Diabetes and Coercive Control: Causes, Risks, and Health Impacts

For World Diabetes Day 2025, the International Diabetes Federation (IDF) championed a theme of Diabetes and Well-being, with a specific focus on the workplace.¹ The campaign urged employers to combat stigma and foster supportive environments — a worthy cause, but one that illuminates a troubling blind spot at the heart of global diabetes advocacy.

For millions of survivors of intimate partner violence, the primary barrier to health is not workplace culture. It is a partner who weaponises their chronic condition — withholding insulin, sabotaging diet, restricting access to medical appointments, and using the unpredictability of blood glucose as an instrument of control. This is something I encounter regularly in my coaching practice with survivors of coercive control, and it is confirmed by a growing body of peer-reviewed research.²

The link between coercive control and Type 2 diabetes is physiological, not merely circumstantial. Chronic psychological trauma activates the body’s stress response systems in ways that are now well-documented in the endocrinological and epidemiological literature — disrupting insulin regulation, driving chronic inflammation, and creating the precise metabolic conditions in which Type 2 diabetes takes root and becomes impossible to manage.^{3 4}

Understanding this link is not only a matter of academic interest. For the healthcare practitioners, employers, and policymakers who interact with people living with diabetes, it is a clinical and ethical imperative. And for survivors themselves — many of whom have never had their metabolic health understood in the context of the abuse they have experienced — it may be the framework that finally makes sense of years of unexplained illness.

What is Diabetes?

Diabetes is a chronic metabolic condition that arises when the pancreas either ceases to produce sufficient insulin or when the body becomes unable to utilize the hormone effectively. Insulin serves as the body’s primary regulator of blood glucose; without it, sugar remains in the bloodstream rather than being converted into energy.

This sustained state of high blood sugar — known as hyperglycaemia — acts like a slow poison, causing irreversible damage to the nerves, blood vessels, and vital organs over time.

Conversely, the “careful balancing act” of management carries its own risks: hypoglycemia. If insulin, food intake, and physical activity are not precisely synchronized, blood sugar can plummet, leading to immediate confusion, shakiness, or a life-threatening loss of consciousness.

Types of diabetes

Diabetes is broadly categorized into two primary forms:

• Type 1 Diabetes (T1D): An autoimmune condition, typically diagnosed in childhood, where the body mistakenly attacks its own insulin-producing cells.
• Type 2 Diabetes (T2D): The most prevalent form, accounting for over 95% of cases. It involves a progressive resistance to insulin, frequently driven by a complex interplay of genetic predisposition and lifestyle factors.

Why Diabetes Management Matters

The consequences of mismanagement are systemic. In 2021 alone, diabetes was the direct cause of 1.6 million deaths, with nearly half of those occurring in individuals under the age of 70. This rising mortality rate is a stark anomaly; while deaths from other major non-communicable diseases have begun to fall, diabetes-related fatalities continue to climb. The resulting complications are devastating:

• Retinopathy: Irreversible eye damage and blindness.
• Nephropathy: Chronic kidney disease and failure.
• Neuropathy: Nerve damage often leading to foot ulcers and amputation.
• Cardiovascular Disease: A significantly heightened risk of heart attack and stroke.

Global Toll of Diabetes

The global toll is staggering. As of 2022, an estimated 59% of adults aged 30 and over living with diabetes were not receiving the necessary medication—a treatment gap that is most acute in low- and middle-income countries. This suggests that for more than half the world’s diabetic population, the “balancing act” of management is not a choice, but an impossibility.

What is Coercive Control?

Coercive control is a strategic pattern of behavior used to erode a victim’s autonomy. It is a psychological imprisonment characterized by isolation, financial abuse, and the meticulous monitoring of one’s daily life.

Signs of coercive control

• Put-downs
• Threats
• Isolation
• Monitoring your time
• Deprivation of basic needs
• Monitoring communication
• Taking control of your daily life
• Rules and regulations
• Financial abuse
• Criminal damage
• Assault or rape
• Obstruction of employment

Potential complications

Some of the long-term impacts like chronic anxiety, major depressive disorder, post-traumatic stress disorder (PTSD), loss of support networks.

