Depression in Adults with Type 1 Diabetes

Learning the symptoms and how to cope

In the 40-plus years since Larry was diagnosed with diabetes, he has raised a son through a divorce and brought up three step-daughters. He has suffered from complications of his type 1 diabetes that led to him losing his sight in one eye. And he’s suffered from depression, he says, to the point of having suicidal thoughts.

“I did not seek out a psychologist that also understood diabetes because I did not realize it was a significant part of my difficulty in coping,” Larry says. “I did, however, get good help and support from a psychologist recommended by a trusted friend. I can say without hesitation that getting this help allowed me to finally come to terms with my diabetes.”

Despite it all, Larry was fortunate. He had a friend he could turn to, and had the courage to seek out professional help. Too often, people suffering from the dual diagnosis of diabetes and depression don’t get help, or they treat each of the problems in isolation. And while experts are still at odds about the relationship between diabetes and depression, most agree that there is one.

A 2003 study by the Centers for Disease Control showed that people with diabetes may be twice as likely to suffer from clinical depression as people without. And a 2004 study of 3,010 people over age 15 in Australia showed that 24 percent of people with diabetes were clinically depressed whereas 17 percent of the rest of the population was. On the other hand, a 2005 Norwegian survey of 60,869 individuals didn’t find any significant difference between people with diabetes and the rest of the sample group with regard to factors that would indicate depression.

Still, statistics show that adults with both type 1 diabetes and depression are more likely to be divorced, widowed, or separated; to have low household income; to not see doctors or fill prescriptions because of financial concerns; are twice as likely to go to an emergency room for primary health care; and are three times as likely to report that poor health limits their activities.

“So many patients and parents come in and say, ‘I’m the worst diabetic’ or ‘I am the worst parent,'” says Barbara Anderson, Ph.D., professor of pediatrics at Baylor College of Medicine in Houston, Texas. “That is a function of not knowing where to look for support. I reply, ‘What do you do well?’ Then I help them find their little successes to build on.”

Adding to the difficulties, diabetes and depression can impound each other. Swings in blood sugar levels and poor diet can both mimic signs of depression and actually lead to clinical depression.

Signs of depression include:

  • fatigue
  • insomnia or excessive sleeping
  • weight loss
  • weakened concentration
  • memory lapses
  • loss of interest in activities

According to Steven Kisk, M.D., M.S.P.H., “Most patients present only a few such symptoms.” Writing in the book “Psychiatric Secrets” (Hanley & Belfus, 1996), Kisk notes, “If the presentation consists predominantly of physical symptoms, the diagnosis of depression in a patient with diabetes may be difficult. Poorly controlled diabetes with persistent hyperglycemia and ketonuria may present with physical symptoms similar to the physical symptoms of depression.” In addition, he writes, the side effects common to anti-depressants can be especially problematic to people with diabetes.

Ways to Cope

The good news is that while the search is on for a cure for diabetes, there are things that can help relieve depression, which might be the bigger half of the battle anyway. The leaders of the Australian study concluded that “the effect of depression on quality of life is greater than the effect of diabetes.”

Experts suggest a number of steps to help alleviate depression:

  • Find a therapist familiar with problems associated with diabetes if possible.
  • Try group counseling–it can do much to make a person feel less isolated.
  • Get into a routine of taking care of yourself, monitoring blood-sugar levels and watching your diet–this can help with both physical and emotional symptoms.
  • Volunteer to help other people with diabetes–it can help you gain a feeling of control over your own health and well-being, and JDRF provides many opportunities to pitch in.

In addition to these suggestions, it’s a good idea to build a network of family and friends who can help overcome feelings of isolation and despair. In short, finding ways to own your health–rather than resenting or ignoring it–can be crucial to maintaining a positive outlook, which in turn has a positive effect on physical health.

“Most people think you just have to pull yourself up by the bootstraps and move on,” says Joseph Solowiejczyk, R.N., M.S.W., C.D.E., Clinical Manager of Counseling & Presentations with the Animas Corporation. “I think it actually takes more courage to cry and break down than not to fall apart. The health care professional can make it feel safe for you to collapse and be reborn.”

That was the sort of help that eventually led Larry–who is now a volunteer with the JDRF Online Diabetes Support Team–to pull himself out of depression and start living his life again.

“I was able to learn a lot about myself and how to better manage my life within the family,” Larry says, “and how to not allow diabetes to push me into despair and resignation.”