Today is the 10th of October….World Mental Health Day. It is a day to raise the profile of mental health issues but also to remove the stigma that surrounds these issues. There is a strong association between diabetes and mental health issues such as depression.
Diagnosis & The 5 Stages of Grieving
The shock of a diagnosis of diabetes, as well as burnout from self managing your diabetes can greatly affect your mental health. It takes at least 18 months from diagnosis for people to come to terms with the fact that they have diabetes. It is recognised that people when diagnosed with a chronic condition such as diabetes, go through the five stages of grieving . These are anger, denial, depression, bargaining and acceptance . Some people may experience all or none, some might experience one, they do not come in any particular order, or over any particular length of time.
But it is important to recognise that this is a normal ‘grieving’ process for the loss of your health and there is help there. Obviously if you feel you are not coping with your diagnosis &/or diabetes, your GP is your first port of call. They can signpost you to other services that maybe of benefit to you. It is vital that mental health issues be addressed in diabetes care as good mental health leads to better control.
Diabetes & Depression
Studies show that people with diabetes have a greater risk of depression than people without diabetes .We do not really know why this is true but it could be due to the fact that the stress of daily diabetes management can build up. You may feel alone or set apart from your friends and family because of your diabetes. If you are at risk of diabetes complications such as nerve damage, or if you are having trouble keeping your blood sugar levels where you’d like, you may feel like you’re losing control of your diabetes.
Poor relationships with health care professionals and a lack of support can also increase the sense of hopelessness and helplessness associated with diabetes.
Depression can get you into a vicious cycle. It can block good diabetes self-care. If you are depressed and have no energy, chances are you will find such tasks as regular blood sugar testing too much. If you feel so anxious that you can’t think straight, it will be hard to keep up with a good diet. You may not feel like eating at all. Of course, this will affect your blood sugar levels.
During the day, high or low blood sugar may make you feel tired or anxious. Low blood sugar levels can also lead to hunger and eating too much. If you have low blood sugar at night, it could disturb your sleep. If you have high blood sugar at night, you may get up often to urinate and then feel tired during the day.
Other physical causes of depression can include the following:
- Alcohol or drug abuse
- Thyroid problems
- Side effects from some medications
Signs of Depression
If you suffer from any or some of the following symptoms, it is advisable for you to talk to your GP:
- Difficulty concentrating, remembering details, and making decisions
- Fatigue and decreased energy
- Feelings of guilt, worthlessness, and/or helplessness
- Feelings of hopelessness and/or pessimism
- Insomnia, early-morning wakefulness, or excessive sleeping
- Irritability, restlessness
- Loss of interest in activities or hobbies once pleasurable, including sex
- Overeating or appetite loss
- Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
- Persistent sad, anxious, or “empty” feelings
- Thoughts of suicide, suicide attempts
The following links and booklets I have found particularly good to give to people with diabetes when they are struggling to cope with their diabetes:
One of my favourite websites to signpost people with diabetes and health care professionals to is the Behavioral Diabetes Institute which provides excellent information and resources http://behavioraldiabetesinstitute.org/
A great read by Dr. William Polonsky who has done immense research in the whole area of diabetes is The Diabetes Burnout: What to do when you can’t take it anymore? http://www.amazon.com/Diabetes-Burnout-What-When-Anymore/dp/1580400337
You are not alone, and that is the first thing to realise. In 17 years in my role as a diabetes educator, there is no symptom, emotion and behaviour that I will not have seen repeated throughout people with diabetes. Reach out and get help. Obviously your first port of call is your GP, your diabetes team, family, friends etc. Reach out and ask for help…..it is there.
 Brown, Sharon A. “Diabetes and grief.” The Diabetes Educator 11.2 (1985): 53-57.
 Kubler-Ross, Elisabeth, and David Kessler. On grief and grieving: Finding the meaning of grief through the five stages of loss. SimonandSchuster. com, 2005.
 Mezuk, Briana, et al. “Depression and type 2 diabetes over the lifespan a meta-analysis.” Diabetes care 31.12 (2008): 2383-2390.