The Causal Role of Coercive Control in Type 2 Diabetes for Survivors of IPV

The link between trauma and Type 2 diabetes is no longer speculative; it is physiological. Survivors of IPV often exhibit symptoms of Post-Traumatic Stress Disorder (PTSD), a condition that triggers a chronic inflammatory response and neuroendocrine dysfunction.

Research indicates that women with high levels of PTSD symptoms are nearly twice as likely to develop Type 2 diabetes as those without trauma exposure. Furthermore, severe psychological abuse—measured by the Women’s Experiences with Battering (WEB) score—is associated with an 80% increased risk of developing the condition. This association is similar in magnitude to the risk posed by severe childhood physical or sexual abuse. 

The Physiological Link Between Trauma and Type 2 Diabetes

The relationship between psychological trauma and metabolic disease is one of the most significant and underappreciated findings in contemporary health research. It is also one that has particular relevance for survivors of coercive control, whose experience of chronic, sustained psychological abuse creates precisely the physiological conditions in which Type 2 diabetes develops and escalates.

The HPA Axis and Chronic Stress

When a person is exposed to threat — whether physical or psychological — the hypothalamic-pituitary-adrenal (HPA) axis activates, triggering the release of stress hormones including cortisol and adrenaline.⁵ In short-term threat situations, this response is adaptive: it mobilises energy, sharpens attention, and prepares the body for action. In conditions of chronic stress — which is precisely what coercive control creates — the HPA axis remains in a state of sustained activation, flooding the body with cortisol over extended periods.⁶

Chronically elevated cortisol has a direct and well-documented effect on glucose metabolism. Cortisol raises blood sugar by stimulating the liver to produce glucose and by reducing the sensitivity of cells to insulin — the hormone responsible for allowing glucose to enter cells and be converted to energy. Over time, this insulin resistance is one of the primary pathways through which chronic psychological stress contributes to the development of Type 2 diabetes.⁷

PTSD as a Metabolic Risk Factor

Research has consistently identified PTSD — which occurs at disproportionately high rates among survivors of intimate partner violence and coercive control — as an independent risk factor for Type 2 diabetes, even after controlling for lifestyle factors such as diet, physical activity, and alcohol use.⁸ Women with high levels of PTSD symptoms are nearly twice as likely to develop Type 2 diabetes as those without trauma exposure.⁹

The mechanisms through which PTSD elevates metabolic risk are multiple. The chronic hyperarousal characteristic of PTSD maintains the HPA axis in a state of activation, sustaining cortisol elevation. The sleep disruption that accompanies PTSD impairs glucose regulation independently — a single night of poor sleep is sufficient to measurably reduce insulin sensitivity in healthy adults.¹⁰ The social isolation that frequently accompanies both PTSD and coercive control removes access to the social support that is itself protective against metabolic disease.¹¹

Psychological Abuse and Insulin Resistance

Beyond PTSD, the severity of psychological abuse specifically — measured by validated tools such as the Women’s Experiences with Battering (WEB) scale — is associated with an 80% increased risk of developing Type 2 diabetes.¹² This association is comparable in magnitude to the metabolic risk posed by severe childhood physical or sexual abuse, which is itself one of the strongest known environmental risk factors for Type 2 diabetes in adulthood.¹³

What this body of evidence establishes, collectively, is that coercive control is not merely a social problem with health consequences — it is a direct cause of metabolic disease, operating through well-understood physiological pathways. For healthcare practitioners, this demands a clinical response: screening for coercive control should be considered a routine component of diabetes assessment, particularly in women presenting with difficult-to-manage blood glucose levels or unexplained treatment non-adherence.¹⁴

How Coercive Control Is Used to Sabotage Diabetes Management

For a person living with diabetes, effective self-management requires a level of agency, predictability, and access to resources that coercive control is specifically designed to destroy. The overlap is not accidental. In the hands of a controlling partner, a diabetes diagnosis becomes both a vulnerability to exploit and a mechanism of punishment.

