World Diabetes Day is a global health initiative to increase awareness about diabetes. It is a day that brings the world’s attention to diabetes and how it affects people’s lives. Diabetes can have a huge impact on a person’s mental and physical health, but sometimes, people find out they have developed diabetes later in life. In other cases, there are complications from diabetes that lead to debilitating medical conditions such as blindness or heart disease.
The World Health Organization estimates 347 million adults had diabetes in 2013, with another 80 million undiagnosed. This translates to 9% of the population having diabetes–nearly 1 in 10 adults worldwide.
The World Health Organization also reports that the total global economic burden of diabetes is over $825 billion. This includes the direct medical costs of caring for people with diabetes and the indirect costs, such as lost productivity due to illness and early death. Diabetes also increases the risk for many other complications such as blindness, kidney failure, lower limb amputation, and stroke.
Studies show that having diabetes is associated with a 40% increased risk of depression. This appears to be true in both those recently diagnosed and those who have had the disease for several years before diagnosis.
There are many reasons why this link exists:
(1) Like diabetes itself, depression can be something you’re born with or develop later in life due to environmental factors or trauma. Many studies document children whose parents have type 1 (juvenile) diabetes are much more likely to develop depression than their peers.
(2) The same lifestyle factors that increase your risk for type 2 diabetes can also lead to depression: poor diet, lack of exercise and obesity, smoking, and alcohol use. Eating too many processed foods and refined carbohydrates is linked with an increased risk of developing insulin resistance, a characteristic common among diabetes and depression.
Other studies suggest that sleep apnea (the most common form of sleep-disordered breathing) may cause some cases of depression in people with diabetes. Several studies show that stopping breathing while asleep is associated with feelings such as sadness or hopelessness. This association appears stronger when someone has PTSD (post-traumatic stress disorder). If the person smokes or is obese, this depression risk is increased even more.
(3) Almost all diabetes medications pose some risks of mental side effects, including mood changes and depression. The most serious example is the class of sulfonylureas drugs used to treat type 2 diabetes. These include glyburide (brand name Diabeta), glipizide (Glucotrol), glimepiride similar (Amaryl), and medications that increase insulin release by the pancreas. Because they can increase insulin levels in people who aren’t producing enough of it on their own, these medications are not safe for children or young adults under age 20.
Sulfonylureas cause hypoglycemia (low blood sugar) which can lead to confusion and other mental symptoms. There’s also concern that these drugs may be linked with dementia among the elderly, although more research is needed to know for sure.
Insulin resistance itself has been linked with depressive symptoms in a study of middle-aged adults without diabetes. Researchers at Columbia University found insulin levels were a better predictor of depression than was blood sugar control. In other words, chronically high insulin contributes to insulin resistance, increasing the risk for both diabetes and depression.
In addition to medications, some people report feeling blue while adjusting their medicine dosage or taking less insulin than they’re used to after being diagnosed with type 2 diabetes. This usually passes within weeks but is one more reason why it’s important not to make any major changes to your treatment plan without talking with your doctor first!
(4) People with diabetes are more likely to develop obesity, high blood pressure, and high cholesterol, all of which may increase the risk for depression. Diabetes is also associated with an increased risk of heart disease, stroke, and other chronic conditions that can be disabling or lead to disability over time.
People say they feel sad because they’re no longer able to do the things they used to enjoy or participate in activities, such as work or exercise, that once made them happy. This is often called “depressive realism” – feeling more negative emotions than you might otherwise if you weren’t facing a life-altering diagnosis like type 2 diabetes. Short-term feelings of sadness or hopelessness are normal after learning you have a serious condition like type 2 diabetes.
Sometimes the sudden change in lifestyle that comes with having diabetes causes depression, especially among people who were once active and healthy. This is usually temporary but may require therapy to overcome (and must be treated by a physician before starting any psychotherapy).
(5) Not surprisingly, low self-esteem is linked with eating disorders and depression among girls and young women with type 1 diabetes. A study at Baylor University found that roughly half of the overweight teenagers with type 1 had some degree of eating disorder behavior such as fasting or abusing laxatives. Other studies have found that girls tend to be more depressed than boys both before being diagnosed and afterward. In addition, these young people are more likely to be diagnosed with depression later on.
(6) Among men and women with type 2 diabetes, depression is most common shortly after diagnosis, then generally decreases over time. But if their blood sugar levels remain uncontrolled, they may become depressed again as complications appear. Older adults are also at increased risk for developing new symptoms of depression or having existing symptoms become more severe if they don’t keep their blood sugar controlled (source).
(7) Depression can show up at any age, although it’s much less common in children than adults. Memory loss is a warning sign that your child might have pre-diabetes or diabetes so ask your pediatrician about a regular screening during visits starting at age 10.
If you lose interest in activities you once enjoyed and have other classic signs of depression, see a doctor rule out a treatable physical cause for your symptoms. It’s also important to find a medical professional who will work as part of your diabetes care team and coordinate all the help you need.
(8) If you’re feeling blue now that winter is here but haven’t been diagnosed with type 2 diabetes, talk to your doctor about getting tested anyway. Symptoms like fatigue or irritability may be related to low blood sugar (hypoglycemia), especially if you eat less than usual and feel tired 30 minutes later.
Symptoms like these can make it tough to tell the difference between hypoglycemia and depression (source). Your best bet: Be prepared with fast-acting glucose tablets, fruit juice, or another source of quick energy in your pocket at all times.
Diabetes isn’t the only cause of depression, but it often means more stress because you have to watch what you eat, adhering to a schedule, take medication and monitor your blood sugar if you have type 1 or type 2 diabetes. The good news is that most people who have diabetes can enjoy happy, healthy lives by being aware of their symptoms and following their treatment plan.
(9) Talk with others who live with diabetes about how they manage feelings of sadness or depression – whether that’s finding new hobbies or joining support groups where you can interact with other diabetics dealing with similar issues.
Remember, depression itself isn’t a medical problem, but it can help if you talk to a doctor or therapist to find out the cause. If your symptoms are related to stress or an endocrine problem, a doctor can prescribe a medication to get your symptoms under control and offer additional support through counseling sessions.