Diabetes Self-Management Blog

Last week, I wrote about the relationship between depression and diabetes, and the post received some great replies. This topic is definitely worth two more blog entries, so here goes:

Why Should We Care About Depression?
Depression is more crippling than illness or disability. When you have a physical disability, you can look forward to the game coming on or a friend visiting. When you’re seriously depressed, you can’t look forward to anything. In reply to last week’s blog entry, ewhitt wrote: “It makes me want to be comatose…not go out…not see anyone….just sleep and withdraw….and that is just so not like me before. I have always been large but that hasn’t stopped me from enjoying my life. However, depression has and the thing is the inactivity feeds the diabetes….catch 22…”

The combination of diabetes and depression can be deadly. “When you add diabetes and depression,” says Patrick Lustman, Ph.D., professor of psychiatry at Washington University School of Medicine in St. Louis, “…each becomes more difficult to control, increasing the risks of…complications.”

Why? Well, there are effects on behavior. Depressed people tend to eat more and exercise less, which results in weight gain and sabotages efforts at controlling blood glucose levels. But an even stronger connection is stress. Depression is stressful, and stress increases blood glucose and insulin resistance. A study published in the journal Psychosomatic Medicine found that depression in diabetes correlated with high blood glucose and poor self-care, but that poor self-care played a very small role. The researchers felt the main cause was probably a mind/body effect, such as stress.

Treating Depression
But if depression can trigger diabetes or make it much worse, it stands to reason that effectively managing one’s depression can help bring one’s diabetes under control. Dr. Lustman and his colleagues have tested that theory in a number of studies. They have found that treating depression improved blood glucose control. It didn’t matter if they used the tricyclic antidepressant nortryptaline (brand name Pamelor), a selective serotonin reuptake inhibitor (SSRI) like paroxetine (Paxil), or cognitive/behavioral therapy to treat the depression. People’s blood glucose levels improved in every case.

So medicine and therapy are definitely worth a try. But most depression can also be helped with self-care. The holistic treatments include sunshine, physical activity, social contact, and several others that I’ll talk about next week.

Great Reader Comments
The best part of this job is the feedback I get from you. Barbara asked “Is there any correlation with depression and Type 1 Diabetes?” Yes, there definitely is. A study published in the Journal of Psychosomatic Research found that depression is two to three times as common in youth with Type 1 diabetes as those without it. The chances of complications also increase with depression.

Thanks to pepdot and paperprincess for sharing their stories of taking control of their depression. Way to go!

Thanks also to Bluebird and Beth for their advice about dealing with my Internet addiction. It’s helping.

Please share your ideas about self-managing depression with a comment here.

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Comments
  1. I have been diagnosed with having depression. I am currently taking cymbalta. What do you know about this med. I am so sleepy all the time. I even switched from morning to evening in taking this med. I suppose it is just relaxing me so much that I could fall asleep anywhere or anytime. Any commments will be appreciated.

    Posted by Diane |
  2. I agree 100% Big Ds requires great skills in self-care, management & enpowerment. Both Ds run in my family. I had a major episode of depression in 1993 & was put on medication, but it really did not open my eyes to the implications until I was diagnosed T2 in 2006. My Qs are: What is the genetic connection between the two Ds? I know one aggravates the other, but at the genetic level what is going on? Now on cellular insulin resistance. Researchers from Northwestern found at least one of the causes of Alzheimers is the resistance of the brain cells to absorb blood glucose and they coined this “T3″ on account that it is another resistance in a different part of the body. Maybe T2 is the resistance of muscle cells that keeps blood glucose level high. We need to research more about the etiology of cell resistance, besides saying that the receptor sites on the brain cell or muscle cell membranes, drastically drop, hence medications are need to reduce this resistance.

    Posted by nkwong |
  3. I have been on drugs for depression for many years I am type 2 diabitic and have heart disease with 3 stints. Still yet it is hard for me not to get in that depressed rut. I find it easy to know what I should be doing butI find it harder to follow thru with these ideas. I have thought about a support group helping but I am haveing trouble finding support. But I shall not give up maybe I should start my own support. But yes this is a hard thing to deal with everyday. We just cant give up.

    Posted by mell |
  4. Daniel and Mell there is a lot of interest on Double D on the mbs of ADA and BDI too. I have seen quite a few questions and comments on this subject. Being an empath myself, I’d like to share what I have learned, not just the physiology part, but spiritual meaning of having such conditions, hoping to improve the outlooks of “sufferers”. If we regard Double D as a challenge and a lesson to learn in this life, we can gain insights and cope with these two “debilitating” diseases and their implications. But, the outcome and course do not have to be so grim, as described the physicians.

    Mell if you start an electronic support group, please let us know.

    Posted by nkwong |
  5. Diane, sleepiness is one of the known side effects of Cymbalta. I like your idea of taking it at night. If that doesn’t work, you have the choice of lowering the dose, taking another medicine like Provigil to counteract Cymbalta’s sleepiness, changing to a different antidepressant, or going with self-help remedies like those I will discuss in my next blog entry.

    NKWong, I don’t think the genetic connection between depression and diabetes is well understood yet. However, the life situation connection is often that stress, especially feelings of powerlessness, promote diabetes and depression.

    Mell, you rightly identified social support as a powerful treatment for diabetes. If there’s no diabetes support group near you, you can look at http://www.diabetesmonitor.com/b153.htm for advice on starting one. But that might be too much for you — see what’s available in your community or what your doctor might be willing to help with. I’ll write more about support groups soon. Don’t Give Up!
    David

    Posted by David Spero RN |
  6. I was diagnosed w/DII in 8/07. Sugar was 418,LDL cholesterol 356. In two months time, blood sugar AIC @ 6 and LDL direct at 75. They took me off statin (what pain in my body) and the 2.5 glipizide 2 x daily. I felt more safe when I was taking the glipizide. I must admit had a hard time losing weight with the glip but been off it for 4 weeks and dropped 14 pounds. I’m 5′8 x weight 150 lbs. Female. My stress over my blood sugar levels now is caotic. I am scared all of the time. My stress levels now are affecting my blood sugar levels. I guess they will never be as low as with the glipizizde but what do I do. Start taking anti depressants. I am not depressed, I am motivated but I guess out of control compulsively. Can someone please help me.

    CAE

    Posted by CAE |

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