Helpful Hints for the Season and Beyond
Managing diabetes can be tough in any season. As winter approaches, though, some people with diabetes find that staying on top of a management routine – and everything else – gets even harder. Do any of these scenarios sound familiar to you?
• Your physical and mental energy wanes. Your exercise regimen disintegrates. Procrastination takes hold, and you leave chores uncompleted. Meal planning and preparation feels overwhelming, leading you to cut corners. Despite sleeping longer hours, you wake up feeling unrefreshed; caffeine provides a pick-me-up but later backfires by causing insomnia, leaving you feeling even more tired the next day.
• Cravings for sweets, chocolates, and starches intensify, making it doubly difficult to maintain a healthy diet.
• Your thought processes turn sluggish; normally manageable mental tasks, such as counting carbohydrates, remembering appointments, or balancing your checkbook, feel challenging, even overwhelming.
• Generally pleasurable activities such as hobbies and sex no longer bring enjoyment.
• Your participation in social activities plummets, and you lose the camaraderie and encouragement of friends.
If these situations ring a bell, you’re not alone! One-third of Americans report experiencing a wintertime slump. Living farther from the equator – in New England or Canada, as opposed to Florida or Texas – increases the odds that you will contend with the winter blues. Furthermore, 6% of the US population experiences more prominent and troublesome symptoms that clinicians call seasonal affective disorder, or SAD. (“Affective” refers to mood, just one of the domains that SAD can impact.) While SAD sufferers should obtain professional guidance to treat it, those experiencing the winter blues can often feel better by employing some home remedies.
How the blues begins
While more people experience a low mood in the winter months than at other times of the year, it may be surprising to learn that the “winter blues” is not exclusively a wintertime phenomenon. Symptoms can, in fact, start as early as late summer and may not let up until late spring. (Summertime SAD, on the other hand, can be thought of as the opposite of the winter blues and is characterized by symptoms such as irritability, agitation, insomnia, and suppressed appetite. A person could have both winter and summer SAD, or the lesser “blues” version of each.)
While some people who get the winter blues may complain bitterly about the cold, and others might blame their doldrums on the demands of the holidays, rigorous scientific research has established that changes in light – the shorter days, reduced intensity of sunlight, and later dawns of winter – are the main cause of the winter blues. (That being said, you may also feel bothered by the cold weather and holiday season obligations.)
Many bodily processes rely at least in part on cues from visual light. Most obviously, daylight alerts us to awaken, and nighttime darkness readies us for sleep. Other bodily processes and functions – gastrointestinal, hormonal, etc. – wax and wane throughout the day, each according to its own “clock.” To function properly, each of these internal clocks must be coordinated with the others, and all of them must be coordinated with nature’s daily clock: daytime and nighttime. Inadequate or ill-timed light exposure disrupts these normal rhythms, negatively affecting mood, energy, appetite, and mental performance.
Anything that reduces or disrupts our exposure to sufficient and properly timed light and darkness can cause the “blues,” season notwithstanding. Jet lag and night shift work can wreak havoc on our body clocks. Weather patterns – a midsummer string of overcast days or a wintertime snowfall that reflects and intensifies sunlight – can induce a dreary or a cheerful mood. Some types of cataracts, diabetic retinopathy, and other eye diseases can interfere with the transmission of the light signal to the brain, which may cause a year-round winter blues—type phenomenon. (There’s some indication that in some cases cataract surgery may reverse the problem.)
Our modern lifestyle blurs the distinction between day and night, exposing us to the bright lights of TV and computer screens at night and, with long hours spent indoors, depriving us of exposure to bright outdoor light during the daytime. Many Americans, who tend to spend roughly 90% of their time indoors, may be suffering from an environmentally induced year-round form of the winter blues.
It is not known how many people with diabetes experience the winter blues, but depression – a broader category that encompasses SAD – is significantly more common among people with diabetes than in the general population. It’s not exactly clear why this is the case, and theories abound. Diabetic retinopathy may play a role by reducing the light signal sent to the brain. Both diabetes and depression may see their likelihood increased by a common factor like a sedentary lifestyle. Whatever the cause or combination of causes, people with diabetes have reason to take extra precautions to recognize, prevent, and fight the winter blues.
