Struggling to manage difficult emotions and lows connected to diabetes is very common for people with both type 1 and type 2 diabetes, those who are newly diagnosed and those who have been living with the condition for many years.

Many of the challenges of daily life with diabetes or diabetes diagnosis can cause a whole range of emotional reactions including anger, hopelessness, fear, worry, bitterness, frustration irritability, guilt and shame.

It’s natural to feel low sometimes!

These are strong emotions and are usually experienced as negative, and it is natural to feel ‘low’ when having to deal with these alongside diabetes.

Feeling ‘low’ or ‘a bit down’ is different from feeling ‘depressed’, however depression is very common among people with diabetes and is unfortunately, often overlooked or not easily spotted by healthcare teams

Individuals with diabetes are twice as likely to experience depression as the general population. Coupled with this, it has been demonstrated that people with both diabetes and depression are far more likely to have poorer blood glucose management

So why do people with diabetes become depressed?

The daily tasks of managing diabetes can be a huge challenge – juggling medication, injections, blood glucose monitoring, regular clinic visits along with all the usual stresses of life can put people with diabetes at real risk of developing difficulties with low mood.

Not everyone with diabetes develops depression – why is this?

Depression is caused by a combination of biological, psychological and social factors.

This means that some people are more prone to developing difficulties managing low mood due to their family background; for example a family member with depression; and early experiences, for example bullying or lack of nurturing relationships

However, in addition to these psychological and social factors such as thinking styles, coping styles and the level of social support available also play an important role.

So what exactly is depression?

Depression is diagnosed when 5 or more of the following symptoms are present everyday for more than two weeks; and they interfere with daily routines such as work, diabetes self-care, childcare or social life

  • persistent sad, irritable or ‘empty’ mood
  • loss of interest in activities once enjoyed, including sex
  • significant change in appetite or body weight (gain or loss)
  • difficulty sleeping, waking very early (feeling sad) or oversleeping
  • feelings of worthlessness, helplessness, guilt
  • decreased energy, fatigue, feeling ‘lacklustre’
  • restlessness and irritability
  • difficulty concentrating and remembering
  • recurring thoughts of death or suicide

How many of these depression symptoms do you recognise in your own life? Although depression doesn’t just go away by itself, it can be successfully treated.

Cognitive behavioural therapy

Antidepressant medication can be useful, but research indicates that talking therapy, particularly Cognitive Behavioural Therapy (CBT), either alone or in combination with antidepressant medication, is very effective in tackling the symptoms of depression.

CBT was developed by the psychiatrist Aaron Beck in the 1960s. It proposes that there are four aspects to parts to depression – thoughts; feelings, emotions and moods; behaviours; and physical symptoms.

Aaron Beck and the psychology researchers that followed him, showed that by changing any of the components above, particularly our thinking patterns, we can begin to make positive changes to our experiences of low mood.

All of us, with and without diabetes have thoughts that are sometimes unhelpful.

It is human nature to be self-critical to some extent; it evolved as a way of keeping us striving to do better (which, in the harsh days of ‘survival of the fittest’, kept us alive!).

Some types of thinking are less helpful than others

However, there are certain types of thinking that are less helpful that people with diabetes can often find themselves engaging in. Some of these are listed in the table below:

Types and styles of thinking
Style of thinking Typical thoughts
Making rules Making a lot of rigid rules about diabetes, using words like ‘should’, ‘must’, ‘got to’ and ‘ought to’ (e.g. “I must have perfect diabetes control”)
Making extreme statements Using extreme words like ‘always’, ‘never’ and ‘typical’ to describe things (e.g. “I never get my blood sugar control right”)
Bearing all responsibility Taking total responsibility for things that may not totally be your fault (e.g. food choices when limited choice available, developing complications)
Catastrophic thinking Predicting that things will go wrong, or that the worst will happen (“Nothing I do can stop diabetes complications”)

This is one of series of Psychology articles by Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

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