Medical sabotage — the deliberate disruption of a victim’s healthcare — is a recognized form of coercive control, and diabetes management offers perpetrators an unusually broad range of opportunities to cause harm.^{15 16}

Withholding medication and equipment

Insulin, blood glucose monitors, testing strips, and continuous glucose monitoring (CGM) devices are all items that can be hidden, destroyed, or simply withheld. A perpetrator who controls household finances and purchases may simply decline to refill prescriptions. One who controls physical space may lock medication away. The result — dangerous or life-threatening blood glucose levels — can be framed as the victim’s failure to manage their condition, reinforcing the abuser’s narrative while causing measurable physiological harm.

Dietary sabotage

Diabetes management depends critically on diet. A controlling partner who determines what is purchased, cooked, and eaten has direct access to blood glucose regulation. This can take the form of forcing the consumption of high-sugar foods, withholding meals to induce hypoglycaemia, providing inadequate nutrition, or denying access to the specialised dietary products — low-glycaemic foods, sugar-free alternatives — that form part of a management plan. Each of these acts of dietary sabotage can be individually deniable while collectively causing serious harm.

Sleep deprivation

Sleep is not a passive component of diabetes management — it is an active one. Sleep deprivation reduces insulin sensitivity, elevates cortisol, disrupts appetite-regulating hormones, and impairs the capacity to monitor symptoms and respond appropriately.¹⁵ A controlling partner who deliberately disrupts sleep — through arguments, demands, noise, or physical interference — is not only causing psychological harm. They are causing metabolic harm. This is rarely recognised as medical sabotage, but it functions as such.

Financial control and healthcare access

Healthcare for diabetes — medications, monitoring equipment, specialist appointments, dietary products — carries real financial cost. A perpetrator who controls household finances can restrict access to all of these simultaneously without ever laying hands on a medication bottle. Financial abuse and medical sabotage, in this context, are the same act expressed through different means.¹⁷

Obstruction of medical appointments

Healthcare appointments are a point of potential disclosure — an opportunity for a survivor to speak privately with a clinician who might identify signs of abuse or ask the right questions. Perpetrators frequently obstruct these appointments: by creating conflicts that make attendance impossible, by accompanying the victim to appointments and remaining present throughout, or by monitoring communications with healthcare providers. The result is both the denial of medical care and the severing of a potential lifeline.

Post-separation sabotage

Medical sabotage does not necessarily end when a relationship does. In post-separation contexts, a former partner may attempt to interfere with healthcare by withholding financial support needed for medications, making false reports to healthcare providers, or continuing to interfere with the survivor’s access to medication or equipment through shared living arrangements or custody arrangements involving children.

Gestational Diabetes and Coercive Control

Gestational diabetes — a form of diabetes that develops during pregnancy and typically resolves after birth — presents a particular set of risks for women experiencing coercive control, and it remains almost entirely unaddressed in both the domestic abuse and obstetric literature.

Pregnancy itself is a known period of heightened risk within coercive control relationships. Research consistently shows that abuse frequently begins or escalates during pregnancy, with controlling partners using the vulnerability of pregnancy as leverage for increased control.¹⁸ For women who develop gestational diabetes during this period, the risks compound in ways that can be life-threatening.

Gestational diabetes requires careful monitoring, dietary management, and in some cases medication — all of which depend on a level of autonomy and resource access that a controlling partner may actively deny. Blood glucose levels that are inadequately managed during pregnancy carry serious risks for both mother and baby: macrosomia (abnormal fetal growth), premature birth, pre-eclampsia, and an elevated risk of the baby developing Type 2 diabetes in later life.¹⁹

Beyond the immediate management risks, women who develop gestational diabetes face a significantly elevated lifetime risk of developing Type 2 diabetes — a risk that chronic stress, PTSD, and the physiological effects of sustained coercive control are likely to compound further.²⁰

For midwives, obstetricians, and healthcare practitioners working with pregnant women, the co-occurrence of gestational diabetes and indicators of intimate partner violence should prompt careful, trauma-informed assessment. Asking about safety, providing private consultation time, and connecting women with specialist support are not only best practice — in this context, they may be lifesaving.

Recognizing the Signs — For Survivors and Healthcare Practitioners

One of the defining features of the diabetes-coercive control intersection is how invisible it can be — to the survivor, to clinicians, and to the broader support systems around them. Understanding what to look for is essential for both identification and intervention.

