18 Responses

  1. Joseph Kousa, MD
    Joseph Kousa, MD May 23, 2011 at 8:50 am | | Reply

    Controlling the blood sugar and achieving average 120-150 mg/dl with A1C below 7.0 should help manage depression. Also we find large number of people deficient in vitamin D3 which is otherwise silent. Make sure the level is checked and deficiency corrected. Otherwise, I think patients with depression should be promptly diagnosed and managed by a professional.

  2. Carol
    Carol May 23, 2011 at 10:05 am | | Reply

    Just tell me how to get rid of the diabetes and the depression will be gone as well.mis

  3. AmyT
    AmyT May 23, 2011 at 12:04 pm | | Reply

    @DrKousa – that’s a bit insulting. You make it sound easy to simply “achieve average 120-150 mg/dl with A1C below 7.0.” Any idea how freakin’ difficult that is for some folks?!

    Also, the point is that it’s a vicious cycle: poor BG results lead to depression + depression leads to poor BG results.

  4. Barbara
    Barbara May 23, 2011 at 12:20 pm | | Reply

    Well said, Amy! Thanks! As one who struggles with T1 and depression, the last thing I need a doc to say is: “if you’d keep your blood sugars under perfect control, you’d not be depressed”. I’ll get right on that.

  5. Joseph Kousa, MD
    Joseph Kousa, MD May 23, 2011 at 2:11 pm | | Reply

    Thank you for your response. I agree with you one hundred percent. On the other hand, depression may cause a person to lose interest and not take care of themselves. Like you said it is a vicious cycle. The good news is that for most people it is not hard to achieve HGB A1C below 7.0. You know something .. there is a good way to do things: Follow a process, due diligence. Have a good doctor and a good dietician, arm yourself with knowledge and education and go about in your business solving the most difficult problems like a breeze. Please do not feel insulted. I learn myself every day and love learning. I face challenges and sometimes I am defeated, but still love facing them and resolving issues. Wish you the very best.

  6. Diabetty
    Diabetty May 23, 2011 at 5:34 pm | | Reply

    It’s really nice to see someone addressing this issue. I’ve been struggling with depression for about half my life, and although I’m fairly new to diabetes (dx late November 2010), I can definitely see the correlation between mood and control. When my mood is low, I’ll tend to either binge on carb-heavy foods (toast, cake, cookies, and especially pasta) or skip eating altogether until I feel woozy. Not good. I consider myself lucky in that I can keep my depression under control most of the time without medication, but I’m definitely concerned about diabetes burnout.

  7. T1 in Boston
    T1 in Boston May 23, 2011 at 9:10 pm | | Reply

    “for most people it is not hard to achieve HGB A1C below 7.0. ”

    Hmmm, so let’s see here…

    -Follow a process – check!
    -Due diligence – check!
    -Good doctor – check!
    -Good dietician – check!
    -Loves learning – check!
    -Education – check check!
    -Knowledge – check check check!
    -Takes all challenges like a breeze – checkeroo!

    Hmmm. Dang, then why was my last A1c above 7.0 then?

    Oh, I know what it must be, it must be because…. I have Type 1 Diabetes!!!

    Our dear Dr. Kousa, you do not sound to us like a Type 1 Diabetic. If only you knew what it was like. If only you could possibly understand. If only.

  8. Natalie Sera
    Natalie Sera May 23, 2011 at 10:22 pm | | Reply

    Great column! Just wanted to mention that there are lots more antidepressants than the tricyclics, which are really rather old-fashioned. Even the SSRI (Selective Serotonin Reuptake Inhibitors) have been around for quite a while. And there are new ones, like Cymbalta (which is also used for neuropathy), Celexa, Lexapro, and more, which I don’t know the names of. The reason I bring this up is that if one drug doesn’t work, there are MANY others to choose from. Don’t give up if the first one doesn’t work.

    As a life-long sufferer of depression, I also heartily agree with your advice about finding a good therapist. The key word here is GOOD. There are a lot of crummy ones out there; I tried 4 of them before I found my current one. He doesn’t know much about diabetes, but he DOES know about feelings, and how to help me express them and get to the root of them.

    I do agree with Dr. Kousa that BG control is paramount. I wouldn’t specify a number, but last year, I had a major depression, and started bingeing on carbs, and periodically omitting insulin, and ended up in a coma that almost killed me. What I learned from that experience is that, whatever else I DON’T do, like the dishes, the laundry or the cat boxes, I WILL take care of my diabetes, because once the diabetes is wildly out of control, it’s impossible to take care of any other aspect of your life. If you even have to be hospitalized because you are not taking care of your diabetes, then do it — the alternative REALLY isn’t worth it.

  9. Wicked Diabetic
    Wicked Diabetic May 23, 2011 at 11:31 pm | | Reply

    We have found that the don’t do’s have added to depression. Although there are physical reasons for feeling depressed it is important to remember to have fun and live life to the full. Be indulgent at times and remember that you are human and deserve to be happy!

