Depressed People With Diabetes: Blood Sugar Risk?
Experts say biological changes or a lack of interest in self-care might be to blame
The risk of hypoglycemia was unaffected by the type of treatment received. People taking oral medications were just as likely to have a hypoglycemic episode as those taking insulin, according to the study.
Overall, people with diabetes who were depressed had a 42 percent greater risk of having a severe hypoglycemic episode, and a 34 percent higher risk of having a greater number of hypoglycemic episodes.
Katon said there are two likely explanations for these increased risks. One is that depression leads to psychobiological changes that cause big fluctuations in blood sugar levels, which may make it harder to prevent low blood sugar levels.
The other possibility is that depression leads to a lack of interest in the self-care that's necessary to manage diabetes well. "People who are depressed may be less likely to test their blood sugar levels regularly. They may adhere to their medications less well. They may forget if they've taken them, and then end up taking an additional dose," said Katon.
Another expert, Eliot LeBow, a therapist with a diabetes-focused practice in New York City, and a type 1 diabetic himself, agreed that "depression can affect a person's ability to manage their diabetes." But, he said there was an important piece of information missing from the study: how much diabetes education a person has had. People who've had more diabetes education would probably be less likely to have a severe hypoglycemic episode, LeBow suggested.
He also noted that high blood sugar symptoms can look a lot like depression symptoms. "Sometimes, when you make a few changes in how someone is managing their diabetes, their depression may lift," said LeBow.
Both experts agree that people with diabetes who are depressed need to get help. And, fortunately, there are treatments available -- psychotherapy and medications. Katon said there are depression medications that don't significantly affect blood sugar levels.
According to the U.S. National Institute of Mental Health, depression symptoms include:
- Long-term sadness, anxiety or hopelessness.
- Feelings of guilt and worthlessness.
- A loss of interest in activities you once enjoyed.
- Sleep and appetite changes.
- Trouble remembering things.
- Difficulty concentrating or making decisions.
Although the study found an association between depression and greater risk of hypoglycemic episodes, it did not prove a cause-and-effect relationship.