Severe Depression

Can't help a lot as I don't know whether anti-depressants can cause blood sugar change. I'm slightly surprised by the twice a day injections; normally for T1 it would be more? Are these mixed insulin of a fixed amount? You can't easily carb count with mixed insulins. If depression remains due to poor blood sugar control then a discussion with the DN about a change to Basal/Bolus regime with perhaps 4-5 injections per day would aid blood sugar control BUT a depressed person may not be able to manage a more complex insulin regime so the right answer isn't obvious. I inject typically 4 times a day and may be measure only 2-3 times. That's lower than most people but I'm quite stable and predictable. The fact that the friend is overweight implies too much insulin and eating too many carbs to match?

As with everything, will have to test and see how the meds effect your friend. For me, I found I was having alot lower numbers and did need to adjust my insulin to lower amounts. my type 1 happened first, depression followed after, though not immediately. During the time I was on basal/bolus my numbers were higher, especially in mornings, which, I think was the main contributer to my depression, and found a pattern in which sustained good periods of mood coincided with better readings. Did the better readings alone influence my mood, honestly dont know, maybe. Would if possible, use a basal/bolus, due to greater flexibility, and.hopefully better readings as said above, and test more often should your friend feel able to swap to this, and, during the change of insulin routine would recommend testing pre meal, 2 hours after, pre bed, and if driving, pre getting in the car. Best wishes to your friend.

Type 1, pumping nova rapid

T1s get dawn phenomenon.

Your friend is on an old school regime that needs her to eat fixed amounts of carbs at set times. Does she know how many carbs she is supposed to eat at each meal?

Depression and poor diabetes control affect each other and need to be treated together, ideally, by staff who understand both conditions.

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Thanks for the updated info. As Spiker says, the current insulin regime may be OK for starters but really needs to change over the coming weeks if it is to provide better control and enable eating more freely which may in itself help with the depression. It is easy for me to comment from afar not knowing all the facts, but if you can get the attention of HCPs who fully understand depression and insulin regimes it will help to agree the best way forward

Are you sure we are not talking about a T2 who has progressed to needing insulin in the last two years?

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Antidepressants have actually been associated with the development of T2: It's mentioned as a side effect here with a link that discusses it in more detail. http://www.nhs.uk/Conditions/Antidepressant-drugs/Pages/Side-effects.aspx

Whatever type she has, the twice daily biphasic regime that she is using needs a regular diet in terms of timing of meals, of exercise and consistency of carb content .
You cannot simply alter it to accommodate more or less carbohydrates. Both basal and meal time insulin are included in the same injection. If you reduce the carbohydrates and reduce the insulin then there may not be sufficient insulin to act as a basal , glucose levels may rise between meals and overnight. If you don't reduce the insulin then insulin levels may be too high for meals and cause hypoglycaemia. Any changes have to be gradual This leaflet shows how it works and how this type of insulin is adjusted
http://www.nhslanarkshire.org.uk/Se... Adjustment for twice daily mixed insulin.pdf

However, it is really something that she should be discussing with her HCP.

If her sugar is all over the place, then Novomix is obviously not working for her. I had similar problem when I was put on Novomix right after diagnosis - my sugar was not even close to normal. The dose was not enough to cover my lunch, so I was getting high after it. My DN suggested upping the dose, but that caused hypos after breakfast. So I had to eat 2 breakfasts to cover for the hypo, and the dose was still not enough to cover my lunch. This causes big swings in BG and I was gaining weight (I was eating too much to cover the morning hypo!). The swings and high BG caused me to feel terrible (both physically and mentally). I was changed to basal-bolus and it works great for me. I was certanly having mood swings - from bad to good when my sugar was swinging like that.

If may be useful to talk to the DN about changing the regime - if your friend agrees to doing 4 injections per day. I wouldn't worry sbout antidepressants effect on the BG - with basal-bolus is easy to simply change the dose as needed to cover for any effect like this.