Signs that diabetes management may be being sabotaged

For survivors, recognising that a partner’s behaviour constitutes medical sabotage can be as difficult as recognising any other form of coercive control — particularly when individual acts are deniable and the pattern is gradual. The following may indicate that diabetes management is being deliberately disrupted:

Medication or equipment consistently going missing, being unavailable, or being withheld without explanation. A partner who controls access to food and consistently provides meals that are inappropriate for blood glucose management. Being prevented from attending medical appointments, or having a partner who insists on being present throughout. Blood glucose levels that are consistently difficult to manage despite apparent adherence to a treatment plan. Fear or anxiety about discussing health management needs with a partner. Financial restriction that specifically limits access to medication, equipment, or specialist food.

For healthcare practitioners — what to look for

Clinicians treating patients with Type 2 diabetes who present with unexplained treatment non-adherence, persistently difficult-to-manage blood glucose, or frequent emergency presentations are in a position to ask questions that might otherwise never be asked. Trauma-informed enquiry — delivered privately, without judgment, and with clear information about available support — can open doors for survivors who have had no other opportunity to disclose what is happening at home.

The HITS screening tool (Hurt, Insult, Threaten, Scream) and the Women’s Abuse Screening Tool (WAST) are validated instruments for identifying intimate partner violence in clinical settings that can be used appropriately and sensitively as part of routine diabetes care.²¹

A survivor who is struggling to manage their diabetes in the context of coercive control does not have a self-management problem. They have a safety problem. The clinical response must reflect that understanding.

If You Are Living with Diabetes and Coercive Control

I developed the Coercive Trauma Recovery Method™ from seven years of direct professional work with survivors of coercive control and narcissistic abuse. The method is built on the recognition that coercive trauma is a specific category of injury — distinct in its neurological signature, its dismantling of identity, and what genuine recovery from it requires — and that survivors need a framework designed for that specific injury, not a generic approach adapted from it. I also offer expert coaching on how to prove coercive control in court. Book a free 15 minute consultation to learn more.

How to Support Someone with Diabetes Who Is Experiencing Coercive Control

If you are a friend, family member, colleague, or healthcare practitioner who suspects someone is experiencing both diabetes-related medical sabotage and coercive control, your response can make a material difference — and how you respond matters as much as whether you respond.

• Do not focus solely on the diabetes. If you notice that a person’s blood glucose management seems chaotic or that they are frequently in medical crisis, resist the instinct to focus the conversation exclusively on diet, adherence, or self-management. Ask, gently and privately, how things are at home. Whether they feel supported. Whether they have access to everything they need.

• Believe what you are told. Survivors of coercive control frequently minimize their experience, particularly when it involves a partner. If someone discloses that a partner is interfering with their medication or diet, take it seriously. Medical sabotage is abuse.

• Offer specific, practical support. You could offer to collect prescriptions, to store medication safely, to accompany someone to a medical appointment, or to help them access emergency food that is appropriate for their glucose management needs. Concrete offers are easier to accept than vague ones.

• Know where to direct them. Diabetes UK has resources for people whose health is being affected by their home environment. The National Domestic Violence Hotline and Refuge (UK) both have advisors who can support survivors with complex medical needs. If someone is in immediate danger, contact emergency services.

Rebuilding Metabolic Health After Coercive Control

For many survivors of coercive control, leaving an abusive relationship is not the end of the health journey — it is the beginning of a new and often equally challenging one. The physiological effects of chronic psychological trauma do not resolve automatically with safety. Cortisol dysregulation, insulin resistance, disrupted sleep, and the metabolic consequences of sustained stress can persist for months or years after the abuse has ended, requiring active and informed recovery work.

• The nervous system needs time to recalibrate. The HPA axis — the stress-response system that sustained elevated cortisol throughout the abusive relationship — does not switch off immediately when the threat is removed. Many survivors find that their stress responses remain heightened, their sleep remains disrupted, and their blood glucose remains difficult to manage even after reaching safety. This is not a failure of recovery — it is a physiological reality that requires patience and appropriate support.

• Trauma-informed care is essential. Standard diabetes care that does not account for the role of trauma in metabolic dysregulation will be less effective for survivors. Seeking healthcare practitioners who understand the relationship between psychological trauma and physical health — and who can provide care that addresses both simultaneously — is an important part of recovery.