  10. AmyT
    AmyT May 24, 2011 at 6:20 am | | Reply

    @T1 in Boson – Thank you for that! Clearly, plenty of doctors out there do not have a CLUE what their diabetic patients are dealing with on a day-to-day basis. Ugh!

  11. Be your own advocate; Control your diabetes life - The Diabetic Underground : The Diabetic Underground

    [...] The 411 on Depression + Diabetes ( Share this:FacebookDiggRedditStumbleUponEmail [...]

  12. Health as a Human Right
    Health as a Human Right May 24, 2011 at 1:21 pm | | Reply

    Thank you for this post. The co-occurrence of mental health illness with a chronic health condition is profound and has serious consequences. You give great suggestions for type 1′s to seek treatment through therapy and medication. There are several options.

    I might add that in addition to depression other mental illnesses pervade those with disabilities including anxiety and eating disorders. The confluence of factors that contribute to each of these mental health illnesses in someone already dealing with a chronic conditions can wreak havoc on one’s ability to care for themselves.

    It’s quite a difficult road – being depressed about having diabetes, being anxious about perfect blood sugars and what the doctor will chastise you about or struggling to accept your body with type 1. Unfortunately, there is no “checklist” there is no easy answer. An A1c of 7.0 may be really difficult for some to reach – don’t judge that person because they may have other difficulties they are struggling with. Another person could take another extreme and obsessively attack their diabetes – it also may not be the healthiest way to live even if the numbers are perfect. And then again, having an A1c doesn’t necessarily help depression. Sure, A1c’s have an effect on mood but depression is a serious medical condition that will continue no matter what your A1c is.

    Vitamins, supplements, medicines and therapy can be a great help – so find a doctor or therapist you trust. Unfortunately many of our endocrinologists and other doctors don’t address the mental health part of type 1. They focus on the rigidity of numbers to the detriment of deeper issues. So if you are not getting anywhere with your doc, keep asking elsewhere. There is help out there.

    To find out more about Mental Health Illnesses, go to:
    - National Institute of Mental Health (
    - Mental Health America (
    - American Psychology Association (linked above)

  13. Joseph Kousa, MD
    Joseph Kousa, MD May 25, 2011 at 9:33 am | | Reply

    Having depression with diabetes adds to the complexity of the problem. The good news is 1) This can be hard but not impossible. 2) There is plenty of help out there. 3) If you live in the United States, then you are blessed with access to the latest achievements of mankind in the last one million years in terms of medical care and yes this is the best county in the world period and we are blessed to live here amongst the nicest people like yourselves. 4) Never give up. Instead get up and get the help you need and your life will be better and enjoyable again despite diabetes and depression. Depression is a brain drain out of neuro-transmitters that can be replaced with modern medications.

    Thanks to every one in this column for their responses.

  14. Joseph Kousa, MD
    Joseph Kousa, MD May 25, 2011 at 9:38 am | | Reply

    I meant to mention that we find large number of patients deficient in vitamin D even in the summer months. As you might know, vitamin D deficiency is linked to depression. Normalizing vitamin D level will eliminate depression as a contributory factor in the incidence of depression. It will enhance your mood, give you energy and make depression treatment easier. Other benefits of vitamin D is that it also modulate the immune system, helps you prevent and fight infections ( common colds and UTIs) and helps prevent cancer. Diabetics as you know are immune-compromised and a boost in the immune system is a welcome step.

  15. MariaCDE
    MariaCDE May 26, 2011 at 6:32 pm | | Reply

    Thanks for this very informative and important discussion. It’s completely normal to feel down every now and then, but if it persists it’s important to seek help. Very nice post!

  16. dave Jeffords
    dave Jeffords May 27, 2011 at 10:09 am | | Reply

    Only one organization in the world is dealing with Diabetes and Depression. It is the San Diego based Behaviorial Diabete Institute . One of thier board members is at UCSF treating patients with depression and diabetes. Check them out for ressources on line and workshops too..

  17. Holli Moreno
    Holli Moreno May 30, 2011 at 11:34 pm | | Reply

    “Depression, like diabetes, is manageable and treatable if you get help, so don’t wait. Whatever you choose to do, just know that you are not alone!”

    Great encouragement. There certainly are help out there. :)

  18. Wendy L.
    Wendy L. June 14, 2011 at 12:41 pm | | Reply

    Chicken or egg, when too many lows hit the same brain center as booze would, and does. Why do not these Doc’s understand too many lows also contributs to this low depression. Also depression in the DSM is tagged with Major Medical Disease. Personlly having an added tag or lable is more burdensome then understanding, the constant DOING diabetes requires food carb counting, finger sicks, injections, cooking food, running for the glucose tabs, when the lows come.

    Or when MD turns face and says all of medical complications are just the diabetic’s bad Karma. A1C 6.1-5.3 five plus years, weight loss 50+ Lbs, till this Karma crap. If MD doesn’t care, or blames paitents for this and other auto immune disease, hard to stay motivated. Harder still when other doc’s close the practice, or wait 6-12 weeks to get into new doc, will this new one be kind, caringing or judemental.

Leave a Reply