Written by: Alicia Rodrigo-Miller, Dietetic Intern
Does Diabetes Increase the Risk of Depression?
Depression is defined as a group of conditions associated with the elevation or lowering of a person’s mood and can present itself in a number of ways (1). Depression can range from mild to severe and often shows up as feelings of sadness or a decreased interest in activities that previously brought an individual joy (2).
It’s estimated that people living with diabetes may be up to 2-3 times more likely to develop depression and 20% more likely to develop anxiety than people without diabetes. It is estimated that only 25-50% of people with diabetes are diagnosed and treated for depression, which leaves a large number of people that go undiagnosed and thus untreated (2). Diabetes distress is an emotional response that is specifically linked to the diagnosis and day-to-day demands of managing diabetes. Studies have shown that diabetes distress can be the result of the pressures and emotional burdens associated with self-managing care of a chronic condition. Diabetes distress can manifest itself in feelings of anxiety, anger, or depression (4). It is estimated that up to 45% of individuals may suffer from diabetes distress though most of those individuals may not meet the criteria to be diagnosed with clinical depression (5).
In order to prevent further complications, it is important to understand how both diabetes distress and depression can impact health outcomes, recognize when an individual may be depressed or at risk, and how to seek support if needed.
How Can Depression Affect Diabetes Outcomes?
Feeling sad, discouraged, or anxious can become burdensome or overwhelming while managing a condition like diabetes. People with diabetes and depression may experience stress, guilt, or denial in association with their condition. Diabetes distress and depression can lead to uncontrolled blood sugar levels and an increased risk of complications from diabetes (5). One study explored the idea that there is a significant relationship between diabetes distress and decisional conflict as a result of diabetes distress. The study suggested that the strain of self-managed care led to poor emotional health and quality of life, which contributed to poor decision-making that resulted in poorer glycemic control (6). Appropriate management of diabetic distress and depression has been associated with improved outcomes inclusive of but not limited to improved self-care, better control of blood sugars, reduced risks associated with cardiovascular complications, and reduced risk for mortality (5).
Are You At Risk for Depression?
Depression and diabetes distress manifest themselves in many different ways. Some key symptoms of depression include feelings of sadness, feeling empty, losing interest in past activities that brought joy, overeating or loss of appetite, feeling restless or being unable to sleep, sleeping excessively, having trouble concentrating or making decisions, feeling tired, hopeless, irritable, anxious, headaches, cramps, digestive issues, thoughts of harming yourself or harming others (2). If you are feeling any symptoms associated with depression it is important to have a conversation with your primary care physician or seek support from a specialist in mental health. Understanding that you are not alone and that your condition can be managed successfully is a great first step that should be acknowledged.
Ways to Seek Support
Some ways to manage mild anxiety are increasing your physical activity level, adopting a practice of meditation or yoga, limiting alcohol and caffeine, eating a healthy diet, getting enough sleep, or participating in a peer support group (2).
Managing diabetes distress is just as important to treat even though it is not considered to be a major depressive disorder. It is important to communicate your symptoms with your primary care physician and ask for a referral to a specialist if needed. You can also request further support from a diabetes educator or sign up for a diabetes support group to help manage the emotional burdens and expectations of self-care (2). Check out this article for more on the benefits of joining a diabetes support group.
With 1 in 5 adults with T2D experiencing depression and 1 in 3 adults with T2D experiencing diabetes distress it is crucial that these conditions are recognized and addressed. Routine screening should be a standard in healthcare settings and it is important to be aware of the signs and symptoms of these conditions so that you can advocate for yourself. You can start by paying attention to your feelings or any changes in your normal mood or disposition. It is also important to communicate openly with your healthcare practitioner and make sure you get the needed support. Additionally, you may want to consider checking out these 10 tips from the CDC on coping with diabetes distress.
- Sartorius N. Depression and diabetes. Dialogues Clin Neurosci. 2018 Mar;20(1):47-52. doi: 10.31887/DCNS.2018.20.1/nsartorius. PMID: 29946211; PMCID: PMC6016052.
- CDC. (2018). Diabetes and Mental Health. Retrieved from https://www.cdc.gov/diabetes/managing/mental-health.html
- Mezuk, B., Eaton, W., Albrecht, S., & Golden, S. (2008). Depression and Type 2 Diabetes Over The Lifespan: A meta-analysis. Diabetes Care, 21, 2383-2390. Doi: https://doi.org/10.2337/dc08-0985
- Kreider, K. (2017). Diabetes Distress or Major Depressive Disorder? A Practical Approach to Diagnosing and Treating Psychological Comorbidities of Diabetes. Diabetes Theory, 8, 1-7. Doi: 10.1007/s13300-017-0231-1
- Bruno, A., Choi, D., Thorpe, K, and Hu, C. (2019). Relationship Among Diabetes Distress, Decisional Conflict, Quality of Life, and Patient Perception of Chronic Illness Care in a Cohort of Patients With Type 2 Diabetes and Other Comorbidities. Diabetes Care, 42, 1170-1177. Doi: https://doi.org/10.2337/dc18-1256
- CDC. (2019). 10 Tips for Coping with Diabetes Distress. Retrieved from https://www.cdc.gov/diabetes/managing/diabetes-distress/ten-tips-coping-diabetes-distress.html
By Katya Meyers, Dietetic Intern
We know that getting enough sleep is good for us. But, did you know that researchers have linked diabetes to poor sleep, both in terms of risk and health outcomes after a diagnosis? People that suffer from common sleep conditions, such as sleep deprivation, obstructive sleep apnea, and insomnia are at increased risk of diabetes. And, if you already have diabetes and one of these conditions, it may be more difficult to control your diabetes.
