Q&A: Depression and Diabetes

Last week, the DiabetesSelfManagement.com editors received the following letter via e-mail and asked me if I could answer it on this blog. The letter touches on many issues related to mental health and diabetes, and I’ll address them in my next few blog entries.


Dear Diabetes Self-Management,

I’ve been wondering about how my mental illness may be affecting my Type 2 diabetes. Because of my low self-esteem, I have not been able to stop eating continuously, and I have no motivation to stop. I have so many things I wish to do that are very rewarding to me emotionally, but no drive to do them. My feelings have also been affecting my work with people with mental illness. If I don’t have motivation or encouragement, how can I give someone else what they, too, are lacking? My supervisor has even gone as far as to getting me to teach a group all about diabetes, just so I could help myself with my Type 2. But it has not worked.


Dear S.,

It really sounds like you are having quite a struggle with your mental health, your eating habits, and getting motivated to take care of your diabetes. Some health-care professionals act as though these are simple issues, and yet they are often the biggest issues that people who have diabetes deal with.

Mental health issues are often overlooked because we tend to focus on the body, glucose control, weight control, eating, and exercise. We know that mental attitude and mental health have an impact, but we often don’t know what to do about them. It is truly easier to manage the technical aspects of glucose monitoring and medication than to try to do something about the mental aspects of the disease. Life would be quite a simple matter if we could all just adopt a positive attitude and then get on with taking care of ourselves. But sometimes, depression or anxiety begin to interfere, and we may feel powerless to do anything about our diabetes. In fact, depression is twice as likely to affect people with diabetes as it is to affect people without diabetes. In many cases, depression may precede the onset of Type 2 diabetes.

Depression and diabetes interact in such a way that when one condition is not under control, it makes the symptoms of the other one worse. For example, if you have depression and your eating is excessive, then the symptoms of the depression may get worse. You may feel more tired, more emotional, less able to concentrate, hungrier, or angrier. You may have problems sleeping and may just not feel like doing very much. It is also true that if you have depression that is not being managed, you will have far less energy to deal with diabetes and probably very little motivation to manage your eating since for a while, at least, it feels good.

Because of this interaction, you need to control both your depression and your diabetes at the same time. This is very hard to do on your own, so I recommend partnering with a certified diabetes educator, an endocrinologist, a mental-health therapist, or a psychiatrist. All of these people will have their own unique approach, but at least you will have someone who can help you manage the mental and physical aspect of these two problems. For depression, antidepressants or psychotherapy can both be equally useful, and often, trying both is best. The diabetes is equally important to address. And the good news is this: While diabetes and depression can make each other worse, if they are managed, they can make each other better.

Part of the problem right now is that if you don’t have much energy, it will be hard to “get it together” to manage your depression and your diabetes. That is where the professional support comes in. The health-care professional can provide the helpful push to get you started and the nudge to help you keep going.

So to start, make an appointment with one of the health-care professionals I mentioned, and show up to talk about the struggles you identified in your e-mail. Next week, I will discuss emotional eating, the difficult pattern it establishes, and some ideas for how to deal with it.

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  • poliwog

    I’ve been struggling with this for a while, only understood the depression/diabetes link in the last two years. My biggest problem is trying to un-learn twenty years of bad habits (not testing, not counting carbs and guessing how much insulin to take, even skipping doses). Like -S. I mean well, start each day with every intention to stick to my plan. I have a mental-health therapist, a nurse educator and a supportive doctor.
    Short of a ‘babysitter’ do you have any other suggestions?

  • Ann

    We have assumed for a long time that people who eat compulsively do so because of emotional problems. This may be so for some people. However, in the last few years, we have learned a lot about hormones and peptides that contirbute to appetite regulation, such as leptin, amilyn, and exenatide. In particualr, since exenatide became available as Byetta, many people who thought they had emotional eating problems have had weight loss success.
    I think it’s possible that the stress of depression causes PHYSICAL appetite dysregulation in some — perhaps many — people. This seems especially likely in people who have already gotten help for depression,a nd are still unable to decrease their eating enough to lose weight.

  • richard

    i have diabetes and clinical depression also,but i dont eat too much. however, can depression affect your blood sugar?

  • Janet

    I am a type 2 diabetic who is being treated with avandia, Lantus insulin at night and Lispro before each meal. I Have been diagnoised with severe depression and am takg effexxor xt, but I feel that it is not helping any. I feel exacting as you have described: no energy, no want to do things, starting the day with good intentions but not following through, etc. Now I am eating chips and danishes like they are going out of style, consequently I am gaining weight instead of losing. Excersise, not happening . . .no energy for that.

  • Levita

    I know what you mean about depression… I fight it all the time…. I have good days.. But it is so hard… It is a never ending battle… You want to give up… But Diabeties is a way of life… And you just have to deal with all that goes with it… *sigh*


    In your article you suggested turning to your health care professional for advise during depression. I went to my health care professional as an emotional mess, asking for help.

    What I learned from him was that he doesn’t have time to deal with someone with ongoing problems. The next time I scheduled an appointment, I learned that he had cancelled me as a patient.

