Mental health issues are among the common problems associated with diabetes, though perhaps the most frequently overlooked.

Although the American Diabetes Association recommends that doctors screen diabetic patients for possible mental health problems, few physicians actually do.

For instance, depression is twice as likely among diabetics than in the general population.

Patients with diabetes also have an increased risk for anxiety and eating disorders.

Eating disorders occur more frequently in female diabetics than males. In fact, women with diabetes have twice the risk of developing an eating disorder. Up to 40 percent of females between the ages of 15 and 30 with Type 1 diabetes suffer from eating disorders.

Thanks to the discovery of insulin and other medications, as well as active healthy lifestyles, patients with diabetes are able to control their blood sugar levels better than in the past.

Over time, however, the illness can still lead to changes in the structure and function of the brain.

The brain is very sensitive to the sharp rises and falls in blood sugar levels that occur regularly with diabetes. The illness also leads to excess inflammation, which can damage brain cells and blood vessels.

Damaged brain blood vessels compromise circulation and delivery of oxygen and nutrients to neurons.

Type 2 diabetes increases the risk for vascular dementia because the disease damages the blood vessels in the brain.

The longer a patient has diabetes, the higher his or her risk for dementia.

Those who do develop dementia tend to be obese, have high blood pressure and higher levels of triglycerides, and lower levels of the “good” HDL cholesterol.

During hypoglycemic incidents, patients may experience anxiety, confusion, headache, dizziness, and even difficulty talking and walking.

Severe blood sugar drops can cause delusions, psychosis, seizures, fainting, or even coma.

If hypoglycemic episodes become frequent or chronic, patients may not always notice them or experience the usual symptoms of hunger, shakiness, clammy skin, or palpitations.

Some experts believe that repeated hypoglycemic episodes cause long-term memory issues and increase the risk for dementia.

Patients with diabetes also have a greater likelihood of cognitive decline as they age.

People with diabetes tend to have a greater number of risk factors for Alzheimer’s disease, such as heart disease, elevated cholesterol, and hypertension. Persistently high blood sugar levels may contribute to the cognitive decline seen in these patients.

Research has shown that learning and memory abilities correlate with a patient’s ability to maintain normal blood sugar levels.