Diabetes and depression is a topic I feel strongly about, but also one that is not easy to discuss. Many people with diabetes and relatives to those with diabetes do not want to acknowledge the psychological issues one can have when living with diabetes. These issues are not only related to the fact that diabetes is a chronic disease, that one has to inject insulin to survive, and that one has to modify diet, exercise, relationships etc etc.
In fact, John McManamy, author of “Living well with depression and bipolar disorder” says that a Kaiser Permanente study of some 1,680 subjects found that those with diabetes were more likely to have been treated for depression within six months before their diabetes diagnosis. About 84% of people with diabetes reported a higher rate of earlier depressive episodes. He goes on to say that a 2004 Johns Hopkins study tracking 11,615 initially non-diabetic adults aged 48–67 over six years found that ‘depressive symptoms predicted incident Type 2 diabetes. Women, in particular are at greater risk, according to other studies; and another study shows that this risk, among both men and women, persists even after controlling weight, caloric intake, smoking, and economic factors.
It has clearly been shown that depression is higher in people living with diabetes, and that this differs from other chronic disease. It is also clear that the depressive tendencies people struggle with are exacerbated by volatility in blood sugar, and can be reduced when control is improved. I recognize this, since I know that when I was “high” I felt tired, lethargic and often hopeless. This would lead to thoughts not moving fast enough, and frustration with my own capacity as a thinker. I would be sad about small things and be emotional about events that otherwise did not bother me. The worst part of depression triggered by blood sugar volatility is the feeling of loss of control and the vicious circle triggering poor management of diabetes which makes both the physical problems and the psychological issues worse!
My recommendation is as always to try to stay in control and when you do slip, ask for help! Being alone with your disease is the worst, and the concept of peer-to-peer mentoring helps, especially with more emotional issues than with medical and physical details. It is hard for a doctor or a nurse to understand the sense of hopelessness, fear of complications and the loss of control that we feel at times when living with diabetes. This is when a friend who also has the disease can help you tremendously by bringing you up in your mood, and down from the rollercoaster of sugar.
My other piece of advice is to reduce the simple carbs in your diet– it really helps you control the volatility. As you may have seen in children without diabetes, their mood is seriously affected by high sugar meals, and the subsequent crash is hard on parents and caretakers.
Lastly, exercise creates a natural surge in anti-depressive hormones such as serotonin and endorphins so adding exercise to your daily regimen will reduce the risk of depression.
I had a pancreas transplant in 2010, and since then my HbA1c has been normal with few glucose excursions. My mood and my energy levels have improved dramatically, but yet, when I eat a carb-loaded meal (rarely!) I do feel a high in the beginning, but then I dip and I lose my mojo. I feel lost and without control. I may have solved the sugar highs, but I am still vulnerable to lows in sugar and that is still my trigger for also feeling low in my mood.
Sugar is evil and I hope that in the future children will not be fed high-sugar meals and handed candy as rewards – it kills, mutilates and makes you sad!