daily functioning. By this point, blood sugar levels may have been elevated for months or years, potentially causing damage to blood vessels, nerves, and organs that could have been prevented with earlier intervention.
The normalization of symptoms also affects communication with healthcare providers. During routine medical visits, people may not mention these changes because they’ve become accustomed to them or don’t perceive them as medically significant. This can delay diagnosis even when regular medical care is being received.
Early intervention opportunities
Recognizing these warning signs creates valuable opportunities for intervention that can prevent or delay the development of full-blown diabetes. Lifestyle modifications implemented during this early stage can often restore normal blood sugar regulation and eliminate symptoms entirely.
Dietary changes focusing on reducing refined carbohydrates and added sugars can significantly improve blood sugar control and reduce symptom severity. Emphasizing whole foods, lean proteins, and high-fibre carbohydrates helps stabilize blood sugar levels and reduce the stress on insulin-producing cells.
Regular physical activity provides one of the most effective interventions for improving blood sugar regulation. Even modest increases in daily activity, such as taking regular walks or using stairs instead of elevators, can enhance insulin sensitivity and glucose utilization by muscle cells.
Weight management becomes particularly important for people experiencing these warning signs, especially when excess abdominal weight is present. Even modest weight loss of 5-10% of body weight can significantly improve blood sugar control and reduce diabetes risk.
Medical evaluation importance
While lifestyle modifications can be highly effective during the early stages of diabetes development, medical evaluation remains essential for proper diagnosis and monitoring. Blood tests can detect elevated glucose levels and insulin resistance before symptoms become severe, allowing for more targeted intervention strategies.
Regular monitoring of blood sugar levels, blood pressure, and cholesterol levels provides valuable information about cardiovascular risk and overall metabolic health. These measurements can guide treatment decisions and help track the effectiveness of lifestyle interventions over time.
Medical evaluation also helps rule out other conditions that might cause similar symptoms. Thyroid disorders, kidney problems, and certain medications can produce symptoms that mimic early diabetes signs, making professional medical assessment important for accurate diagnosis.
The timing of medical evaluation becomes crucial when these warning signs appear. Waiting for symptoms to worsen or hoping they will resolve spontaneously can result in missed opportunities for prevention and early intervention that could preserve long-term health and quality of life.
Long-term implications of early recognition
Understanding and responding to these early warning signs can have profound implications for long-term health outcomes. People who recognize and address these symptoms during the early stages often avoid the serious complications associated with established diabetes, including heart disease, kidney damage, nerve problems, and vision loss.
The quality of life differences between preventing diabetes and managing established diabetes are substantial. Prevention eliminates the need for daily blood sugar monitoring, medication management, and the constant awareness of dietary choices that characterizes life with diabetes.
Early intervention also provides economic benefits, as the costs associated with diabetes prevention are significantly lower than the expenses related to diabetes management and complication treatment. The financial impact of diabetes extends beyond medical costs to include lost productivity and reduced earning potential.
The psychological benefits of preventing diabetes rather than managing it cannot be understated. The stress, anxiety, and lifestyle restrictions associated with diabetes management can significantly impact mental health and overall life satisfaction, making early intervention efforts particularly valuable.
Recognizing these three warning signs—excessive thirst and urination, unexplained fatigue, and increased hunger with weight changes—provides a crucial opportunity to take control of health before diabetes becomes established. The body’s early warning system offers a chance to prevent a chronic condition that affects millions of people worldwide, but only for those who understand what to look for and take appropriate action when these signs appear.
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