Choosing Wisely

Dealing with managing both diabetes and depression.

IleneBy Ilene Raymond Rush

March 2008 — Last week I lunched with a friend who informed me over her Greek salad that she planned not to get any older.

When pressed, it turned out that she was not speaking of Botox treatments or blond highlights or breast augmentation. She had simply determined that she had enough of this ‘aging business.' No more birthdays, no more additional years. She was fine where she was with what she had, thank you very much.

To which I replied, "Lots of luck with that."

Yet while my resolute if deluded pal wrestles the time and space continuum, her words got me thinking about choices and what we can – and cannot – control in middle age.

Take this month. I planned to write about the connections between diabetes and serious depression. Ten to thirty percent of people with diabetes, according to a CDC study done in 2006, also have depression.

I wanted to share that for me, this subject is all too familiar. That for many years I've wrestled with not one but two chronic diseases, type 2 diabetes and bipolar 2, a variety of manic depressive disease that is light on the mania and heavy on the depression.

Or at least that was my plan.

But then I got depressed.

I got depressed from about the end of November through to the second or third week in February, when one day the sun rose and suddenly – with the help of a bit of medication, a good therapist, and a loyal husband – I found life worth living again.

Serious, clinical depression is extremely tough to explain to people who have never experienced it, but the bell jar metaphor posed by poet Sylvia Plath back in the 60's strikes me as good as any: the sensation is as though there is a thin film between you and anything good in the world. My therapist calls it wearing ‘shit-colored glasses', where nothing looks good and nothing appears worth working for.

Unfortunately, for people with diabetes, depression can complicate treatment plans. Without the incentive of better days ahead, gobs of mashed potatoes, hunks of chocolate cake, and long naps from the afternoon into evening without exercise beckon. Leaving you not only more depressed, but profoundly unhealthy and with your sugars out of control.

I wanted to write about how studies have shown that this diabetes/depression combo can prove a one-two punch: depressed over high glucose readings, people may become even less interested in following an eating, exercise or drug plan, which in turn may bring on complications that make your health care costs rise which can lead to even greater depression.

In short, a downward spiral that leaves you feeling powerless and demoralized.

But when I heard my friend talk about not aging, I had a sudden thought: that sometimes, even when you think that you don't have a choice, you might.

Take type 2 diabetes. When you are first diagnosed with diabetes, particularly if you're in mid-life or later, it can be a shock that the body you've come to trust for so many years has a new biological quirk determined to complicate your life. Depression can feel the same way; a biological condition that weakens you enough to make you want to cry "uncle" to the world.

But along the way, growing like flowers ready to be plucked, are choices. You can't choose to get out of a bad depression, but you can decide to give attention to people who love you and who assure you that better days will come. You can't cure your diabetes, but you can decide to follow your exercise, eating and drug treatment plans as best you can.

Which brings me back to my friend and her campaign against aging. I love the woman, but I don't think it's going to work. While we can forestall signs of aging (see The Real Housewives of Orange County, et. al), or continue to dress as though we're seventeen, we are all pretty much headed in a single direction.

The choice, however, is not whether we age, but how. Do we do it in a way that guarantees our days will be spent in a round of doctors' visits and hospital admissions? Or, do we do it in a manner that makes us as sane, happy, and healthy as possible?

If my friend succeeds, I'll be the first to cheer. Meanwhile, I'm going to choose as wisely as I possibly can.

Click here to read more of Ilene's Second Chances columns here.

Read Ilene's blog.


dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.

Last Modified Date: June 14, 2013

All content on is created and reviewed in compliance with our editorial policy.

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by Brenda Bell
Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...
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