The link between diabetes and ADHD

With October being ADHD Awareness Month, Daniel Sher educates us on the links between ADHD and diabetes, and how to manage both.

Defining ADHD

Attention-Deficit Hyperactivity Disorder (ADHD) is a common childhood developmental condition, affecting about 7.2% of all children. People with ADHD experience a hijacking of the brain’s executive system, which is responsible for focus, planning, organisation and impulse control. For those affected, ADHD can cause problems with school or work performance. In addition, ADHD symptoms can have a serious spill-over effect for diabetes management.

Is there a link between Type 1 diabetes and ADHD?

While some studies say that there is no clear link between Type 1 and ADHD, some research has found that as many as 12% of Type 1 adolescents have ADHD. But why would this be the case?

Research has found that people with Type 1 diabetes frequently have changes in the brain’s grey and white matter areas. These changes, which are linked to poorer blood glucose control, are thought to underlie and worsen some of the cognitive difficulties that people with ADHD experience. For children who develop Type 1 diabetes early in life, therefore, the brain may be changed in a way that makes them vulnerable to ADHD.

Is there a link between Type 2 diabetes and ADHD?

People who grow up with untreated ADHD are more likely to develop Type 2 diabetes, as well as obesity and hypertension, as they get older. How does this happen? A part of the theory is that ADHD impacts planning and organisation, making it harder to regularly engage in healthy physical activity and nutritious meal preparation. Furthermore, ADHD brains tend to crave dopamine rewards and for many, this causes overeating and sugar addiction. 

Diabetes management

There’s no doubt about it: having ADHD makes the already challenging job of managing diabetes that much tougher. How? Anyone with diabetes will know just how complicated it can be to manage this condition. To thrive with diabetes, some of the skills that we need include:

• Knowing how to plan properly and set achievable goals;
• Having good strategies to manage our impulses;
• Finding ways to sustain motivation and avoid burnout;
• Establishing a schedule that makes it easy to remember all of our testing and medications; and
• Knowing how to multi-task and find balance in life.

The common thread between all of these skills is that they are based on the brain’s executive control networks: the very functions that people with ADHD struggle with. For this reason, people with diabetes and ADHD often struggle to plan, set realistic goals, motivate themselves, manage impulses and remember to take their medications on time.

Diet

People with ADHD have reported that they struggle with their diet, which makes diabetes management extremely challenging. This happens because ADHD is an impulse control disorder, meaning that people who have it struggle to stop themselves from engaging in a certain behaviour. This helps to explain why, for example, many people who have ADHD also have binge-eating disorder and related eating difficulties, such as snacking frequently between meals and night-eating.

Additionally, the brain of people with ADHD tends to crave dopamine hits, which often leads a person to snack on foods that are high in refined carbs or sugars. This can lead to insulin resistance and fluctuating blood glucose, which in turn makes the ADHD even harder to manage.

It should come as no surprise, then, that research shows youngsters with diabetes and ADHD often have higher A1c (average blood-glucose) readings. They also tend to have more hospital admissions, longer times spent in hospitals and, consequently, doubled healthcare costs.

How is ADHD diagnosed and treated?

The diagnosis should be made by a medical specialist (paediatrician or psychiatrist) or a clinical psychologist. At times, a psychologist may perform neuropsychological testing to help the doctor make the diagnosis. This helps the parents and doctors understand the exact cognitive strengths and weaknesses that a person presents with, which can help with getting the right support.

If you suspect that you or your little one may have ADHD, it’s important to get a diagnosis from a clinician who has a detailed understanding of how diabetes can change your behaviour and brain. For some children, their behaviour will look like ADHD when in fact it’s being caused by other factors, such as stress, diabetes burnout or fluctuating blood glucose levels.

Is it all bad news?

There’s no doubt about it: having ADHD makes the already tough job of managing diabetes even harder. With the right support, though, people can learn to thrive with diabetes and ADHD. There are many effective treatment options out there, ranging from medication to therapy and lifestyle change. Speak to your doctor or psychologist about getting the right help, to assist you or your little one in learning to establish harmony between the brain, body and behaviour.

References

Akaltun, I., Tayfun, K. A. R. A., Cayir, A., & Ayaydin, H. (2019). Is There a Relation between type 1 diabetes mellitus and ADHD and severity of ADHD in children and adolescents? A case-control study. Osmangazi Tıp Dergisi.

Hilgard, D., Konrad, K., Meusers, M., Bartus, B., Otto, K. P., Lepler, R., … & German/Austrian DPV Study Group, the Working Group on Psychiatric, Psychotherapeutic Psychological Aspects of Paediatric Diabetology (PPAG eV) and the BMBF Competence Network Diabetes, Germany. (2017). Comorbidity of attention deficit hyperactivity disorder and type 1 diabetes in children and adolescents: Analysis based on the multicentre DPV registry. Pediatric diabetes, 18(8), 706-713.

Macek, J., Battelino, T., Bizjak, M., Zupanc, C., Bograf, A. K., Vesnic, S., … & Bratina, N. (2019). Impact of attention deficit hyperactivity disorder on metabolic control in adolescents with type1 diabetes. Journal of psychosomatic research, 126, 109816.

Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics, 135(4), e994-e1001.

Volkow, N. D., Wang, G. J., Kollins, S. H., Wigal, T. L., Newcorn, J. H., Telang, F., … & Swanson, J. M. (2009). Evaluating dopamine reward pathway in ADHD: clinical implications. Jama, 302(10), 1084-1091.

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