The good news is that there are effective methods to combat the winter blues and SAD – as well as other, nonseasonal forms of depression. Decades of scientific research have revealed practical steps that can help and that nearly any person can put to use.
Since people with diabetes may experience symptoms similar to those of depression when their blood glucose levels are out of target range or are fluctuating greatly, this is a good area to examine first. Pay attention to whether your low moods, cravings, or feelings of irritability are accompanied by out-of-range blood glucose levels, whether they resolve when blood glucose levels return to normal, and whether they last minutes or hours versus weeks or months. You may also want to talk to your doctor about whether another medical problem, such as thyroid disease, may be contributing to your mood difficulties.
It is also wise to look into whether your symptoms constitute SAD – which requires professional help–or just the winter blues, a milder condition that is likely to respond to self-help measures. A useful self-assessment tool can be found at www.cet.org. (Click here for more winter blues resources.) It is worth noting, however, that people with SAD or full-blown depression are also likely to benefit from self-help recommendations when used in combination with professional treatment.
Let the sun shine
For some people, chasing away the winter blues is as simple as spending more time outdoors. Getting light early in the morning generally provides the best results, but exposure to natural sunlight at any time of day – even on a cloudy, rainy, or snowy day – is likely to provide some benefit. You need not, and should not, look directly at the sun. Consult your doctor before spending more time outdoors if you take a drug or have a medical condition that causes heightened photosensitivity. It helps to emphasize the difference between night and day by dimming room lights and avoiding TV and computer screens before bedtime and by sleeping in a darkened room.
If exposure to natural daylight doesn’t provide enough relief, there are two illumination devices you might want to consider. The first is a light box, a specially constructed desktop device that uses a bank of fluorescent lights to deliver a calibrated amount of light at the correct height, angle, distance, and intensity to provide the maximum benefit. Properly administered, bright light therapy from a light box is a powerful intervention that can alleviate both seasonal and nonseasonal depression, potentially providing as much benefit as antidepressant medicines but usually with fewer and less troublesome side effects.
Although light boxes can be purchased without a doctor’s prescription, it’s best to obtain professional guidance when starting bright light therapy, because it can be harmful to people with certain psychiatric conditions and some eye diseases, including diabetic retinopathy. In addition, if used incorrectly, bright light treatment can make things worse by causing insomnia, agitation, or other problems. If a light box is deemed inappropriate, another lighting device – the dawn simulator – may be a promising alternative. As the name suggests, this device provides light that gradually brightens to simulate the rising of the sun; it is normally used when waking up. For more information on both devices, visit www.cet.org.
Winter blues expert and psychiatrist Dr. Norman Rosenthal observes that SAD sufferers tend to produce a surplus of insulin during the winter months; this excessive insulin production “appears to subside” with bright light therapy and with the advent of summer. You should therefore closely monitor your blood glucose levels and insulin doses when either starting or stopping bright light therapy. Be sure to tell your primary-care doctor or endocrinologist about your bright-light therapy, even if it is being supervised by another care provider such as a professional counselor.
Just as extra light can help people with winter blues, restricting light exposure – by spending more time indoors and using special blue-blocking glasses – may benefit those with summer SAD. (See www.cet.org for information on blue-blocking glasses.) In addition, the information in the following sections can help improve your mood regardless of the season.
You probably already know that exercise benefits people with diabetes by improving the body’s sensitivity to insulin, whether it is produced by the pancreas or injected. But physical activity can also help chase away the winter blues. Numerous studies confirm what runners have long maintained: that vigorous exercise makes you feel better. Even if you never work out long or hard enough to get that “runner’s high,” modest physical activity is likely to leave you feeling more energetic and content. Good exercise choices may include fast walking or jogging, bicycling, aerobics, or vigorous yoga. For some people, making exercise a social activity by doing it with a partner or attending a class may lead to an even greater mood-lifting benefit.
Researchers have found that exercise is as effective as medication in relieving depression. Exercise triggers the release of the energizing hormones norepinephrine and epinephrine (also called adrenaline) and the mood-enhancing chemicals serotonin and endorphins. Regular exercise also improves blood circulation and stimulates the growth of nerve cells in brain regions responsible for mood regulation.
