We are in Diabetes Awareness Month and facing Thanksgiving challenges to our diets, pertinent to persons with diabetes and pre-diabetes. At the same time, we suffer the stress of the pandemic. These stresses place vulnerable individuals at risk for worsening of their condition at a time when we can not gather in our normal ways. Also, we are entering the holiday season in which depression increases in vulnerable individuals, even more so in this year of COVID-19. As a benchmark, about 23.5 million Americans nationwide have diabetes, and about 14.8 million Americans have major depressive disorder in a given year, according to research statistics. However, matters soon may be getting worse. Estimates are that 55% of adults in California have either diabetes or pre-diabetes. That's up to 13 million adults in the state (2.5 million with diabetes, the rest pre-diabetic).
It has been known that a comorbidity, or co-occurrence, occurs between depression and diabetes. Some estimates have been that up to 30% of individuals with Type 2 diabetes have a diagnosable depressive disorder (Katon, Maj, & Santorius, 2010). In a study in the Annals of Internal Medicine in 2010, Dr. Frank Hu observed that depression increased the risk for diabetes, and diabetes increased the risk for depression. Women who were depressed were 17% more likely to develop diabetes even after the researchers adjusted for other risk factors such as weight and lack of regular exercise. Women who were taking antidepressants were 25% more likely to develop diabetes than their counterparts who were not depressed.
In the same study, women with diabetes were 29% more likely to develop depression after taking into account other depression risk factors. Women who took insulin for their diabetes were 53% more likely to develop depression during the 10-year study. Concerns are even higher in this year of pandemic. Under normal circumstances, estimates are that approximately 8-11% of people over the age of 12 suffer from moderate to severe depression. However, during the pandemic, there is evidence that the rate of serious depression has increased. A US Census Bureau survey found that 44% of Californians reported levels of anxiety and depression commonly associated with diagnoses of generalized anxiety disorder or major depression.
Certain factors such as physical activity and body mass index may partially explain the link between depression and diabetes. However, they do not completely explain the connection.
I agree with the research conclusions that the common denominator may be stress. I have written frequently about the role of stress in the initiation or exacerbation of multiple medical conditions to include diabetes. In our book on stress management (I Can't Take It Anymore: How to Manage Stress so It Doesn't Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), we discussed depression and diabetes in detail. The book is available on Amazon at https://www.amazon.com/dp/1542458056. For more information on the book and authors, please visit our website at www.manageyourhealthandstress.com.
People who are depressed have elevated levels of stress hormones such as cortisol. Elevated levels of cortisol can lead to problems with glucose or blood sugar metabolism, increased insulin resistance, and the accumulation of belly fat. These all have been noted as diabetes risk factors. Now if you develop Type 2 diabetes and have not been identified as depressed, you still are faced with the stressors associated with diabetes management such as blood sugar control and treatment for complications. This can lead to decreased quality of life and increased probability of depression. Research studies have shown that depression leads to poorer physical and mental functioning, so a person is less likely to follow a required diet or medication plan. Over time, thoughts may become more depressive such as "I'll never be healthy again"; "Why did this happen to me?"; "I'll never be happy again". These thoughts can lead you into a spiral of depression and worsen diabetic management. Treating depression with psychotherapy, medication, or a combination of these treatments can improve a patient’s ability to manage diabetes.
But what about the issue of pre-diabetics raised in the first paragraph? Do you know your status and that of your loved ones? Perhaps you indeed are pre-diabetic yourself. Symptoms of diabetes include: 1. Being very thirsty; 2. Urinating frequently; 3. Blurry vision; 4. Being irritable; 5. Tingling or numbness in your hands or feet; 6. Feeling worn out; 7. Wounds that don't heal; 8. Yeast infections that keep coming back.
Have you had a depression screening or think you may be depressed? Symptoms include:
1. No longer finding pleasure in activities that you once enjoyed; 2. Insomnia or sleeping too much; 3. Loss of appetite or binge eating; 4. Inability to concentrate; 5. Feeling lethargic; 6. Feeling anxious or nervous all the time; 7. Feeling isolated and alone; 8. Feeling sadness in the morning; 9. Feeling that you "never do anything right"; 10. Having suicidal thoughts. If you experience four or more of these symptoms for up to two weeks, please consult your primary care provider or a mental health professional. If you have suicidal thoughts, please see a professional immediately.
There is excellent care available but you have to take the first steps. As noted, evaluate your stressors in life, be aware of your mindset and the possibly depressing thoughts and limiting beliefs you tell yourself, and consult information and experts on diabetes management.
Again, your good physical and mental health are the results of choices you make. Stress is a choice. Don't make it yours. Good luck on your health journey.
Dr. Paul Longobardi
For information on these and related topics please see my website at www.successandmindset.com