    Reality is that doctors have a very small window of time for each patient.
    Honestly, in 25 years as a diabetic, I have found no one who truly can help with my wide range of issues.

  • daveb

    I too am a Type 2 also with Depression and Hypertension, being treated with a whole cocktail of drugs. It doesn’t help that the side effects of some drugs is debilitating lethargy. I am trying to determine which are the worst causes and move them to bedtime. Maybe it will help me sleep. Yes I have seen a “semi-professional” mental health care provider but when you have no insurance and limited funds. Well what can I say, without insurance you are a pretty well lost soul in today’s system. Especially when you are in an income “gap” where you make too much to qualify for gov’t assistance but not enought to afford insurance.

  • Mary Ann

    Read S’s letter & the comments.I myself,have been in EVERY SITUATION DISCRIBED(some to the extreme)over past 37yrs.I am Bipolar Two,NOT MANIC.Mood swings,but tend to depressed end.Being Hypo-manic is to feel “normal” so I can function.All the issues described,are SERIOUS & I don’t want to OVER SIMPLIFY.But each one can only be addressed ONE STEP at a time.From my own experience,find a GOOD PSYCHIATRIST(you may have to see several to find THE ONE)who will,step by step,address the symptoms you are experiencing,at any given time,& work with medication(adding too or taking from)in order to find a combination that deals with those symptoms,UNTIL a combination is found,that’s helping you.ONLY THEN,will you be able to FUNCTION enough to tackle the diabetes,eating & weight issues.First thing in vist,talk to MD,no money,no insurance,etc.Samples carried me a lot of years.MD not helpful,find another!Sample meds are plentiful & help from drug companies is out there.No more room,(sigh).GOOD LUCK!!

  • tamigirlrocks

    I can relate to you, S. I have Hep C, type 2 diabetes, I am bi-polar, and I am on methadone for my recovery from a heroin addiction. It is so very difficult to treat and maintain all of these issues.
    As far as the depression, I spent almost one and one-half years in “bed” due to severe depression, diabetes and my interferon treatment for Hep C. My Value Options clinic site gave me a new doctor (psych) who put me on Lamictal. The drug was origionally intended for epilepsy patients, but was found useful to people with bi-polar disorders. For the first time since my heroin addiction did I feel alive! I still struggle to balance all of my conditions and my meds, but my support folks help in a big way.
    May God bless you and help you!

  • Toni

    Depression, insomnia, lack of interest: sex,hobbies, getting up,I was told that I had diabetes 10 months ago, did great lost 30lbs by dieting and walking( no diabetic meds)Lost all motivation, serotonin level was to low to be detected. I was told that my diabetes could have caused serotonin to be low. I have been super depressed and was put on lexapro 20mg. Now my endocrinologist says I have Hashimotos disease, butit is not related to my serotonin or diabetes or any of my symptoms. Can’t see psych until my thyroid is stable but they have been trying for over a year calling it just low thyroid. My Dr. doesn;t feel comfortable changing my antidepressant. I have had Crohns disease for over 12 yrs, so I am used to living with chronic disease but for some reason I feel like I am falling in a deep hole and can’t find energy or motivation to watch my diet or walk. I feel like a burden to my fiance and an embarrassement to him. He is really great but it is just my feeling and depression.

  • Margaret

    I have had Diabetes, Hypothyroidism and peri-menopause for 5 years, experiencing severe depression with littlest energy. I finally decided to change doctors, writing down a checklist of consistent repeating symptoms. (Speak up)! Also consider med dose or med change.I’m getting a new blood test, hopeful for a reason for my severe energy loss(adrenaline loss)with depression. Recently, I committed to better eating and med consistency. I start each day’s energy with stre-e-tching a little and be-e-nding a little then go walk 30min. to and back. Consistency results-better sleep, less depression, better people, life interest. I added coffee-which helps my depression adding extra alertness and energy. So the literature is true, a specific daily habit of aerobic heart/body movement can cause good body changes, and in some cases, a natural additive can help.
    So Help settle down, readjust those hurting hormones! (Body) changes are hard, but good results exemplify! . ūüôā

  • Tagalong

    I fully understand what S. is dealing with. I’m in the same position, maybe not quite so hurting. Your advice is very like that given when someone needs help to lose weight–weight loss programs focus on providing education on what to eat–but for many of us, it isn’t that we lack understanding of nutrition and weight loss programs or diabetes care. It is that we have some mental pain that demands relief now, and keeps us from doing what we know is right. The only real immediate relief that I have been able to get all by myself is eating foods that are not appropriate for a diabetic (sweet things or too much of anything). Walking helps, calling friends can help–but sometimes these are steps (no pun intended) that are hard to take. Anti-depressant medication helps, but for someone like me with chronic depression, it doesn’t take away all the pain. (Not to minimize the situation, but thank God for chocolate!)

  • maryann

    ive been on methadone for 15 yrs+ because i was a herion addict about 6 months ago i was diaonosied with diabetes type 2 and now ive been feeling sick as if im in a withdraw stage. my legs hurt me real bad and im so unconforable at night with anixaty in my legs. my question is does the diabetes interfere with my methadone medicine