DIABETES AND DEPRESSION – A CRY FOR HELP

“The mind is its own place, and in itself, can make heaven of hell, and a hell of heaven”.

“Let’s talk”, launched on April 7th, 2017, with a spotlight on depression, seems to be a fitting theme on World Health Day. According to WHO statistics, nearly 350 million people suffer from depression worldwide and it is also the leading cause of disability. Those suffering from any chronic illnesses such as kidney and heart disease, lupus, HIV/AIDS, and, of course, diabetes, are more prone to depression.

Depression is twice as common in people with diabetes. The problem is bifacial; those with diabetes are at increased risk of developing depression, due to its chronic nature and subsequent complications, while those who are depressed are at risk of getting diabetes. The predominance of poor lifestyle decisions, unhealthy food habits, smoking and alcohol, less physical activity, and weight gain when one is depressed, are all risk factors for diabetes.
The rise in incidences of depression could be due to the pressures of modern living, materialism, a competitive environment, occupational and family demands. Physical and mental health are closely interlinked which is why diabetes and depression can be a double whammy. Depression can be attributed to many factors, such as genetic, brain biochemistry, stressful life events, trauma, and strained interpersonal relationships, apart from chronic stress.
Diabetes and depression can be likened to two sides of a coin, wherein there is a biological and behavioural link. On the one hand, the over-activation of stress hormones, such as cortisol and ACTH can aggravate sugar levels. On the other side of the coin, lack of self-care, which is invariable when one is depressed, can lead to poor health outcomes. Some individuals may get overwhelmed with the challenges of managing diabetes on a daily basis, which can lead to depression.

What is depression and what are the risk factors?

It is normal to feel grief at the loss of a loved one, or show emotional reactivity to some distressing situation, but when it takes longer than usual to return to normal, look out for warning signs. If it has been at least 2 months since a major life event has occurred, or if there has not been any such major life event but one is experiencing several of these symptoms, it may be DEPRESSION:-

Feeling sad or empty most of the time for at least two weeks.
Diminished interest or pleasure in the usual activities.
Crying spells without reason.
Low self-esteem or feelings of guilt.
Difficulty in sleeping or excessive sleepiness throughout the day.
Poor appetite or eating excessively.
Unusual fatigue and loss of energy.
Difficulty concentrating on normal activities.
Feeling agitated, lethargic or slow.
Weight gain or weight loss, without any effort.
Recurrent thoughts of death or suicidal ideas.
If these symptoms are generally making one feel dysfunctional by coming in the way of social and personal relationships and hindering one’s responsibilities at work, one could be depressed.

Risk factors for depression include:
Family history of depression
Abuse, either physical, sexual or emotional
Death or loss of a loved one
Conflict due to interpersonal relationships, outside or within the family
Major life events such as marriage, losing one’s job, divorce, relocating, etc.
Certain medications taken for other conditions may trigger depression.
Apart from these, studies have shown that women and older people are more vulnerable and likely to get depressed.
Those with diabetes should be screened for depression regularly, as it can largely go undetected. Hence, appropriate detection and early intervention will help resolve complex health problems. In the larger picture, self-management and good control of diabetes could decrease the risk of depressive symptoms and complications.
Despite so much progress and awareness regarding treatment of depression, prognosis continues to be poor, perhaps due to the following reasons:

Stigma regarding ‘mental illnesses’
Feelings of worthlessness and failure that prevents one from acknowledging that one is depressed.
Financial constraints that act as a barrier to effective treatment.
Negative perceptions about side effects of anti-depressants.
Management of depression:
Management of depression and diabetes should be a collaborative effort which involves the following aspects:
Professional help.
A combination of cognitive behavior therapy and medication has been found to be effective in combating depression.
Social support from family, friends and support groups help in lessening feelings of isolation.
Proper adherence to the diabetes regimen in the form of healthy diet, regular medication and physical exercise.
Regular assessments by the concerned physician as well as mental health professionals have the twin benefits of alleviating feelings of depression as well as controlling sugars.

Apart from all these, involving oneself in pleasurable activities and following a structured lifestyle will be greatly beneficial for those who are going through ‘low’ phases. However, despite one’s best efforts, sometimes it’s easy to be weighed down by lethargy and low energy levels due to diabetes and depression. So do set realistic goals for yourself, take small steps, stay motivated, and do not give up! As Margaret Thatcher put it, “You may have to fight a battle more than once to win it.”

UNDERSTANDING INSULIN RESISTANCE – THE KEY CONSPIRATOR

UNDERSTANDING INSULIN RESISTANCE – THE KEY CONSPIRATOR

Don’t be scared about the highly technical terminology. I would make it easy for you to understand what it means and how to remain healthy.

Human body, though a very complex machine is not that difficult to understand. I have made it easy for you to understand in my earlier article –

Simplifying the most complex machine – human body

The body has an inbuilt mechanism to maintain energy balance. Any interference from our end leads to weight gain and the same is explained in another article –

Why am I putting on weight?

Role of Insulin

Glucose is the basic source of energy for every cell of the body. The glucose generated through digestion of carbohydrates in our food reaches cells via blood. Now at the level of cells for uptake of this glucose another component is required and that is insulin. Insulin is a hormone produced in our body by pancreas. This is an inbuilt check to ensure that glucose enters the cells only if required. The excessive glucose gets converted to fat and is stored as reserve largely in abdomen.



