Research shows that if you have diabetes, your risk of developing depression more than doubles. In fact, some studies show that it could be as high as four times more likely1. This is an important topic to address and discuss. Doing so could mean significantly improving your quality of life!
You know the drill: count carbs, inject insulin, factor activity levels and stress risk into carb-counting equations, monitor blood glucose levels (BGLs), rest, eat, treat.
When I was first diagnosed with T1D at age 32, I asked a fellow T1 what typically sends her BGLs off kilter. “The wind,” she told me. I laughed, but it didn’t take me long to get it. No matter how vigilant we are, how meticulously we count carbs, or how perfectly insulin is dosed, there’s always the risk of one rogue BGL sneaking up on us. We follow our regimens perfectly, then check our glucose monitors to find a double-down arrow indicating a rapidly dropping BGL, and suddenly we’re seconds away from throwing a basket of clementines across the room and sobbing because our primal instincts kick in and our body feels like it’s about to give out. I’ve definitely never thrown clementines in a hypoglycemic episode, by the way. Eh hem, never.
We have to count and dose and measure everything perfectly because our lives quite literally could depend on it. We HAVE to be good at math and knowing the density of all foods we consume, and then exactly how a walk around the block will impact our BGL after injecting.
This is a non-stop cycle that we T1Ds never get a break from. Sometimes we can’t be perfect. We can’t get it right. We have no choice but to subject to our BGL roller coasters and throw our hands up on a ride we don’t want to be on. It’s no wonder the chronic condition adds such significant pressures, feelings of frustration and even hopelessness.
Why Type 1s?
Mood significantly impacts anyone’s behavior – whether you live with diabetes or not. With T1D relying so heavily on daily self-care, a larger percentage of those who struggle with depression often also struggle to manage their diabetes.
It’s hard to always know exactly what causes what – whether it’s the depression leading to lack of motivation in managing the diabetes, or the high BGLs and overwhelming thoughts and fears triggering the depressed mood. More research needs to be done to tackle this issue. However, we do know that taking care of ourselves, both mentally and physically, is important to the mind-body connection.
We also know that one common risk factor of depression includes having a physical illness. Other risk factors include a personal or family history of depression, major life changes (hello, diabetes onset!), trauma, or stress (hello, diabetes many days), or being on certain medications.
If diagnosed later in life, you may have a hard time coping with new limits, changes in lifestyle, or planning for treatments that come along with managing diabetes.
Your mental health affects how you deal with your physical health, so if you become depressed, you’re less likely to manage your diabetes well, which can lead to complications and poor health in general. Both aspects of care are paramount and affect your well-being in tandem, so don’t neglect either!
Depression & glucose control
Studies show that even subclinical depression (ie. showing some signs of depression, but not meeting full criteria of a diagnosis) has a relationship with blood glucose control. In other words, you don’t have to be incredibly depressed for depression to have a negative impact on your health.
Studies also illustrate a correlation between frequency of checking BGLs and depression. Those who check their blood glucose less frequently often show increased signs of depression. Alternatively, feeling sad causes stress on the body, which, as many of us T1s know, can cause increases daily blood glucose levels.
How do I know if I’m depressed?
It’s common to “feel down” at some point in life. This happens to people living with and without diabetes. But, when emotions such as hopelessness and despair take hold and won’t go away, you may be experiencing depression. Depression is more than feeling bummed. It’s a persistent feeling (lasting more than two weeks) that can feel debilitating, life-altering and throw you down the rabbit hole of self-doubt. Just trying to get through the day can be overwhelming, as it can interfere with your ability to work, study, eat, sleep, and enjoy life.
Depression can look different from person to person. It can be intense, or subtle to where you didn’t notice until a loved one mentioned the changes. However it presents, there are some common signs and symptoms. It’s important to remember that these symptoms can be part of life’s normal lows. But the more symptoms you have, the stronger they are, and the longer they’ve lasted — the more likely it is that you’re dealing with depression.
Common symptoms of depression
If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment. The severity and frequency of symptoms and how long they last will vary depending on the individual and his/her particular illness. Symptoms may also vary depending on the stage of the illness.
