Diabetes is a condition that affects 30.3 million people in the United States. But while most of diabetes research focuses on treating the physical aspects of the disease, some say there’s another component that needs to be addressed, too—the mental health toll of living with the illness.

A new study released this week by Diabetes UK found that three in five diabetes patients experience emotional or mental health issues that are directly linked to their diabetes diagnosis.

One 2012 study found that people with diabetes are more likely to develop depression than those without it. The new research backs this up, with 64% of respondents indicating that they often or sometimes felt down because of their diabetes. Not only that, depression can impact the ways in which people take care of their physical health. They may be more likely to skip medications or adhere to dietary regimens.

The reasons why these two conditions can often be linked is unknown, but according to the American Diabetes Association, the stress of managing diabetes on a daily basis can contribute to feelings of frustration and discouragement. People may also feel isolated if they feel like others can’t understand what it’s like to live with diabetes.

A diabetes diagnosis may also create or increase anxiety and compulsive eating. And binge eating and depression are closely linked; nearly half of people who have a history of binge eating have also struggled with a mood disorder at some point, according to the National Association of Anorexia Nervosa. But compulsive eating in diabetics comes with increased risk. Bingeing can raise blood sugar levels, and diabetes makes it harder for the body to normalize those levels.

And, according to Forbes, the required dietary restrictions needed to manage diabetes, as well as the need for some insulin-dependent diabetics to monitor their carbohydrate intake, can sometimes lead to disordered eating patterns.

Lis Warren, who was diagnosed with Type 1 diabetes in 1965 when she was 13 years old, told the Huffington Post UK that she developed an eating disorder following her diagnosis. “After many years of a disordered relationship with food, I even had seizures from low blood sugar when I routinely ate insufficient carbohydrate to lose weight,” she said. “I didn’t speak to anyone about how diabetes had affected me psychologically for 40 years. I could easily have died from regularly bingeing and dieting and I feel very lucky to be alive, and remain well, because I finally got support.”

One positive finding from the new Diabetes UK survey is that people are seeking treatment for their struggles—one in five reported seeking help from a trained professional to manage their feelings and their disease.