mental health and diabetes in asian Americans

types Diabetes

Diabetes or Diabetes Mellitus is a chronic condition that is characterized by one’s body’s inability to convert the glucose (sugar) in food into energy and effects about 537 million adults from the ages of 20-70 around the world, and 1.2 million children ages 0-19 are affected by Diabetes Type I around the world. It is projected to rise to 643 million by 2030 (International Diabetes Federation, 2021). There are four common types of diabetes.


Prediabetes is caused by one’s body not responding to insulin production and resulting in higher levels of blood sugar. A person with prediabetes has an A1C range between 5.7-6.4%, when normally it is less than 5.7%. (A1C is a test that assesses for the percentage of blood that has sugar-coated hemoglobin.) Individuals with Prediabetes commonly exhibit the following risk factors:

  • Overweight
  • +/= 45 years old
  • Immediate familial history of Type II Diabetes (see below)
  • Physical activity less than 3 times per week
  • Polycystic Ovary Syndrome (PCOS)
  • Giving birth to a baby who is more than 9 pounds
  • Gestational Diabetes (see below)

Having Prediabetes can lead to Type II Diabetes (see below) if not managed (CDC).

Prediabetes: Could It Be You? (February 2020, CDC)

Gestational Diabetes

Gestational diabetes is characterized by a pregnant person’s body being affected by insulin production. This can also impact the person’s pregnancy and their baby’s health. Individuals with Gestational Diabetes have a higher risk of developing Type II Diabetes (see below) as well. There aren’t as many symptoms an individual with Gestational Diabetes may experience other than the possibly having increased thirst or more frequent need to urinate. Possible risk factors a pregnant person may be:

  • Overweight or obesity
  • Little to no physical activity
  • Diagnosis of Prediabetes
  • History of gestational diabetes in previous pregnancies
  • PCOS
  • Family history of diabetes
  • History of delivering a baby more than 9 pounds in previous pregnancies

Gestational Diabetes can cause complications in both the pregnant person and the baby. The pregnant person may experience the following complications:

  • High blood pressure
  • Preeclampsia
  • Deliver via C-section
  • Developing Type II Diabetes in the future

The baby of a person with Gestational Diabetes can have the following complications as well:

  • High birth weight leading to complications in delivery
  • Preterm birth
  • Respiratory Distress Syndrome (RDS) which is characterized by experiencing severe breathing difficulties
  • Hypoglycemia (low blood sugar)
  • Developing Type II Diabetes or Obesity in the future
  • Stillbirth

(Mayo Clinic)


Type I Diabetes used to be known as Juvenile Diabetes because it was predominantly diagnosed in children, however it can be diagnosed in adulthood. It is chronic condition that is characterized by a one’s pancreas inability to produce enough insulin. While the causes for Type I Diabetes is still being researched, it is believed that genetics, viral exposure, or environmental factors can cause Type I Diabetes. Treatment is primarily concerned with managing insulin levels, diet, and lifestyle. Common symptoms of Type I Diabetes may be:

  • Increased thirst
  • Frequent urination
  • Unhistorical bed-wetting in children
  • Increase hunger
  • Accidental weight loss
  • Irritability, mood changes
  • Fatigue
  • Feeling physically weak
  • Blurred vision

Individuals with Type I Diabetes can develop further complications throughout their body in the future if blood sugar isn’t managed well:

  • Development of cardiovascular diseases
  • Neuropathy (nerve damage)
  • Nephropathy (kidney damage)
  • Diabetic retinopathy (eye damage)
  • Foot problems
  • Oral complications
  • Dermatological complications
  • Pregnancy complications

(Mayo Clinic)


Diabetes (Type 2) (American College of Cardiology, 2019)

Type II Diabetes is also a chronic condition that is characterized by irregulation of sugar transformation into fuel, resulting in too much sugar in the bloodstream. Type II Diabetes is caused by the pancreas inability to make enough insulin and the body’s cells become resistant to that insulin. While there is no cure for Type II Diabetes, patients can manage the disease with weight loss, proper diet, physical activity, combined with medication. People with Type II Diabetes tend to experience the following symptoms:

  • More thirst
  • Increased urination frequency
  • More hunger
  • Accidental weight loss
  • Fatigue
  • Blurred vision
  • Sores can take awhile to heal
  • Having more infections
  • Numbness or tingling in extremities (hands and feet)
  • Parts of skin are darker than the rest of the skin (often seen on the neck or in the armpits)

Individuals are at higher risk for developing Type II Diabetes if they experience any of these factors:

  • Overweight or obesity
  • Fat distribution is mainly in the abdomen (mens’ waist of 40″+; women’s waist of 35″+)
  • If a person doesn’t use up the sugar through physical activity
  • Other family members have Type II Diabetes
  • High levels of the “bad” cholesterol (triglycerides) and low levels of “good” cholesterol (High-Density Lipoprotein, HDL)
  • The risk of developing Type II Diabetes increases as one ages
  • Prediabetes
  • Gestational Diabetes or giving birth to a baby weighing 9 pounds or more
  • PCOS