So, what does the research say about not getting enough quality sleep and the impact on your health? And, how much shut-eye should you be getting each night?
Can not getting enough sleep can increase your risk of diabetes?
The Center for Disease Control recommends adults get a minimum of 7 hours of sleep each night but reports that 1 in 3 adults all short of this recommendation. In the sleep lab setting, restricting sleep to 4-5 hours a night for a week results in lower glucose tolerance and insulin sensitivity. Large scale meta-analysis studies report that there is a “U-shaped association” between the length of sleep and diabetes—those getting 7-8 hours of sleep each night are at the lowest risk of having diabetes, as compared to people who sleep significantly more or less than that amount (2).
Chronic sleep deprivation can worsen blood glucose control
Another large meta-analysis showed a 1.3 fold higher increase in fasting glucose levels or hypoglycemic medications for people who reported sleeping less than 5 hours per night, as compared to a group sleeping 5-8 hours. However, more might not provide greater benefit…sleeping more than 8 hours did not seem to have any positive effect (2). Additionally, there is extensive research indicating that acute and chronic sleep deprivation is associated with poor insulin resistance in individuals with diabetes as well as those without.
Sleep deprivation can increase your cravings for junk food and lead to weight gain
Using fMRI scans, researchers from UC Berkley showed what most of us already know…a sleepless night makes us more likely to reach for pastries and pizza, not salad and whole grains. Brain scans indicated decreased activity in the frontal lobe, which governs complex behavior making, and amplified activity in the areas which are associated with more primal brain structures that control motivation. As a result, participants were more likely to reach for high calorie, high-fat foods. This may partially explain the link between obesity and lack of sleep (3).
Untreated sleep apnea can impair pancreatic Beta cells
Sleep apnea is often thought of as a side effect of obesity. However, research indicates an independent association between sleep apnea and diabetes. Hypoxia can damage pancreatic beta cells, which explains the association at least in part. Some studies show that CPAP therapy may have beneficial effects on glycemic control. Data has been mixed, however, and more research is needed in this area (2,4).
You need quantity AND quality
It’s not just how much you are sleeping, but how well you are sleeping that also must be taken into account. Reducing the amount of slow-wave sleep, without changing the total sleep time may also result in insulin sensitivity. In addition “circadian misalignment” or changing the normal sleep/wake pattern, as in shift work, may also worsen insulin sensitivity (5).
While how much sleep you need is individualized, it seems that too little sleep can significantly impact metabolic health. Research is still needed to unravel the links, but an increase in sympathetic or “flight or fight” response, higher cortisol levels, inflammation, and more cravings for junk food are all possible ways in which too little sleep leads to poor diabetes control and outcomes. Aim for at least 7 quality hours of sleep a night for optimal health and blood glucose control.
How Working with a Diabetes Coach Can Help You Reach Your Goals
It’s well known that managing your diabetes well can help prevent the development of diabetes-related complications but despite the benefits, diabetes can feel like a full-time job on top of an already full plate. Maybe you know what you need to do to get in better control but it seems to get pushed to the backburner or maybe all the conflicting information on the best plan or diet has you throwing your hands up and hesitate to make any changes at all. Whatever the scenario, working with a diabetes coach can help you formulate an individualized plan, stay on track and avoid diabetes burnout along the way.
What is a Diabetes Coach and What To Look For
While there is no formal definition of a diabetes coach there are some important characteristics you will want to keep in mind when selecting someone to work with.
Educational Background and Experience
- Diabetes is a complex chronic condition that is constantly changing, not only due to the progressive nature of the disease but the rapidly changing therapies to treat it. Choosing a diabetes coach with who is also a Certified Diabetes Educator ensures your coach has an extensive background in diabetes management as well as required continuing education to keep up the respected credential.
Communication Style and Method
- When deciding on a diabetes coach it’s a good idea to ask questions about their communication style and methods to ensure it’s a good fit. How often will you meet? Will it be in person, or virtually? How often will you share blood sugar logs? Will you keep a food journal? What about been visit support, how accessible will the coach be? These are just a few examples to get you started but asking questions to ensure both parties are on the same page will be essential.
- Equally as important, is finding someone that you have a good rapport with. You will be communicating with your coach frequently and honestly sharing insights on your daily meals, moods, blood sugar, etc. can be very personal. It’s important to find someone that you trust and feel comfortable sharing this information with.
What to Expect in Working with a diabetes coach
The experience in working with a diabetes coach will look different depending on who you decide to work with however you should generally be able to expect to develop a relationship with someone advocating for your care. You should be able to talk through your goals and concerns related to your diabetes and feel supported in coming up with an action plan. Prior to your follow up visits with your doctor you should also be able to expect a session to talk through questions to ask, upcoming labs and concerns.