Managing T1D and ADHD: Tips from a Psychologist - T1D Exchange

While the relationship between diabetes and attention-deficit/hyperactivity disorder (ADHD) is not entirely clear, research shows that people with type 1 diabetes (T1D) are more likely to have ADHD. In fact, a recent meta-analysis suggests that ADHD occurs 35% more frequently in people with T1D than in the general population.  

This means people with T1D are more likely to experience the challenges associated with ADHD — which can make managing diabetes even harder. Let’s take a closer look at what ADHD is, how it can impact diabetes management, and the steps you can take to live successfully with both conditions. 

What is ADHD? 

People living with ADHD commonly have issues with paying attention, controlling actions, and being impulsive. Or, they may have a combination of these symptoms, which can affect how a person functions. ADHD doesn’t just occur in children. It’s a condition that affects adults too. 

If you live with ADHD, you’re likely familiar with the following symptoms:  

• Inattention: Difficulty staying focused on tasks, maintaining attention, and staying organized 

• Hyperactivity: Constant movement or fidgeting, excessive talking, and a sense of restlessness 

• Impulsivity: Acting without thinking, seeking immediate rewards, and interrupting others, which can result in making decisions without considering long-term effects 

I think I have ADHD — what should I do? 

If you think you have symptoms of ADHD but don’t have a diagnosis, you’ll want to have a comprehensive evaluation by a qualified mental health professional or another healthcare provider. 

They’ll gather information from ADHD symptom checklists, behavior rating scales, and detailed histories from the people you interact with regularly. This will provide essential information for an accurate diagnosis. ADHD cannot be diagnosed from brief observations alone. 

As a diabetes psychologist, I’ve seen ADHD impact many different facets of T1D management, from changing pump sites to bolusing and even eating. A few of my clients have described the challenges they face living with both conditions. Perhaps they may resonate with you or someone you love.  

• “I get distracted when I go to fill my pump and start doing something else while getting my supplies.” 
• “I forget to bolus, so I have an insulin pump with all the reminders set.” 
• “I really struggled to eat enough before taking medications for ADHD. Everything was more important than food. Because of all the preparation to eat with T1D I would simply get overstimulated and move on. Medication has helped me drastically, and I can’t believe I went without it for so long.” 

How is ADHD treated? 

Treating ADHD usually involves a combination of three things: medications, therapy, and lifestyle adjustments. We’ll help you to figure out each one. 

Medications such as stimulants can help manage symptoms by improving focus, attention, and impulse control. Although it might seem counterintuitive for someone with ADHD to take stimulants, these medications work by increasing the levels of certain neurotransmitters in the brain. This includes dopamine and norepinephrine, which help improve attention while reducing hyperactivity and impulsivity. 

Cognitive-behavioral therapy (CBT) can help provide strategies for people to manage their ADHD symptoms, such as breaking tasks into smaller steps, using reminders and alarms, and creating structured routines. This can be especially helpful for people whose symptoms are making it difficult to manage their blood glucose. 

Lifestyle adjustments like regular exercise, a healthy diet, and sufficient sleep can also play a vital role in managing ADHD symptoms. Having a consistent daily routine can help minimize distractions, while improving focus and organization. By gaining insight into how ADHD symptoms affect diabetes management, your care team can help you develop strategies that work best for you.    

What strategies can I use for ADHD with T1D? 

While there isn’t one single strategy that works best for everyone, we know that by combining traditional and out-of-the-box strategies, you’ll be more likely to find an approach that’s best for you. We’ll help you get started. 

• Create routines: Establish daily routines to help you manage ADHD and T1D together. Using alarms and reminders to monitor your glucose values and give insulin at meals can be helpful. Developing routines can help reduce your mental load, and in turn, you’ll likely find yourself forgetting essential tasks less and less.

• • Try to eat meals regularly. Start by focusing on one at a time, with breakfast, for example. Add eating breakfast to your “to-do” list, so it’s something to check off while getting ready for your day. Once you have this habit down, work on adding another meal.

• Organize supplies: To keep your diabetes supplies organized, try keeping them in the same place. Setting reminders to reorder supplies can be helpful. Even better, by using auto-refill options from a mail-order pharmacy or durable medical supplier, they’ll simply arrive on your doorstep.  

• • Having extra supplies on hand in various locations (i.e., your car, purse, office), you’ll be less likely to run out. It’ll also reduce the time and stress of searching for supplies when they’re needed.

• Use technology: Diabetes devices, including continuous glucose monitors and insulin pumps, can help monitor glucose levels and remind you when to take insulin. The data from these devices give insight into areas where you may need more support. You may prefer an ADHD app to help you stay focused and on track. InFlow and Todoist are a few of my favorites.

• • Most insulin pumps have “missed bolus” alarms, which work great when you eat regularly throughout the day. Alarms are just “alarms” unless you’re tuning into them. By making a mantra such as, “I’m listening for my alarms, and I’ll take action when they go off,” you’ll likely have more success.

• Seek support: Consider working with a healthcare team that understands both conditions for additional support and guidance. Seeking peer support, either in-person or online, can provide significant benefits, insights, and encouragement. 

Who should be on my healthcare team? 

A diabetes-specific provider such as an endocrinologist, diabetologist, and a Certified Diabetes Care and Education Specialist (CDCES) will listen, collaborate, and find solutions for your diabetes management with ADHD. 

A mental health professional such as a psychologist, clinician, counselor, or therapist is someone you’ll meet with regularly and offer therapies that are a good fit for you. For many, this is CBT. 

A psychiatrist or psychiatric nurse practitioner can prescribe any necessary ADHD medications.  

What out-of-the-box strategies can I use for ADHD with T1D? 

Consider adding the following strategies if more “traditional” approaches aren’t working for you. Clients I work with have found the following to be helpful: 

• Mindfulness: Practicing mindfulness can help increase self-awareness and improve focus, making it easier to manage ADHD and T1D. 

• Physical activity: Moving your body regularly can help with ADHD symptoms and improve overall well-being.  

• Creative outlets: Activities such as art, music, or writing can help balance stress and improve focus. 

• Accountability partners: Have a friend or family member help you stay accountable and support you in managing both conditions. 

How do I talk to my diabetes care team about ADHD? 

It is important to be open and honest when talking about your ADHD symptoms. If you notice challenges with diabetes management tasks like taking insulin, monitoring your glucose, counting carbs, and others. Your diabetes care team can help you create a personalized treatment plan incorporating strategies for both conditions. 

The bottom line is that managing T1D takes a significant amount of planning, and ADHD can make future-oriented thinking challenging. But there’s good news. With the right strategies and support, managing both conditions and improving your overall quality of life will be easier than ever.