Question: A few months ago, I lost my job and then I found out I have retinopathy. Since then, I have been pretty down in the dumps, irritable, and I just feel out of it. When you feel like this, it is hard to talk yourself into looking for a new job. And now I can't seem to motivate myself to follow through with any of my diabetes care. I am embarrassed to admit it, but I haven't even been taking my medications regularly. My doc thinks that I have depression and he wants me to start on an antidepressant medication. I thought people with depression cried all of the time and I never cry. If this is depression, I am very reluctant to add another medication. Do you have any suggestions for me?

Short Answer: It seems likely that you do indeed have a depressive disorder. Antidepressant medication may be a useful and important treatment component in your recovery. Give it a try!

Long Answer: From your description, it does sound like your doctor is probably right and that you are struggling with a depressive disorder. As you mentioned, frequent crying can be a common response to depression, but certainly is not a required symptom. Depression can include changes in your mood and can affect your motivation (which you have described), but may also include other features-- like a change in your eating and sleeping patterns, a lack of energy, social withdrawal, and a loss of pleasure in things you usually enjoy (like food, friends and sex). To make things worse, recent evidence suggests that people with diabetes are almost twice as likely to develop a depressive disorder as people who don't have diabetes. Several studies have found that nearly 1/3 of persons with diabetes show significant symptoms of depression. That's a lot! So, we congratulate you and your doctor for discussing these symptoms and taking them seriously.

As if suffering with depression wasn't bad enough, there are many ways that depression together with diabetes can make for a dangerous combination. As you've discovered, depression commonly leads to problems with self-care (including poor eating habits, more sedentary lifestyle, and skipping medications). This can lead to chronically elevated blood sugars, which can make you feel even more tired and irritable. Without proper treatment, it can be a downward spiral—depression leading to high blood sugars, making you feel even more tired and depressed, leading to even poorer self-care and even higher blood sugars, and on and on.

But there is good news. Effective treatments are available that can help people with diabetes to overcome depression, and treating depression has a positive influence on diabetes outcomes as well! Although I understand your concern about adding another medication, antidepressants are usually an important part of treating depression. For many people, they work very well, and can help you to feel like your old self. Several studies have shown that a combination of antidepressant medication with brief psychotherapy (counseling) may be the best approach. After a few weeks, antidepressant medication may provide significant relief from depression, while counseling can help to address the important psychological aspects of depression—including the stresses and frustrations associated with living with diabetes. The best available evidence points to the particular value of cognitive behavioral therapy, a form of counseling where you can develop new and more effective coping skills, learn how to challenge your own negative and unhelpful thoughts, and set realistic goals for making changes in your life. Finally, be aware that there are additional steps that you can take on your own to combat depression. Regular physical activity is a potent anti-depressant (and cheap to boot), so get out there and start moving! "Making yourself" do activities you used to enjoy, especially social activities, can also give your mood a real lift and help break the isolation. Finally, getting your blood sugars back under control can help to diminish some of the symptoms of depression. For more information, see chapter 11 in my book, Diabetes Burnout: What To Do When You Can't Take It Anymore. And good luck!
 

Question: My work as an engineer requires me to be focused and to attend to many details. Lately I have noticed that I am having a hard time concentrating. Sometimes I feel like I am in a fog and that I am not as effective at work. Could my lack of concentration be related to my diabetes?

Short Answer: It is possible. If you are having significant trouble with your concentration, it might indicate a problem with hypoglycemia, sleep quality, or even depression.

Long Answer: There is no evidence that people with diabetes are more likely to experience difficulties with concentration than anyone else, but there are a few diabetes-related problems that may impact your ability to concentrate.

The most likely culprit is low blood sugars, also known as hypoglycemia. Hypoglycemia can lead to a number of obvious symptoms including increased heart rate, excessive sweating, or other body changes linked to epinephrine (adrenaline) release. But sometimes these symptoms are absent, while more subtle changes may occur. These are called neuroglycopenic, or "brain sputtering", symptoms. Because of low blood sugars, your brain isn't getting enough of the fuel it needs, and so it starts to have trouble working as it well as it could. For some people, this may mean a slight difficulty with following a conversation, a need to re-read a paragraph several times, or perhaps not remembering where you left the keys to your car. So, if you are occasionally having trouble with concentration, the first thing that you might want to do is check your blood sugar.

A second possible explanation for your difficulties with concentration is fatigue and/or poor sleep. If you are not getting sufficient, restful sleep, your concentration may suffer throughout the next day. Of course, there are lots of reasons why people do not get sufficient sleep, and this is not necessarily linked to diabetes. However, diabetes can certainly contribute to this problem. Chronically high blood sugars, frequent hypoglycemia, or even wildly fluctuating blood sugars may lead to fatigue. Some people have frequent, mild hypoglycemia while sleeping. Even though they may not know this is occurring, it may lead to problems with sleep quality and, thus, problems with fatigue and concentration throughout the next day.

Finally, there is the possibility that depression is impacting your ability to concentrate. We know that people with diabetes are about twice as likely to struggle with depression than people without diabetes. And depression can be sneaky. Some people may not notice feeling particularly sad, but there are plenty of other symptoms – like concentration problems, difficulty sleeping, chronic fatigue, and a loss of pleasure in daily activities – that point to the possible presence of a depressive disorder.

So yes, a problem with concentration can be linked to diabetes. It may be a warning sign that problems with hypoglycemia, sleep quality, or depression may be occurring. Or it may have nothing to do with your diabetes whatsoever! In any case, if it continues, it is definitely worth talking with your doctor about this problem.
 

