- Binge eating
- Missing insulin injections to lose weight
- Missing insulin injections
- Depression as a consequence of diabetes
- Two screening questions for depression
- A score to assess depression
- Depression & eating disorders contributing to diabetes
- Stopping smoking reduces depression
- Birmingham Healthy Minds self-referral
Eating disorders and mental health problems in diabetes
Eating disorders and mental health problems are very common in diabetes. This ofen leads to retinopathy. Here are some examples of problems and helpful sites for patients.
A psychologist (or dietician or diabetes specialist nurse trained in psychological techniques) really needs to advise and help people with any of these problems, unless they are very mild.
In North Birmingham we have very little support available from psychologists except for patients with the severest problems, but the WHO recommends a far greater availability and psychologists should be available to help everyone with diabetes.
Addicted to eating
This is common in type 1 diabetes, affecting 10% of men and 25% of women. See. Counselling helps...but discuss this with your doctor or nurse first; medical treatment is needed if you have a severe problem counselling & /binge eating
Missing insulin to lose weight
Many people with diabetes notice they may gain weight using insulin. There are a number of reasons for this, including
- too little exercise.
insulin to aid weight loss. Missing insulin does
help people lose weight, but the HbA1c rises often above 10%, and results in severe retinopathy etc..
This problem needs expert help from the diabetes team or an expert psychologist.
- a diet high in refined carbohydrate and fat, (hamburgers, for example) increase hungers and over-eating, and weight gain. Eating a diet with more fibre and less energy dense food helps you feel full more quickly.
- See young people & eating disorder & Children with diabetes.
This is common. Again, expert advice is needed. This is more common at times of stress of if you are depressed. If anyone is on well designed insulin regime, such as lantus/rapid acting insulin, and their diabetes is not controlled with a high HbA1c, it is likely they are missing injections, possibly deliberately.
Depression as a consequence of diabetes.
Two screening questions for depression
- During the past month have you been bothered by feeling down, depressed, or hopeless?
- During the last month have you often been bothered by having little interest or pleasure in doing things?
- If patients answer yes, ask if help with their problems would be appreciated.
This is common also. Expert advice is needed. See . Score your depression, see the table below. It is more common if neuropathy or any other diabetic complication is present, or if a person has other medical problems.
Cognitive therapy is very helpful for depression, and has been highly recommended. If you are depressed, ask your doctor for this treatment. Depression needs to be treated to achieve good control (DC 09).
People with diabetes who are depressed achieve better control and better health with from care provided by diabetes nurses who are also trained in the treatment of depression (a short 2 day training program), with consultations every 2 weeks initially. Such care is sporadic in the UK NEJM 2011.
A score to assess depression
- Depression? patient-health-questionnaire-phq-9
- 2 Questions
- during the last month, have you often been bothered by having little interest or pleasure in doing things?
- during the last month, have you often been bothered by feeling down, depressed or hopeless?
- both yes=possible depression; both no = no depression
|Becks Depression Score See A twenty-one question survey completed by patient|
|Answers||Interpretation of score||Questions|
Depression & eating disorders contributing to diabetes
Some anti-psychotic drugs contribute to diabetes. But more importantly number-wise is the fact that many forms of over eating or obsessional eating (such as eating lots of chocolate) may contribute to obesity and thereby type 2 diabetes.
Many people eat when they get fed up, but when this causes obesity naturally
it can lead to diabetes. In theory many eating disorders can be prevented.
If you like to eat when you are fed up, stick to fruit or salads or other high fibre food. If you start to become overweight then expert help early will prevent more serious problems later.
Depression may have a profound influence on diabetes and its complications. For instance
- Patients are more likely to present late
- Less likely to walk/keep fit.. higher blood pressure as a result
- Less likely to test glucose, adjust insulin does, see doctor for check-ups
- More likely to smoke (this is an antidepressant) and drink (addiction)
- Depression can contribute to diabetes Golden.
- Depression and diabetes.
Other problems contributing
Many mental health conditions exacerbate diabetes. For instance, agoraphobia most can be treated with cognitive therapy, though the more severe conditions may need drug treatment in addition.
Not 'accepting' diabetes
This is common. This can lead to many problems. Many people deny they have diabetes, and do not make a major effort to control it. This leads to serious retinopathy and poor sight. Psychological treatment is needed form a psychologist at an early stage. Unfortunately many such people refuse to consult a psychologist...this is a major public health problem.
5 steps to happiness
- connecting with friends and family
- learn something new
- be active
- take notice.. enjoy the present
- helping friends & strangers
- from guardian.co.uk
- Stopping smoking reduces depression BMJ 2014. Smoking increase depression significantly.