By Dr. Sanjay GuptaType 2 diabetes can exact a psychological toll on patients who have had to manage the condition for a long time as well as on the newly diagnosed.
Marcia Smith knows the emotional toll diabetes takes. When Smith’s doctor told her in 1999 that she was in the pre-diabetic stage, she started to cry. “It was a really shocking thing to hear,” said Smith, who was eventually diagnosed with type 2 diabetes.
“One of the things I realized is that you have to stay calm after your diagnosis,” said Smith, who is now a health ambassador for the American Diabetes Association. “You lose sight of a lot of things, and you’re not paying attention and not taking care of yourself. There’s a lot of self-pity that goes on.”
Newly diagnosed patients are often overwhelmed by the steps needed to manage their condition, from monitoring blood sugar and altering their diet and exercise routine to educating themselves on how the disease affects their bodies. For patients who have had to cope with diabetes and possible complications for some time, the disease is often accompanied by signs of depression.
People with diabetes are twice as likely to have depression, according to a study in the journal Diabetes Care. The relationship between the two conditions isn’t entirely understood, as Sherita Golden, MD, an endocrinologist at Johns Hopkins Diabetes Center, points out. There may be biological reasons for the onset of depression related to high glucose.
“The lifestyle modification that comes with type 2 diabetes has definite psychological effects,” said Xavier Jimenez, MD, a psychiatrist at the Cleveland Clinic. “Over time there are adjustment issues like depression, anger, and frustration with the new lifestyle they have to adapt to.”
Dr. Jimenez sees many type 2 diabetic patients handling their disease in one of two ways. Some feel so challenged by the behavioral modifications needed to manage diabetes that they resist change and the diagnosis altogether. Others become so preoccupied with the diagnosis and anxious about taking care of themselves that they tend to excessively monitor their blood sugar and food intake. “Either reaction catches up to you and can easily turn into depression,” said Jimenez.
So how can you tell if a friend or loved one with diabetes is depressed?
“If someone loses interest in activities they once enjoyed, if they have trouble sleeping or concentrating, have weight loss or weight gain, or are agitated more than usual, those are some of the biggest indicators of depression,” said Dr. Golden. Depressed patients are more likely to overeat, not exercise, and neglect monitoring their blood sugar – all of which can worsen their diabetes.
When Pablo Sierra was diagnosed with diabetes, he didn’t take the disease seriously at first. A self-admitted lover of sweets, he told himself that the diabetes wasn’t that bad once he was on medication and ignored the changes he needed to make to his diet and physical activity.
It wasn’t until he attended a diabetes seminar at a local hospital that Sierra realized he was taking the disease too lightly. “One of the presenters said diabetes is like looking at a clock. It looks like the hands are stuck in one place, but in reality it’s always moving,” said Sierra. “Just like diabetes is always there and affecting you.”
Sierra resolved to manage the disease better and not let it overwhelm him. “Don’t go into denial,” he said. “It’s the worst thing you can do. If you can just focus on the few big things like blood sugar, diet, and exercise, you can manage most of it.”
Patients who have had to deal with diabetes for long periods of time are at risk of becoming demoralized. Jimenez said this can happen with other chronic illnesses such as asthma and kidney disease requiring dialysis.
“Sometimes we term that demoralization instead of depression, when we see that drop in self-care,” said Jimenez. “It’s basically people saying they’re sick and tired of being sick and tired. It’s a little less severe than depression, but should still be addressed.”
A patient’s primary care doctor, endocrinologist, or diabetes educator can help them develop a treatment plan that fits their lifestyle. The support of family and friends can also be invaluable. “Some people…don’t have the support network, which is essential for good control of diabetes,” said Jason Baker, MD, an endocrinologist at Weill Cornell Medical College and a diabetic himself.
The support of others can be “one of the main recipes for success in taking control and preventing things like depression from developing in diabetes,” said Dr. Baker.
Finding an outlet for stress is another key. “Meditation, keeping stress low, acupuncture, any sort of method in which they feel more relaxed absolutely will impact their blood sugar and diabetes control and should also have a positive impact on their depression,” according to Baker.
“A lot of people can get depressed because they don’t know what to eat and don’t know what to do. There’s a lot of confusion,” said Smith. “You have to face your fears about diabetes and tell yourself, ‘I am controlling the diabetes, it’s not controlling me.’ ”