How are Diabetes and Depression Linked?

February 19, 2014

Are diabetes and depression linked? Well according to the American Diabetes Association, 15-20 percent of diabetics also struggle with some form of depression—and with the stresses related to coping with diabetes, it’s not surprising to see why. Constantly monitoring and managing blood sugar and insulin levels over long periods of time and enduring the treatment of complications brought on by the disease can make day-to-day life more difficult, thus increasing the probability of depression.

While stress can be the primary cause of depression among diabetics, the metabolic effects of diabetes on the brain may also be a major contributing factor of depression. Dr. Ralph E. Carson, RD, Ph.D. and Executive Director of FitRx says:

“It can be a truly vicious cycle; depression can lead to poor lifestyle patterns, i.e. unhealthy eating, little-to-no exercise, smoking and weight gain—all of which are risk factors for diabetes.”

More links between diabetes and depression:

  • Physical damage caused by diabetes, i.e. neuropathy, vascular, retinopathy and infections.
  • Tension between patient and physician or dietitian regarding diet, activity, weight management and medications.
  • Scientific research has shown that depressed people are more likely to skip medications, get little exercise, have an unhealthy diet and/or or have difficulty managing their weight.

In many cases, depression sadly goes undiagnosed, untreated or even undetected. However, health professionals typically recognize the symptoms. Treating depression is crucial—when combined with diabetes, depression directly contributes to poorer blood glucose control, greater risk of heart disease and retinopathy and shorter life span. Some studies suggest that diabetics with a history of depression are more likely to develop diabetic complications than those without depression.

Warning signs of depression among diabetics:

  • Sadness, irritability or constant feeling of emptiness
  • Loss of pleasure or interest in doing things one used to enjoy
  • Feelings of hopelessness or pessimism
  • Decreased energy, increased fatigue and feeling “slowed down”
  • Difficulty concentrating, remembering and making decisions
  • Feelings of worthlessness, guilt or helplessness
  • Insomnia, early-morning awakening or oversleeping
  • Changes in appetite and eating patterns that result in weight changes
  • Nervousness or restlessness
  • Recurrent thoughts of death or suicidal thoughts

Preventing and managing depression

Restful sleep (typically 7-9 hours per night) restores the mind and body. Sleep that is disrupted or inadequate over long periods of time can lead to difficulty concentrating, irritability and chronic fatigue. Fatigue decreases the changes of exercise, and lack of activity can make it difficult to sleep, which can lead to depression.

Regular physical activity, such as brisk walking for 30 minutes per day (or whatever you are able to do), has been shown to reduce the symptoms of mild and moderate depression. Besides boosting mood, regular exercise can provide protection against heart disease while also lowering blood sugar, blood pressure and “bad” cholesterol levels.

The Behavioral Diabetes Institute advises, “By breaking out of typical patterns, even if it feels forced at first, you can begin to feel better again.”

• Take part in activities outside the home.

• Plan for “fun” activities, even though they may not seem like fun right now.

• Get social. Take a class, join a club, find a new hobby.

Oftentimes, physicians refer patients diagnosed with depression to a psychiatrist, psychologist, licensed clinical social worker or professional counselor. Many physicians already work with mental health professionals on a diabetes treatment team. These professionals guide clients through the rough waters of depression and the two main types of treatment, which include counseling/ psychotherapy and antidepressant medications.

How we treat the cycle

People who are depressed have elevated levels of stress hormones such as cortisol, which can lead to problems with glucose or blood sugar metabolism, increased insulin resistance and the accumulation of visceral abdomen tissue. These are all risk factors for diabetes.

Dr. Carson says:

“At FitRx, we obtain records from clients’ referring physicians. Each client undergoes a thorough medical workup that includes an HbA1c, or glycolated hemoglobin test that detects what a client’s average blood glucose level was over the past several months. We do this by measuring the concentration of hemoglobin molecules in red blood cells with glucose attached.”

A major contributor to pre-diabetes is intra-abdominal fat, which can progress to metabolic syndrome, insulin resistance and Type II diabetes. The entire FitRx program is designed to reduce stress/cortisol levels. When you reduce this visceral abdominal tissue though mindful eating and activity, individuals experience less cortisol production!

FitRx also applies therapeutic interventions associated with grief, trauma and co-occurring psychological conditions.

Through healthy eating, changes in lifestyle patterns and stress reduction therapy, visceral abdominal tissue is reduced, producing less insulin resistance and reducing HbA1c. And when self-esteem improves, stress—thus depression—are further reduced.

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