• Sleep recovery is a metabolic priority. Given the significant impact of sleep deprivation on insulin sensitivity and glucose regulation, prioritising sleep as part of recovery is not merely a wellness recommendation — it is a medical one. Trauma-informed therapy approaches such as EMDR and somatic therapies can help address the hyperarousal and nightmares that frequently disrupt sleep in trauma survivors.

• Rebuilding financial stability enables healthcare access. For survivors whose diabetes management was disrupted by financial control, economic recovery and healthcare recovery are inseparable. Accessing benefits, securing independent income, and rebuilding financial stability directly enables the medication, equipment, and dietary resources that diabetes management requires.

• Recovery is possible — and it is physical as well as psychological. The brain and body that adapted to the conditions of coercive control can adapt again, in the direction of health and safety, with time and the right support. Many survivors find that as their nervous system begins to calm — through therapy, through stable and safe relationships, through consistent routine — their blood glucose management improves alongside their psychological recovery. The two are not separate processes. They are the same process, expressed in different registers.

Summary

The intersection of diabetes and coercive control represents one of the most serious and most overlooked health crises in the field of intimate partner violence. The evidence is clear: coercive control causes Type 2 diabetes through well-understood physiological pathways — chronic cortisol elevation, HPA axis dysregulation, PTSD-driven metabolic disruption, and sleep deprivation that independently impairs insulin sensitivity. Severe psychological abuse is associated with an 80% increased risk of developing Type 2 diabetes — a figure comparable to the metabolic risk posed by childhood physical or sexual abuse.²²

Once diabetes is present, coercive control becomes a mechanism for its active weaponization. Medical sabotage — the withholding of medication, dietary disruption, sleep deprivation, financial restriction of healthcare access, and obstruction of medical appointments — transforms a manageable chronic condition into a potentially life-threatening one. For survivors, the chaos of blood glucose management is not a self-management failure. It is the predictable consequence of abuse.

Diabetes management requires agency, predictability, and resource access. Coercive control can destroy all three. Until the global health community — the International Diabetes Federation, diabetes care teams, obstetric services, and primary care practitioners — recognizes domestic abuse as a primary determinant of metabolic health, the goals of well-being and effective diabetes management will remain out of reach for the millions of survivors living at this intersection.

The path forward requires coordinated action: routine screening for intimate partner violence in diabetes care settings, trauma-informed clinical approaches that understand treatment non-adherence as a potential safety signal, financial recovery support that enables healthcare access, and the kind of sustained, expert recovery coaching that addresses the physiological and psychological dimensions of healing simultaneously.

Related Links

• The Complete Guide to Narcissistic Abuse Recovery
• The Neuroscience of Narcissistic Abuse–and How to Heal
• Coercive Control & Femicide Research
• The Global Coercive Control Legislation Index
• The Global Femicide Legislation Index

How Narcissistic Abuse Rehab Can Help

Are you or a loved one is ready to break free from a toxic relationship and reclaim your life, Narcissistic Abuse Rehab is here to kick start your recovery journey. We craft tailored solutions that support your unique path to healing, offering high-impact one-on-one coaching sessions every week. Our world-class coaching services employ effective, evidence-based strategies to help you rebuild your inner strength, reconnect with your purpose, and achieve your recovery goals. Experience online support that empowers you to overcome past wounds and embrace a fulfilling future. Book a FREE 15-Minute consultation today.

How to Cite This Page

Wakefield, Manya. (2025). Diabetes and Coercive Control: Causes, Risks, and Health Impacts. Narcissistic Abuse Rehab. Retrieved from https://www.narcissisticabuserehab.com/diabetes-and-coercive-control-causes-risks-and-health-impacts on [Date].

Media Mentions

• This article has been cited as a source in Ground News.

