The Ups & Downs of Diabetes
Diabetes doubles your risk of depression—but there's help and hope for those who struggle.
You can't sleep. You have no energy. You can't concentrate. You feel lousy. Yes, it could be your blood sugar. But it could also be depression. Having diabetes doubles your risk of depression. And there's more: Depression not only can make your diabetes worse but also can significantly increase your risk of diabetes-related complications, such as heart disease and kidney disease. Yet, research indicates that fewer than 25% of these patients receive treatment for their depression.
Blood Sugar Blues
Just what is it about depression and diabetes? Many factors are probably at work, says Patrick J. Lustman, PhD, a professor of psychiatry at Washington University School of Medicine in St. Louis.
Factors include:
- The overwhelming nature of diabetes. Checking blood sugar can fill anyone with anxiety. You may also feel out of touch with friends and family who don't seem to understand what you're going through. Thoughts of diabetes complications—such as heart and kidney conditions—can make you feel out of control or afraid. You may also feel hopeless if, despite your best efforts, your blood sugar remains elevated and you need additional medication, says Donna M. Rice, RN, a certified diabetes educator and president of the American Association of Diabetes Educators.
- The effect of diabetes on the brain. Very high or very low blood sugar affects your brain chemistry in ways that can make you more susceptible to depression, says Lustman.
- The effect of depression on sugar metabolism. Depression increases stress hormones, which can, in turn, increase blood sugar levels, says Lustman.
- Lifestyle. The same habits that can contribute to or worsen diabetes—smoking, obesity, poor diet, lack of exercise, and excessive alcohol—can also contribute to and worsen depression.
Did You Know?
Women—with or without diabetes—are twice as likely as men to suffer from depression.
Feel Better Now
It's easy to get overwhelmed with diabetes and everything you have to do to keep it under control. Try these tips to calm your mind:
- Don't blame yourself. Type 2 diabetes is a progressive disease. Over time, your body's ability to make insulin declines. Even if you do everything perfectly, you may need more and different medication to control your blood sugar, says Rice.
- Focus on what you can do. Many people feel anxious before testing their blood sugar and frustrated afterward, says William Polonsky, PhD, a certified diabetes educator and president of the Behavioral Diabetes Institute in San Diego. Polonsky tells his patients to put a piece of masking tape on their glucose meters. On the tape, write, "It's just a number." Your blood sugar reading is an important number, but it is not a reflection of who you are as a person, he says. If it's too high or too low, ask, "What can I do about this?" Don't blame yourself.
- Talk with your doctor. An unexpected change in your mood may mean that your blood sugar isn't where it should be. In fact, chronic high blood sugar can make you feel irritable or tired. You may need a medication change or an adjustment in your routine.
- Meet with a diabetes educator. Concerns about diabetes can lead to anxiety and sadness. For example, you may worry too much that you'll lose a limb to diabetes because you had a friend who lost a limb. A diabetes educator can help ease those fears or put them in perspective, helping you to focus on ways to prevent complications.
- Confront the diabetes police. Family and friends mean well when they say, "I don't think you should be eating that." But these comments can add to your frustration. Explain your feelings and help them find ways to support you.
Beyond the Blues
It's important to know that there are well-studied treatments for depression—including therapy and medication—that work just as well in people with diabetes as in those without.
You may have heard about lifestyle changes—such as exercise—that help lift mood. These changes are important and often effective. But there's one problem. The fatigue and poor concentration that can accompany depression in a person already struggling with diabetes can stand in the way of his or her making these changes, says Phillips Kay Champion, MD, chief medical officer of Diabetes Centers of America in Houston. When you're feeling too tired to get out of bed, you're definitely too tired to exercise. For this reason, you may first need antidepressant medication, psychotherapy, or both, says Lustman. Once you feel better, it will be easier to make lifestyle changes.
Be sure to see a mental health professional who regularly treats patients with diabetes and make sure he or she communicates with your primary diabetes doctor about your treatment. And don't stop taking the antidepressant medication just because you feel better—work with your doctor to determine the proper length of treatment. Sticking with treatment is especially important for people with diabetes. Lustman's research shows that many people with diabetes tend to relapse about once a year, a rate higher than that of the general population with depression.
Enjoy Life Again
Once you feel better, optimize blood sugar control by consistently taking your medication and visiting your doctor for routine checkups. And try to take small steps toward improving your diet and exercising.
Another important step: Get support. Studies show that social isolation can make depression worse. If you're lonely, take out a piece of paper and write the names of family, friends, coworkers, and spiritual counselors who can support you physically or emotionally. Keep this list handy. If depression sets in again, reach out to someone on the list. If the situation doesn't improve, reach out to your doctor right away to get the help you need.
Could You Be Depressed?
If you answer yes to 3 or more questions below, see a health care professional immediately to be evaluated for depression.
- Have you lost interest in activities that you once enjoyed?
- Do you have trouble falling asleep, wake up frequently during the night, or wish you could sleep during the day?
- Do you wake up earlier than you wish to but have trouble going back to sleep?
- Has your appetite changed? Are you eating more or eating less?
- Do you have trouble following TV programs, conversations, or things you're reading because you can't concentrate?
- Do you feel tired and listless much of the time?
- Do you often feel so anxious or nervous that you can't relax?
- Do you often feel guilty or feel like you never do anything right?
- Do you feel worse in the morning than at other times during the day?
- Do you have suicidal thoughts?
Source: American Diabetes Association
YOUR DAILY COACH
Put something on the calendar. Sign up for activities to get you out and about regularly. This is especially important if you're retired and don't have the routine of work. It doesn't matter whether it's bingo, ballroom dancing, or a support group. As long as you look forward to it, it helps create a structure to your day that can help prevent depression.
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