If you have diabetes, it’s normal to experience a wide range of emotions, as well as suffer physical setbacks. This can be particularly true right after a diagnosis, as many people may need time to grieve their health or lifestyle they had pre-diagnosis. This can also be true for parents or caregivers of those diagnosed with T1D.
Depression, even the most severe cases, can be treated. The earlier that treatment begins, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two.
Find a therapist
Psychotherapy (ie. “talk therapy”) aims to help a person identify and change troubling emotions, thoughts, and behaviors. Most psychotherapy takes place through individual sessions with a licensed and trained mental health care professional, or in a group setting.
Finding a therapist can be a daunting task. It’s hard to know where to start, what to look for, and what questions to ask. Remember, it’s your therapist’s job to determine your diagnosis and treatment needs. It’s enough to simply let them know what you’re struggling with day to day. So, “I’m having a hard time coping with my diabetes,” or “I took an online assessment, which showed I have some symptoms of depression,” are enough for your new therapist to start with.
While it’d be great to find a therapist who has experience with clients who have Type 1, this is not essential (and oftentimes very hard to find anyway). You can provide your mental health clinician with additional information to help her/him understand what Type 1 is and the difficulties you face daily. They can help apply that to the treatment and management of depression.
Below are great resources to finding a therapist in your area:
American Diabetes Association Mental Health Provider Listing (this list is small, especially in smaller cities, but it’s growing!)
You may also call your insurance company, search available therapists on the insurance company’s website (search under Mental or Behavioral Health), or ask for a referral from your doctor.
Antidepressants are medications that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressants before finding one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past may be a good place to start. Talk to your doctor or therapist about whether medication may be a good option for you.
Planning ahead is all a part of self-care and can include reaching out to the support sources of friends, family, community groups and your credentialed diabetes educator or therapist.
In addition to working with a mental healthcare provider, try implementing the following to help maintain a healthy mental state:
- Join a community, reach out to other T1D groups and share your story
- Ask questions to learn more about diabetes and depression
- Perform moderate physical activity (consult your doctor about what would be a healthy level of exercise)
- Eat healthy foods (ie foods that make your BGLs and body happy)
- Maintain a healthy weight
- Limit your alcohol use (remember, this can also mess with our BGLs)
Get in touch with your feelings
Emotions give us information and tell us what’s going on with our bodies. Just as it’s important to regularly check on BGLs, checking in on our feelings is another important piece of diabetes management. Do a simple check-in with yourself throughout the day to observe and describe your emotions. Think about it. What can add to an upset feeling quicker than almost anything else? Not understanding why we’re upset, or what exact emotion we’re experiencing.
As you initially trying to identify your feelings, an emotions list can be very helpful to pinpoint the specific emotion you feel. When you understand each of your emotions, including the message it’s trying to give you and the urge you feel with it, you’ll be able to feel better understand how yourself and be able to make more informed decisions.
Remember that you aren’t alone and there are people out there who understand and have been there. Reach out. Be proactive. Talk about it. There is a wide range of mental health treatments available, so consult an expert today to learn how you can improve your quality of life.
The bottom line is that your mental health matters — early in the game and later on — so talking to a health professional can help. Treating your depression or anxiety may require more than talk therapy though. Some people are genetically predisposed to developing mental illness while life circumstances and stress can bring the onset of symptoms. Treatment could include short-term or long-term medication in conjunction with other forms of therapy.
Diabetes isn’t just a physical challenge with serious implications. It’s also emotionally demanding and can be extremely difficult to navigate mentally. That’s why the most effective treatments for T1D include medical AND psychological care.
Read more about depression and chronic illness here: National Institute of Mental Health
If you think you or someone you know might be contemplating suicide, reach out for additional help here:
Suicide Prevention Lifeline or call 1 (800) 273-8255 (United States)
- Barnard, K. D., Skinner, T. C., & Peveler, R. (2006). The prevalence of co‐morbid depression in adults with Type 1 diabetes: systematic literature review.Diabetic Medicine,23(4), 445-448.