References

1. World Diabetes Day. (2025) Know More and Do More for Diabetes at Work. International Diabetes Federation. ↩︎
2. Mason SM, Wright RJ, Hibert EN, Spiegelman D, Jun HJ, Hu FB, Rich-Edwards JW. Intimate partner violence and incidence of type 2 diabetes in women. Diabetes Care. 2013 May;36(5):1159-65. doi: 10.2337/dc12-1082. Epub 2012 Dec 17. PMID: 23248189; PMCID: PMC3631851. ↩︎
3. Wakefield, M. (2023). PTSD and Depression Comorbidity Raise Risk of Female Mortality. Narcissistic Abuse Rehab. Accessed November 17, 2025. ↩︎
4. World Health Organization.(N/A). “Diabetes.” Fact Sheet. WHO. Accessed November 18, 2025. ↩︎
5. Tsigos, C., & Chrousos, G. P. (2002). Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. Journal of Psychosomatic Research, 53(4), 865–871. ↩︎
6. Mason et al., 2013. ↩︎
7. Tsigos, C., & Chrousos, 2002. ↩︎
8. Heppner, P. S., et al. (2009). The association of posttraumatic stress disorder and metabolic syndrome. Psychosomatic Medicine, 71(9), 1020–1028. ↩︎
9. Mason et al., 2013. ↩︎
10. Spiegel, K., Tasali, E., Penev, P., & Van Cauter, E. (2004). Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Annals of Internal Medicine, 141(11), 846–850. ↩︎
11. Berkman, L. F., & Glass, T. (2000). Social integration, social networks, social support, and health. In L. F. Berkman & I. Kawachi (Eds.), Social Epidemiology. Oxford University Press. ↩︎
12. Mason et al., 2013. ↩︎
13. Danese, A., & Tan, M. (2014). Childhood maltreatment and obesity: systematic review and meta-analysis. Molecular Psychiatry, 19(5), 544–554. ↩︎
14. Wakefield, M. (2023). PTSD And Depression Comorbidity Raise Risk Of Female Mortality. Narcissistic Abuse Rehab. ↩︎
15. Sharps, P. W., et al. (2001). The role of alcohol use in intimate partner femicide. American Journal of Addictions, 10(2), 122–135. ↩︎
16. Sharps, P. W., et al., 2001. ↩︎
17. Postmus, J. L., et al. (2020). Economic abuse as an invisible form of domestic violence. Trauma, Violence & Abuse, 21(2), 261–283. ↩︎
18. Taillieu, T. L., & Brownridge, D. A. (2010). Violence against pregnant women. Aggression and Violent Behavior, 15(3), 234–246. ↩︎
19. American Diabetes Association. (2023). Standards of Medical Care in Diabetes. Diabetes Care, 46(Suppl. 1). ↩︎
20. Bellamy, L., et al. (2009). Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. The Lancet, 373(9677), 1773–1779. ↩︎
21. Sherin, K. M., et al. (1998). HITS: A short domestic violence screening tool for use in a family practice setting. Family Medicine, 30(7), 508–512. ↩︎
22. Mason et al., 2013; Danese & Tan, 2014. ↩︎

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Manya Wakefield

Website |  + postsBio ⮌

Manya Wakefield is a narcissistic abuse recovery coach, coercive trauma specialist, and the developer of the Coercive Trauma Recovery Method™ and TENEL™ (Traumatic Exposure to Narcissism in Early Life) — proprietary recovery frameworks built from seven years of direct professional work with survivors of coercive control, narcissistic abuse, and Adult Children of Narcissists. Both frameworks have been reviewed by Dr. Michael Kinsey, PhD, clinical psychologist, New School for Social Research. She is the founder of Narcissistic Abuse Rehab, a global social impact platform launched in 2019 to support survivors through evidence-based recovery frameworks. Manya is the author of Are You In An Emotionally Abusive Relationship (2019), a resource used in domestic violence recovery groups worldwide. Her original research contributions include the Global Coercive Control Legislation Index (2020) — the first systematic index of its kind on the web — and the Global Femicide Legislation Index (2026), comprehensive legal references used by advocates, legal professionals, and policymakers internationally, cited in peer-reviewed publications including the Southern Illinois University Law Journal, Palgrave Macmillan, and the University of Agder. Her expertise has been featured in Newsweek, Elle, Cosmopolitan, HuffPost, Parade, and YourTango. She hosts the Narcissistic Abuse Rehab Podcast, available on Apple Podcasts, Spotify, and Amazon Music. All content on this site reflects Manya's direct professional experience working with survivors of narcissistic abuse and coercive control, her published research, and her ongoing advocacy work.

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