Much like Type I Diabetes, Type II Diabetes can lead to complications throughout the body:

  • Cardiovascular diseases, such as atherosclerosis (high blood pressure and narrow blood vessels)
  • Neuropathy in extremities and other areas of the body
  • Nephropathy
  • Retinopathy
  • Dermatological complications
  • Slow healing; when left untreated, sometimes the cure requires amputation
  • Hearing problems
  • Sleep apnea
  • Dementia

(Mayo Clinic)

Diabetes in the Asian American Community

In the Asian American community, 1 in 3 people are diagnosed with a type of diabetes (CDC, 2022) and is the fifth leading cause of death in AAPI (Joslin Diabetes). At the U.S. Department of Health and Human Services Office of Minority Health published the statistical differences of Asian Americans and their other nationality counterparts. They found that they are 40% more likely to have diabetes than non-Hispanic Whites. From 2017-2018 South-Asian Americans were 70% more likely to develop diabetes in comparison to their non-Hispanic white counterparts (OMH, March 2021). Due to the distribution of fat, primarily the visceral fat (fat distributed around organs), Asians can appear to be at a healthy weight and often under diagnosed with diabetes. As a result, it is recommended than Asian Americans have their A1C checked if their BMI is 23 or greater (CDC, April 2022). As the Asian population is quite diverse, it is difficult to identify the specifics of each subgroup and more research is needed (NIH News Releases, 2015).

Diabetes Impact on Mental Health in Asian Americans

The Mind-Body Connection impacts the individual with diabetes. People with diabetes are two to three times more likely to suffer from depression for various reasons and not many of these individuals are diagnosed and treated. Anxiety and stress can also impact diabetes prognosis (CDC, 2021) due to the manner in which the body burns energy. As diabetes is impacted by diet, individuals can develop Eating Disorders(MHA) and perhaps even Body Dysmorphia due to the weight fluctuations one can endure throughout the disease process. Furthermore the difference in BMI standards to adjust to Asian body types may impact the individual’s view of themselves. Research has noted that the implementation of conjoint intervention of medicine and lifestyle changes (i.e. diet, physical activity, and therapy) can greatly improve the lives of individuals with diabetes.


Diabetes Care– ADA’s Standards of Medical Care in Diabetes clinical practice recommendations

Drag ‘n Cook– a resource for Asian food recipes with nutritional information

International Diabetes Federation (IDF)

International Diabetes Federation Diabetes Atlas 10 ed. (2021)

Mayo Clinic The Essential Diabetes Book, 3rd ed., Maria Regina Castro, M.D. (2022)

National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States

Prediabetes– CDC

Prediabetes– Mayo Clinic

Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. JAMA. 2015;314(10):1021–1029. doi:10.1001/jama.2015.10029

Type I Diabetes

Type II Diabetes

This month’s article was written by our chronic illness specialist, Aarti S. Felder, MA, LCPC, BCN.

The Mental Health of South Asian Americans with IBD

May 19th was Inflammatory Bowel Disease (IBD) Awareness Day, so I thought it fitting to explore the implications of mental health in South Asian Americans (SAA) this Asian American Pacific Islander (AAPI) Heritage Month.

Symptoms of IBD

There are two types of IBD: Crohn’s Disease (CD) and Ulcerative Colitis (UC) and the following are common symptoms:

  • Diarrhea
  • Unexplained weight loss
  • Bloody stool
  • Fatigue
  • Reduction in appetite
  • Abdominal pain
  • Fever

Additional Symptoms of CD

  • Mouth sores
  • Anal fistula


  • Rectal pain
  • Defecation urgency
  • Tenesmus
  • In children, failure to grow

Futher complications of IBD

  • Colon cancer
  • Side effects from medications
  • Inflammation in other areas of body
  • Sclerosing Cholangitis
  • Blood clots
Addition complications for CD
  • Bowel Obstruction
  • Fistulas
  • Malnutrition
Addition complications for UC
  • Toxic mega colon
  • Perforate colon
  • Severe dehydration

Diet and Lifestyle Implications on Mental Health

In South Asian (SA) culture, people can seek a holistic treatment regimen such as Ayurveda or Homeopathic as an alternative treatment to illness utilizing allopathic therapeutics. The appeal of those treatment modalities is the sense of limited side-effects as opposed to allopathic treatment. Furthermore, Ayurveda and Homeopathic therapies are coupled with lifestyles involving spirituality, diet, and movement. Overall this may be a great way to treat illness when it encompasses several realms to treat the person as a whole, but it is a different challenge to treat IBD as opposed to general gastric distress.

