By Maddie Schulz, LCSW
As a therapist living with Type 1 Diabetes (T1D), I know firsthand that managing this condition is so much more than counting carbs and giving insulin. It’s a 24/7 job that takes a toll not only on the body, but also on the brain—especially the systems responsible for planning, focus, and self-regulation, known as executive functions.
What Is Executive Function—and Why Does It Matter?
Executive functions are the mental processes that allow us to:
People with T1D make hundreds of decisions each day: “How many carbs are in this?” “Did I already bolus?” “Do I need to suspend my basal for exercise?” This kind of ongoing cognitive effort can drain executive functioning resources, especially under stress or during blood sugar fluctuations.
As a therapist, I pay close attention to how my clients with chronic conditions—especially T1D—struggle with what often gets labeled as “self-discipline” or emotional regulation. What may look like laziness, inconsistency, or mood swings is often executive dysfunction shaped by a complex neuroendocrine condition.
Impaired executive functioning makes diabetes management harder, which can lead to more glucose variability, emotional dysregulation, and stress. Over time, this can contribute to burnout—a state of emotional and cognitive exhaustion.
What We Can Do About It
For those living with T1D: if you find yourself forgetting things, struggling to stay organized, or feeling emotionally overwhelmed—it’s not “just you.” Your brain is carrying a neurological load that deserves support, not shame.
Sources
https://diabetes.org/health-wellness/mental-health