Readying Every Resource
Acknowledging and accepting the link between diabetes and depression.
By Scott Johnson
February 2007 — There is no condition like type 1 diabetes.
It is not something that is treated, and then you either get better or you don't.
Type 1 diabetes is unique in that the patient, rather than the doctor, is the one in almost total control. The patient is completely responsible. Medication adjustments, diet decisions, more medication adjustments, lifestyle habits - all of these are primarily up to the patient to manage.
There are people that you can recruit to help you, but at the end of the day, the patient, is the one that makes the decisions and adjustments.
This is a tremendous amount of pressure to deal with. The balance between good diabetes management and a happy, satisfying lifestyle is sometimes hard to find. You have the demands of diabetes management pressing from one direction, and the demands of life hitting you hard from the other. This pressure can be paralyzing at times.
There is never a break from dealing with diabetes. There is no vacation, or time off. Heck, you can't even take a sick day or "mental health" day when needed. It's on you all the time.
When things go wrong, such as a high or low blood sugar, the first thing that many of us do is try to figure out what we did wrong. We try to figure out what we didn't calculate or count correctly, or didn't anticipate or react to well enough. Why is it that we need to try to find some fault with ourselves? Why do we insist on labeling something right or wrong when the lines are not so clearly defined? Often times the high or low is caused by something completely unknown or beyond our control!
Bottom line: We are under an incredible amount of pressure all of the time.
There are also physical impacts of running high or low blood sugars, or swinging up and down. It can run you down, make you feel unwell. Personally, when I have been running high blood sugars, even for just an afternoon, I feel that I'm not up to any task. The task of finding a bit of joy and sunshine in my day as I'm fighting to reign in my blood sugars seems downright impossible. When I'm running low I often feel very weak. I feel just tired and physically run down. At times I feel that I'd rather just stick my head in the sand and wait for it all to "go away".
On top of those physical symptoms, those dealing with diabetes are also at greater risk for depression. Diabetes and depression together is a recipe for disaster. We need to be aware of the symptoms and take action if we feel that something is going on.
I think of depression with diabetes like a vicious downward spiral. It can really sap you of the energy you need to manage your diabetes on a day-to-day basis.
It takes a surprising amount of that energy to tackle the daily tasks of living with diabetes. So much energy is needed for all of the planning and preparation, the anticipating and reacting. It can often feel like you are walking around carrying a heavy load on your shoulders.
When depression starts to draw that energy away from you, you find yourself not doing all that is needed for good blood sugar control, or even just good health! Before you know it, the high blood sugars, or rapid swings from high to low, have you feeling just as bad or worse than the depression does. Depression also has a paralyzing capacity to it. You know you don't feel good, but don't want to put forth any energy or work towards feeling better. You are just stuck right where you are.
It is surprising how much time you can spend feeling bad before you realize that you might need help. It's almost like you get used to feeling bad! You think the world is supposed to be colored a drab gray. You don't remember how things used to be. Or maybe you think that you can eventually pull out of it yourself.
It is very important at this point to start looking at getting some professional help. There is absolutely nothing wrong with needing a little help. It does not indicate a weakness, or lack of character. In fact, it takes a certain strength and confidence to admit that you need help. Finding a therapist that is familiar with diabetes can, in itself, be a daunting task. Maybe the issues you are dealing with don't require a therapist that is familiar with diabetes. If that is the case, any therapist that you like will probably be able to help you. But due to the fact that diabetes seems to invade every little piece of our lives, a therapist that is familiar with it may really help.
You may need some help finding a diabetes-savvy therapist. Try to reaching out to others you know, seek references for therapists that they like or know of. Other good resources for finding therapists are in places like local support groups. Often times, your health insurance may even have a directory of therapists.
It may be a good idea to do some of the legwork in tracking down a good therapist before you actually need one. That will give you a lifeline to use should you find yourself in a crisis. Therapy can be a very valuable tool, especially if you think you might be dealing with depression.
Don't be afraid to use all the tools that you have available. And don't be afraid to add therapy to that list of tools.
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.
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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...