Ayurveda and Homeopathic Treatments

There have been international research done on the use of natural remedies for IBD, however there are several critiques, such as the studies’ procedures or the number of clinical trials. Nevertheless, as with all treatments, ample research must continued to be done to determine effective therapies. In the resources section, there are a few studies that aim to add to the knowledge-base of eastern traditional medicine of IBD treatment. While these studies discussed the efficaciousness of Ayurveda and herbal supplements, some patients following similar regimens as indicated in those studies did not gain remission. The continued active IBD due to ineffective treatment, led to more severe illness. As one can imagine, chronic flares can lead to depression and hopelessness. Some individuals even further expressed frustration and resentment in finding that biologics has a higher efficacious rate in gaining remission, however is not a readily available treatment modality due to availability and financial reasons.


Although diet change has been found to be factor that assist in the symptom reduction (i.e. the anti-inflammatory diet, a low fiber diet, a gluten-free diet, or a low dairy diet to name a few), it alone cannot treat IBD. When diet is poorly used as a treatment strategy for controlling IBD, it can lead to poor nutrition and weight changes as a result of the of either of the illnesses’ symptoms, as well as lethargy due to the insufficient energy derived from the nutrients consumed. The results of these symptoms can lead to depression and anxiety due to poor performance, cognitive dysfunction, perceived “laziness”, for example.

The social implications on Mental Health

As previously mentioned, symptoms of IBD can be perceived as laziness, however in truth, patients may experience struggle with just getting out of bed due to the symptoms of IBD. In this section we will explore other social factors on IBD and mental health for SAA and SA alike.

Body Type

Having IBD can lead to drastic changes in body size as a result of nutrient absorption, appetite changes, lethargy, and the impact on growth in pediatric patients. Furthermore, the side-effects of cortical steroids, such as weight gain and bloating, and the body’s response to perceived starvation during remission (storing fat) can further exacerbate the changes in body size. Just as in any culture, the changes in body size as a result of IBD can lead to poor self-esteem and body dysmorphia, SAAs thoughts about their bodies are further compounded as a result unobtainable beauty standards and the lack of healthy representation in media. Furthermore, in patients with body size changes as well as with colostomy bags can struggle with desirability and fertility (historical data suggests that a colectomy can effect pregnancy in women). Furthermore, patients with colostomy bags, especially in younger individuals, struggle with visibility of the bags and other’s perceptions of it. These experiences can also lead to depression due to feelings of loneliness or social anxiety, out of fear of the judgement.


One of the major religions in South Asia, specifically India, is Hinduism. Hinduism is intertwined in the way of life for Indians as well as Indian Americans. Hindus believe in the concept of reincarnation and the role of Karma as well as Dharma. To pray and mediate is to find inner peace. This can be a contradiction to some individuals with IBD, as having IBD can be perceived has having “unclean” Karma, or imply that the cause of IBD is behavioral in nature (not “praying hard enough”). With such powerful implications, a Hindu may not derive inner peace from prayer and meditation leading to further anxiety (“why is this not working?!”) or depression (“I must be a bad person because I have IBD.”)

Closing Remarks

The aforementioned experiences are by no means exhaustive. Individuals with IBD from various cultural backgrounds can indeed affect mental health. IBD as well as IBS (Irritable Bowel Syndrome) are also affected by mental health. Therefore, treatment must involve physical health intervention as well as mental health intervention.


Own Your Crohn’s – an award winning blog by Tina Aswani

IBDesis Instagram– community of South Asians with IBD

Mayo Clinic’s Definition of IBD

Inflammatory bowel disease in the South Asian pediatric population of British Columbia – Vared Pinsk, Daniel A Lemberg, Karan Grewal, Collin C Barker, Richard A Schreiber, Kevan Jacobson

South Asian Patients With Inflammatory Bowel Disease in the United States Demonstrate More Fistulizing and Perianal Crohn Phenotype – Sushrut Jangi, MD,  Alex Ruan, Joshua Korzenik, MD,  Punyanganie de Silva, MD, MPH

Comparison of Disease Phenotypes and Clinical Characteristics Among South Asian and White Patients with Inflammatory Bowel Disease at a Tertiary Referral Center – Vimal Bodiwala, MD,  Timothy Marshall, PhD,  Kiron M Das, MD, PhD,  Steven R Brant, MD, Darren N Seril, MD, PhD

Effects of Ayurvedic treatment on forty-three patients of ulcerative colitis – Manish V. Patel, Kalapi B. Patel, and  S. N. Gupta

Herbal Medicine in the Treatment of Ulcerative Colitis – Fei Ke, Praveen Kumar Yadav, and  Liu Zhan Ju

Translational Studies on Inflammation: Review and Implications of Traditional Indian Medicine for Inflammatory Bowel Disease – Uma Ranjan Lal and Inder Pal Singh

An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report – Barbara C Olendzki, Taryn D Silverstein, Gioia M Persuitte, Yunsheng Ma, Katherine R Baldwin, and David Cave

Nutrition Tips for Inflammatory Bowel Disease – University of California San Fransisco

This month’s article was written by Aarti Felder, MA, LCPC. Aarti Felder is a daughter of Indian immigrants and is our Chronic Illness Specialist.