Question: My family is always bugging me to take better care of my diabetes, but it's hard for me to get motivated to do so. The problem is that I've had several close relatives, including my mom, die from diabetes... and it wasn't pretty. It seems like diabetes is a death sentence; it's a disease that just gets you in the end, so why exactly should I bother even trying? I know I should try, but it's awfully hard to convince myself that it would matter.

Short Answer: With good care, you can live a long, healthy life with diabetes. Honest!

Long Answer: We don't talk about it enough, but many people feel just as scared and hopeless as you do about diabetes. It is very understandable. When you hear announcements that diabetes can cause blindness, or that some celebrity with diabetes has had a leg amputated or lost his or her life, its easy to start feeling spooked. And when you see diabetes causing terrible harm in your own family, the sense of dread can become even more profound. In our recent studies, we found that close to 70% of people with diabetes feel, at least to some extent, that serious long-term complications are inevitable. But now let's talk about the facts. Yes, just like you've seen, terrible things can and do happen to people with diabetes. But recent scientific research shows us that, without a doubt, you can live a long, healthy life with diabetes. Serious complications don't have to happen. To a large extent, it's not diabetes that can hurt you, its poorly controlled diabetes. What killed your mother was poorly controlled diabetes, not diabetes itself. For example, we now know that if you can keep your A1c below 7.0% and you see a diabetes-knowledgeable ophthalmologist once a year, your risk of running into serious vision problems will be very low—in fact, pretty close to what it would be for someone who doesn't have diabetes. With good care-- which also includes watching your blood pressure and cholesterol, checking your feet regularly, quitting smoking and more-- you can do very, very well. So taking care of your diabetes is worth the effort. And don't just believe us, ask your doctor, subscribe to one or more of the major diabetes publications for the lay public (such as Diabetes Forecast, Diabetes Health and Diabetes Self-Management), or attend a diabetes education program in your community. Get the information you need to truly understand that you and your doctor's positive actions can make a big difference. When you are fully informed, you'll know that there is absolutely no reason to feel hopeless about diabetes.
 

Question: Sometimes I feel like just giving up when it comes to diabetes. I have had Type 2 diabetes for 4 years now, and I really have tried to do all the "right things". I take my medications, monitor my blood sugars, get some exercise almost every day, and try to follow a healthy meal plan. Sometimes my numbers look pretty good, but then there are times when my blood sugars are way up-- for no earthly reason! At these times, nothing I do seems to make a difference. I don't know what else I can do, but it really leaves me feeling discouraged and unmotivated. How can I regain my motivation?

Short Answer: Find out about the A1c test.

Long Answer: Actually, it sounds like you are plenty motivated. You are working hard, but not getting the results you want. Like many other people, you have discovered that sometimes your best diabetes efforts will not lead to the results you were hoping for. While this can be frustrating, it is important to remember to step back and take a look at the big picture. Everyone's blood sugars go up and down–even if you do everything perfectly every day– and expecting that they will never go out of range is unreasonable. In other words, you may be expecting too much of yourself. What is most important to your long-term health is you A1c result (sometimes known as the glycohemoglobin, glycosylated hemoglobin or HbA1c test). The A1c test is a blood test, usually done at your doctor's office, that measures your average blood sugars over the past 2 -3 months. You and your doctor should be having this test done regularly (at least several times each year) and you should be familiar with your results. If your A1c is in a safe place (for most people that would be a number less than 7.0%), then you are probably doing fine-- even if you have occasional blood sugars that are out of range. Sure, you don't want blood sugars bouncing way up all the time, especially if that leaves you feeling tired a lot, but first priority is that A1c number. If your A1c is too high, then you and your doctor need to plot out a solution, but don't beat yourself up unnecessarily. If your A1c is just fine, and you're still concerned about those occasionally high blood sugars, review your medications with your doctor and consider seeing a diabetes-knowledgeable dietitian in your area to learn more about carbohydrate counting. Do the best you can, but make sure that your expectations are not unreasonable.
 

Question: My diabetes has always been managed with oral medications, but now my doctor says that I need to go on insulin. I know he wouldn't suggest this if it wasn't important, but I don't feel so good about "taking the needle". As I think about it, it is probably because if I take insulin, then that means my diabetes would now enter a new, and more serious, phase. I remember when my grandparents first started taking insulin. They seemed so healthy, but after starting insulin—well, it was a quick road downhill. And now it seems like it's my turn. I really want to do anything I can to stay healthy, but I just can't convince myself to start insulin. Got any good ideas?

Short Answer: Insulin doesn't mean your diabetes has become worse.

Long Answer: For most people with diabetes, the idea of starting insulin is not a happy one. And you've identified one of the major reasons why this is so. When you're not so sure that insulin will really help you, and are even concerned that it might harm you (like it seemed to harm your grandparents), you're not going to feel very confident about taking it. But here's the good news—you can't tell how serious your diabetes is by what kind of medication you're taking. People who take insulin don't have a more serious form of diabetes than those taking pills. What puts you in harm's way is how high your blood sugars are (as well as your blood pressure and cholesterol). If your doctor wants you to start insulin, it is because your blood sugars are probably too high right now. In other words, the current state of your diabetes is serious and potentially harmful to you, even if you refuse to take insulin! Since insulin is likely to help you regain better blood sugar control, this will have a positive effect on your health. Honest. Your grandparents probably didn't start insulin until after many, many years of high blood sugars; no wonder they ran into problems shortly thereafter. But that doesn't need to be your story. Being on the right medication, even insulin, can help you to live a long, healthy life. Go for it!