It’s best to start exercising before you’ve fallen into a wintertime slump. If you’re currently physically inactive, see a doctor first to see if there are any precautions you may need to take to exercise safely. Check your blood glucose before, during (at least at first), and after exercise, and make any necessary adjustments to exercises to accommodate your fitness level – for example, simplify aerobics moves or alternate jogging and walking as needed. Consult your doctor if you have any concerns about starting or intensifying your exercise regimen.
Eat, drink, and be merry
Maintaining a healthy diet is likely to benefit your mood. Science has begun to identify some of the specific dietary nutrients that play a role in maintaining good mental health, including omega-3 fatty acids, B vitamins, vitamin D, calcium, and iron. Leafy green vegetables, citrus fruits, and beans are good sources of vitamin B9, also known as folate. Cold-water fish such as salmon, sardines, and anchovies are high in omega-3 fatty acids. Calcium can be found in a variety of dairy and fortified products, as well as in canned fish (with bones) and some leafy green vegetables. Good sources of iron include a variety of fortified products, including many breakfast cereals, as well as chicken liver, oysters, beef, spinach, and several varieties of beans.
Following an overly restrictive meal plan or having a condition that interferes with nutrient absorption can lead to nutrient deficiencies, and some oral diabetes drugs may make the problem worse. Diminished wintertime sun exposure can reduce the skin’s production of vitamin D. However, if you’re considering taking vitamins or other nutritional supplements, it’s important to consult your health-care team beforehand because, in certain cases, supplements can be harmful. A blood test may be necessary to evaluate whether you need or would benefit from a particular vitamin or other supplement.
Some experts recommend reducing your consumption of carbohydrate foods – or at least refined carbohydrates. Addressing a general (not diabetes-oriented) audience, SAD authority Dr. Norman Rosenthal has stated that “limiting carbohydrate-rich foods…can reduce [carbohydrate] cravings, and [help] contain your weight.” He explains that some “patients with SAD secrete more insulin in response to a glucose load than nonseasonal controls…light therapy reverses the tendency to oversecrete insulin in response to a glucose load, which may explain why light therapy reduces carbohydrate cravings.” He concludes: “If patients with SAD have exaggerated insulin responses to carbohydrate-rich meals…this could trigger cravings for more carbohydrates and on and on.” If you feel you may benefit from a lower carbohydrate intake, work with your health-care team to devise a diet that works for you.
Inadequate sleep is powerfully destructive; it can sabotage your mood and ability to function. Chronically poor sleep often causes depression.
You may be surprised to learn that adults need an average of eight and a half hours of sleep every night. Compensating for sleeping short on weekdays by sleeping in on weekends won’t ensure a good mood. Skeptical? Try getting eight and a half hours of sleep every night for two weeks. If you don’t feel better, go back to your old ways!
For some people, getting too much sleep can also lead to a poor mood. Although the winter blues may make you feel like sleeping longer than usual, yielding to this temptation can worsen the problem. If feeling groggy makes it hard for you to get up in the morning, try enhancing the natural dawn light in your bedroom by opening the shades or curtains to let in the morning sun – or consider using a dawn simulator.
Chronic sleep problems are very common, affecting about one in six American adults. As noted earlier, getting adequate daytime light exposure, dimming indoor lights before bedtime, and sleeping in a dark bedroom fosters deep, refreshing sleep. Getting more exposure to morning light may be helpful if you have difficulty falling asleep at night. Getting more afternoon or evening light may help if you tend to wake up at 3 AM or so and be unable to get back to sleep. Vigorous exercise – but not too close to bedtime – often helps relieve insomnia.
Winter-blues sufferers may feel tempted at times to take stimulants like caffeine and nicotine for focus and alertness – but when these stimulants interfere with sleep, they can aggravate the very problems they were intended to solve. Exercise offers many of the benefits of stimulants without the risk of disrupting sleep. Similarly, alcohol may provide some temporary relief from a low mood, but in the long run, it can undermine sound sleep and is a depressant that can worsen the winter blues.
It’s easier to make lifestyle changes in the summer or fall, before your energy and motivation have been undermined by the winter blues. But even if the blues have already taken hold, hard work and determination can turn them around – sometimes in just a few days.
If self-help remedies are difficult to implement, or they just don’t work for you, don’t lose hope! There are many other effective approaches that a professional counselor can advise you about.