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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Mood, stress and diabetes distress

In short

Living with kidney disease and type 1 diabetes means counting, checking and deciding all day, every day. Feeling worn down by that is common, and it is not a weakness. Diabetes distress (feeling overwhelmed by diabetes care), depression and anxiety can all be treated. The ADA asks diabetes teams to check for each of them at least once a year (ADA 2026 §5). KDIGO links depression in CKD with more hospital stays and lists talking therapy, exercise, social support and medicines as options (KDIGO 2024, Table 38). If you ever think about harming yourself, call or text 988 in the US (988 Lifeline).

Your numbers

Checks your diabetes team should offer (ADA 2026 §5):

Check How often
Diabetes distress (also offered to caregivers and family) At least once a year, and again when treatment goals are not being met
Depression At least once a year; more often if you have had depression before
Anxiety At least once a year
Fear of lows At least once a year, and when needed, if you are at high risk of lows
Disordered eating, including skipping insulin to control weight Screened with a validated questionnaire

Where to get help:

Service How When
988 Suicide & Crisis Lifeline (US) Call or text 988, or chat online; free and confidential; text and chat also in Spanish 24 hours a day, every day (988)
Emergency services 911 (112 in the EU, 999 in the UK, 000 in Australia) If someone is in immediate danger
NKF PEERS (US) A trained mentor who has lived with kidney disease, by phone; call NKF Cares 855-653-2273 Monday–Friday, 9 am–7 pm Eastern (NKF)
Your dialysis unit's social worker (US) Ask at your next session Every US dialysis unit must have one (42 CFR 494.140)

Signs to watch for

  • Diabetes distress: strong worry, frustration or burnout about managing diabetes. For example, you dread checking your glucose or feel you are failing whatever you do (ADA 2026 §5).
  • Depression: for example, feeling low or empty most days, or losing interest in things you used to enjoy (ADA 2026 §5). Some signs overlap with kidney symptoms such as tiredness and poor appetite, so tell your team rather than guessing (KDIGO 2024, Table 38).
  • Anxiety: constant worry, a racing heart, or avoiding things, such as exercise, out of fear of a low (ADA 2026 §5).
  • Skipping insulin on purpose, for example to lose weight, is dangerous because it can lead to DKA. It is a known problem that can be treated; please tell your team (ADA 2026 §5).

What to do

  • Answer the screening questions honestly at your yearly check. If no one asks, ask for them.
  • Tell your team when diabetes or kidney care feels like too much. Your plan can often be made simpler.
  • If you are on dialysis in the US, meet your unit's social worker. Checking your emotional and social needs, counseling and referrals are part of your written plan of care (42 CFR 494.80 and 494.90).
  • Ask for a referral to a counselor or psychologist, ideally one who knows diabetes (ADA 2026 §5).
  • Talk to someone who has been there: NKF PEERS, a local support group, or a patient group at your unit (NKF).
  • Keep moving: exercise can help mood (KDIGO 2024, Table 38; Exercise).
  • If you take, or are offered, a medicine for depression or anxiety, make sure the prescriber knows your kidney function, because doses may need adjusting (KDIGO 2024, Table 38).
  • Save 988 in your phone, and tell a family member about it too.

Examples

Burnout. After two years of carb counting, potassium limits and dialysis, you stop checking your glucose. At your yearly review, the diabetes distress questions show high distress. Your team simplifies your plan, a CGM replaces fingersticks, and you start seeing a psychologist (ADA 2026 §5).

Fear of lows. Since a severe low at night, you keep your glucose high on purpose. You tell your team. They screen you for fear of hypoglycemia, set a CGM alert, and help you work on the fear (ADA 2026 §5).

A caregiver who is struggling. Your partner is your care partner for home dialysis and is exhausted. The ADA's distress screening covers caregivers and family members too (ADA 2026 §5). See For caregivers and family.

Ask your care team

  1. Can we go through the distress, depression and anxiety questions today?
  2. Can you refer me to someone who knows diabetes and kidney disease?
  3. Is any of my tiredness, poor sleep or poor appetite from my kidneys or my medicines?
  4. Can we make my daily routine simpler?
  5. Is there a support group or peer mentor I could talk to?

Get help now if…

Call or text 988 (US), or call 911 if someone is in immediate danger

Thoughts of harming yourself or ending your life, or someone else saying they want to. You can call or text 988 for yourself or for someone you are worried about (988 Lifeline). Outside the US, call your local emergency number. Full list: Get help now.

Call your team soon

Low mood or worry that is not going away, or you are skipping insulin, dialysis or medicines because you feel you cannot cope.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.