What is insulin resistance?

Insulin resistance is a condition in which though body has a sufficient amount of insulin it is not able to function properly. It means that for completing its task (which is uptake of glucose by cells), body would require larger amount of insulin. Its analogues to have incompetent people in an organization, you would need more people to complete the same task that can be done by fewer people.

What causes insulin resistance?

There are number of causes that lead to insulin resistance including genetic factors. A person with his first degree relatives having diseases like diabetes, heart disease etc would be at higher risk of having insulin resistance. Genetic factors are beyond our control.
Additionally there are number of other external factors that we can intervene with. Obesity specifically abdominal obesity is the biggest risk factor. There are number of scientific publications on this issue. I have proposed a simple marker to identify if you are having abdominal obesity – Index of central obesity. All this research papers can be accessed here.

The simple message from all this research is that limit your waist size to half of your height. If you are 5 feet 8 inches tall (68 inches), you should limit your waist size to 34 inches.



How does insulin resistance harm you?

Insulin resistance is the key conspirator behind number of diseases. People with resistance would need more insulin in their blood for proper uptake of glucose. This would lead to burden on pancreas leading to deficiency of insulin which will lead to diabetes. Additionally high levels of insulin in blood lead to atherosclerosis (thickening on your blood vessels) which causes blockages in arteries. If the arteries supplying your heart are affected, you can get heart attack, if the arteries supplying brain are affected, it can lead to paralysis. High levels of insulin in blood also lead to cholesterol problems which further increase risk of atherosclerosis. Disease like kidney failure, gangrene etc are also largely due to atherosclerosis. This conglomeration of various risk factors is called metabolic syndrome.

How to prevent and treat insulin resistance?

The best way to prevent insulin resistance is controlling your tummy size – limit your waist size to half of your height.
Control your weight. The ideal weight can be simply calculated by subtracting 100 from your height in cm. If your height is 176 cm, the ideal weight for you is 76 kg.
Regular exercise is improves the sensitivity of insulin. Daily brisk walk of 45 minutes is ideally recommended, more the better.
One should take healthy diet with less of fat and high proteins. Simple carbohydrates (sweets) should be avoided.
Insulin resistance is treated by physicians using drugs like Metformin.


Conclusion

Simply by understanding the basics of Insulin resistance, you can prevent or treat it before it causes deadly diseases like diabetes, high blood pressure, heart attack, paralysis etc. Control your weight, limit your waist size, have a healthy diet and exercise regularly, that’s the key to being healthy.

How I Keep Stress From Affecting My Diabetes - Sweet Clinics

How I Keep Stress From Affecting My Diabetes

A few health issues, a couple of family worries, general anxiety about the state of the world. And while I know I’m not alone, I also know that stress can spell particular trouble for people with type 2 diabetes, raising blood sugars and making it more difficult to stay on track with medications, diet and exercise.

It can also lead you to reach for food, alcohol, or cigarettes. Anything to calm you down.

In the old days, my anxieties turned me to food. I would do okay during the day – I counted carbs and calories and avoided sweet treats. But around midnight, stressed out and unable to sleep, I’d find myself standing before the open refrigerator, scanning the shelves for something, anything to eat. Cold pasta, left-over cheesecake, cake icing from a can.

This habit locked me in a vicious cycle: up until one or two a.m., by morning I’d rise exhausted with higher than normal sugars, which made me more irritable and anxious and even less able to cope with my stressors.

Since that time, I’ve uncovered a few tactics to help me avoid the refrigerator blues. While I don’t always succeed in managing my anxieties, I try not to let them sabotage my diabetes care. They include:

Be kind to yourself.  If you’re stressed, you’re probably also deep into self-criticism, telling yourself you should be stronger, calmer, more in control and on and on. But this is the time to see the positive, even if it means sticking Post-It affirmations on your bathroom mirror to keep you in a better frame of mind.
Up your self-care. Remember those lemon scented candles you got from your cousin for Christmas? Now is the time to put them to use, along with a foot rub from your husband or a pedicurist and a long bathtub soak. Treat yourself gently and well.

Question yourself. Before undermining your diabetes care, ask if eating that ice cream bar is truly in your best interest, and whether it is going to make you feel better. If not, try to think about what might truly help. Writing down your thoughts in a notebook might be useful, as could talking problems over with a friend or a therapist.

Get moving. By now everyone knows that exercise relieves stress. If you’re in an exercise program, don’t stop. But if you’re feeling too worked up to follow a high energy regimen, go for something that you can handle at the moment. Think slow nature walks, yoga, or tai-chi.

Consider meditation. Mindfulness meditation has been scientifically proven to lower your heart rate and cut stress.  And it’s really not hard to begin. For me, I simply remain in bed for five to ten minutes before I rise, close my eyes, relax my body and concentrate on keeping my mind clear. As stray worries drift by, I observe them neutrally, then let them go. At first it may seem strange and unfamiliar, but if you keep with it, it really can help.

Staying calm isn’t easy. Stress – good and bad -- is part of life. But if it’s getting in the way of your diabetes care, talk to your doctor. Nothing is worth more than your good health.