T Minus Two Type Two Diabetes and Other Passions


Depression as a Pre-Existing Condition

This post, originally published on September 10, 2010, is my response for today's prompt for Diabetes Blog Week: "May is Mental Health Month so now seems like a great time to explore the emotional side of living with, or caring for someone with, diabetes. What things can make dealing with diabetes an emotional issue for you and / or your loved one, and how do you cope? (Thanks go out to Scott of Strangely Diabetic for coordinating this topic.)" 

Unfortunately, having diabetes is no protection against other conditions, and diabetes has no hesitation about coming to those already having other conditions.

I was recently having an exchange with Rachel Baumgartel on Twitter, and we were talking about depression. She made a comment to the effect that folks often don't consider the impact when diabetes comes to a person who has depression as a "pre-existing condition". I loved that phrase, because it enabled me to start crystallizing thoughts I've been having for a year or more.

Many, many people with diabetes also deal with depression or anxiety. This seems easy to understand: diabetes is a daily challenge that never, ever goes away. It affects our bodies, minds, and relationships. Many diabetics have a strong sense of guilt, whether it relates to stigmas falsely associated with the disease, perceived failures in managing it, or the effect of the disease on the people we love. The literal highs and lows bring fears about serious illness, even death.

And, of course, there may be something physiological about diabetes that creates fertile ground for depression or anxiety.

But does it go the other way? I've been a diabetic for about two and a half years. I've dealt with depression for nearly forty years. So, in my case, diabetes came to a person already pre-disposed to have problems with the psychological aspects of the disease. I had a pre-existing condition called depression.

(I've written elsewhere in some detail about my experience with depression. I won't do so here, at least not today.)

So, two questions to ponder:
1) What if diabetes comes to a person already suffering from depression or another disorder of the heart or mind?
2) What if diabetes comes to a person who does not yet have depression or another disorder of the heart or mindor another disorder of the heart or mind, but whose body or life already contains the seeds of such a condition?

The answer is going to vary tremendously from person to person. But two things seem pretty certain:
1) The heart/mind disorder is going to make managing the diabetes much more difficult.
2) The diabetes is going to make managing the heart/mind disorder much more difficult.

I'll tell you how it is for me. Depression is a great teller of lies: on not-so-good days, I believe those lies. I don't take as good care of myself because I don't feel worth the trouble. In those moments, healthy changes seem impossible for me, and complications feel inevitable. I don't sleep well, and feel physically weak, so exercise would be more difficult even if I could find the motivation. (There's a key irony here: exercise is fabulous therapy for depression. Do I remember that when I need it? Of course not.) Without really noticing, I feed the fatigue with increased caffeine. And food. And the food isn't free veggies.

On good days, I don't believe the lies, and do take care of myself. But if the not-so-good days have strung together, as sometimes happens, I've lost some previous progress and have some catching up to do.

All of this, good days and not-so-good days, occurs while I'm getting up, going to work, and being good at my job.

Of course, everyone with depression will experience it differently. And depression is only one of the things that can attack a person's mind or spirit, and diabetics with other conditions will have their own challenges.

It would be a wonderful thing if our care providers knew to watch for symptoms of depression and other maladies, and understood that those of us who already have them have extra challenges. But I suspect that most of us don't have such providers, and may need to be assertive in getting the care that we need.

Please, whatever your situation, be gentle with yourself. And, please be gentle with the rest of us.

(Originally posted to diabetesdaily.com)

Comments (4) Trackbacks (0)
  1. As I wrote today, I was lucky – my PCP alerted me that I could have emotional issues.
    And – I also think we/you/whomever need to write more about the symptoms of depression. It’s like diabetes symptoms – sometimes, we’re oblivious.

  2. Well, that’s both of us, kid! I had my first major depression when I was in the 5th grade, but was only diagnosed with diabetes at age 43. Add to that the guilt that maybe I caused my own diabetes, as my family was fond of saying, then you get an eating disorder, and it gets overwhelming. And I DO appreciate those professionals who understand that the depression is a pre-existing condition that just makes diabetes and food management worse. I just wish I had gotten treatment for the depression and the incipient eating disorder WAY earlier, but in those days, depression was not recognized as occurring during childhood, and the only eating disorder that was recognized was anorexia, and that’s not what plagues me. Diabulimia is STILL not recognized as an official eating disorder, but the professionals I work with are trying to come to terms with it, which is better than nothing!

  3. There are mental health issues on the same side of the family as the autoimmune issues. It really makes you (me) wonder…

  4. I was diagnosed with Bipolar, OCD,PTSD, and anxiety about 2 years before diabetes. With all I have learned since I wonder a lot about which really came first. My parent both have diabetes and mental health problems so perhaps nature vs nurture as well? It makes life difficult for sure always gauging my mental and physical and emotional state at any time.

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