Diabetes’ link to mental health

Despite being diagnosed with gestational diabetes during her first pregnancy in 1993, New York resident Isabelle Edwards neglected her doctor’s diabetes and weight-management advice. Soon, she was diagnosed with full-blown type 2 diabetes.

But Edwards, who was in her mid-twenties at the time and had no signs or symptoms of the condition, continued to remain in denial. Result: she developed several complications, and even had to have her right leg partially amputated.

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By the end of the amputation procedure, Edwards had lost her career and home, and become physically weak, mentally strained and broke.

But she didn’t let that be the end of her story.

“I became a keynote speaker, travelled nationally — sharing my story — and was given the name ‘The Diabetes Diva’,” says Edwards, who is now 54. “By day I was a cripple and by night I was out publicly bringing diabetes awareness at open mics, [through] my podcast radio show and in the neighbourhood of Capitol Hill.”

Diabetes and depression

Though a determined Edwards managed to bounce back, Prof Dr Pradeep Talwalkar, a senior diabetologist from Mumbai, says depression is two to three times more common in people with diabetes.

“If you are depressed, you find it difficult to control your blood sugars, and if your sugar levels are not controlled, you become depressed,” he says. “Unfortunately, [among] diabetics, 25 to 30 per cent people do not seek professional help for mental health.”

He says many lose self-esteem because of the several restrictions on their physical activities and lifestyle. ” As diabetes is a lifelong and costly disease, many people face financial burden, which leads to more depression,” says Dr Talwalkar.

Mental-health issues aren’t limited to people with chronic diabetes — they can also affect those who have been recently diagnosed with the condition.

Dr R Vasanth, a psychiatrist at Fortis Malar Hospital, Chennai, says a person who has been recently diagnosed with diabetes has to undergo several significant lifestyle and dietary changes and take several medications.

“A person with severe depression may not be in a state of mind to indulge in physical activity [and] cook a good healthy meal, and this can lead to improper glycemic control,” he says. “The body metabolism also slows down. A lot of endocrinal changes happen that can reduce sugar tolerance in the body.”

Diabetes and mental-health issues

Experts says people with diabetes can develop the following mental health issues:

• Depressive disorder
• Anxiety
• Low self-esteem
• Somatic complications like aches and pains
• Insomnia
• Mood swings
• Substance abuse disorder

Dr Pradeep says mental health issues are more prevalent among those with chronic diabetes since they have been living with the disease and its complication longer than others.

“Elderly people with diabetes are so depressed that they sometimes refuse treatment and hospital admission since they do not want to be a financial burden on their family,” he says, adding that adolescents are affected too. “When they see other kids playing and going on excursions, they feel restricted, and it affects them. If insulin-dependent, they sometimes pretend to take insulin out of anger, worsening their sugar levels.”

According to a Stanford study — ‘Incident Major Depressive Disorder Predicted by Three Measures of Insulin Resistance: A Dutch Cohort Study’ by Kathleen T Watson, Julia F Simard, Victor W Henderson et al — published in the American Journal of Psychiatry in 2022, surrogate measure of insulin resistance showed an 89 per cent increase in the rate of major depressive disorder incidents.

“Here, we see that insulin resistance, a relatively prevalent disease that frequently precedes type 2 diabetes, is associated with a higher incidence of depression,” Watson told Happiest Health in an email interaction. “In this study, triglyceride-HDL ratio serves as an easy-to-measure surrogate for insulin resistance.”

Watson, who is a postdoctoral scholar, department of psychiatry and behavioural sciences, Stanford School of Medicine, said it was somewhat unexpected that insulin resistance led to a significantly increased rate of depression over a nine-year follow-up period.

Tips to improve mental well-being

Dr Vasanth says both diabetes and mental health can be treated concurrently and managed. Some simple ways to improve mental health are:

• Regular physical exercise can help both mind and body
• Balanced and nutritious meals
• Developing a hobby. Learning a new skill that can help you relax and unwind from daily stress.
• Spending time with family and friends. At least have one meal a day with the family.
• Getting good and adequate sleep of about six to eight hours.

Dr Pradeep advises caution for those using antidepressants. “Some antidepressants can [lead to an] increase in weight,” he says. “[And] if the weight increases, the insulin resistance increases.”

Mental health issues, if left undiagnosed, can worsen diabetes and lead to vascular complications, which can reduce the quality of life and lifespan, and increase the cost of treatment. “The cost of treatment of health complications due to diabetes is several times higher than the cost of treatment of diabetes,” says Dr Pradeep. “This forces people with diabetes to depend on the younger members of their family. They notice that their family income has been affected, which in turn [can] cause depression.”

Edwards, the New York resident, says her life shows one should not give up. In fact, she ended up discovering her calling: speaking up for the disabled community and spreading awareness about diabetes.

Having realised after the partial amputation that she could not ‘really’ walk or drive, Edwards one day prepared to discard all her footwear. But she then came across an old favourite pair and decided to try them on one last time.

“Well, little did I know that I was able to walk and stand better in stilettos than on my bare feet,” she says. “To my surprise, I stared waking around the room. Over time, I was strutting. It was crazy! It was like I had a superpower.”