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.
—S.
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.
