Life with diabetes can be tough. In the busy setting of the Diabetes Clinic,
discussions about managing diabetes can often focus solely on the medical
and physical aspects, however it is common to have a whole range of
emotions towards diabetes. You may experience anger, frustration, guilt,
hopelessness, fear, shame, rage, bitterness, irritability, despair, fright, fear
and worry, among others. These difficult feelings can easily be overlooked.
Along the with the obvious physical impact, diabetes affects our:
- Emotions – moods and feelings
- Thinking – about ourselves, others and the future
- Behaviours – the things we do or don’t do
- Our relationships with other important people in our lives
Experiencing difficult emotions connected to diabetes is very usual and
depression can be an often overlooked problem. Depression has been
found to be very prevalent among people with diabetes, in fact individuals
with diabetes are twice as likely to experience it as the general population.
Furthermore, despite findings that people with both diabetes and depression
are far more likely to have poorer blood glucose management; the
report, “Diabetes: State of the Nations” (2005), published by Diabetes UK,
highlighted the lack of recognition and psychological support for people with
What is Depression?
Depression is different from feeling ‘a bit down’ or ‘low’. Depression is
• Five or more of the following symptoms are present every day 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.
Why do people with diabetes become depressed?
Depression is caused by a combination of biological, psychological and social
factors. This means that some people are more predisposed to developing
depression due to family background and early experiences, but factors such
as thinking styles, coping styles and the level of social support available
are also crucial. The daily requirements 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.
How Is Depression Treated?
If you recognise yourself in the list of depression symptoms above then you
are not alone. Although depression doesn’t just go away by itself, it can be
successfully treated. Antidepressant medication can be useful, but research
indicates that therapy, particularly Cognitive Behavioural Therapy (CBT),
either alone or in combination with antidepressants, is very effective in
tackling the symptoms of depression.
What is Cognitive Behavioural Therapy?
CBT was developed by the psychiatrist Aaron Beck in the 1960s. It proposes
that there are four interrelated aspects to depression:
1. Thoughts and thinking styles (‘cognitions’)
2. Emotions and Feelings
3. Behaviours – what we do or don’t do
4. Physical symptom
The theory of CBT recommends that by changing any of the components
above, particularly our thinking patterns, we can begin to make changes to
Unhelpful thinking in depression and diabetes
Everyone, with diabetes or not, has thoughts that are sometimes unhelpful.
When you feel depressed or low, you might like to try and get into the habit of
becoming aware of the thoughts you are having when you notice your mood
changing. Writing down your thoughts may feel like a lot of effort, but it can
really help you to capture and explore your styles of thinking, and see which
are helpful and which are less so. Below is a 5-step process that you can use
to assist you.
5 Steps to Challenging Your Thoughts
Step 1: What is the Situation or Event?
For example, measuring your blood glucose level and it being higher than you
Step 2: What do you tell yourself? What are the thoughts you notice
running through your mind?
“What have I done wrong? I can’t do this. I’m a failure.”
Step 3: What is happening in your body and what do you do?
• Mood – hopeless
• Body sensations – low energy, feel sick, dry mouth
• Behaviours – snapped at my partner
Step 4:Challenge Your Thoughts
Ask yourself some helpful questions:
• What is the evidence for and against this thought?
• Is thinking this way helping me?
• Are there other ways of thinking about this situation?
• If a friend told me they were thinking this way, how would I respond?
• Am I thinking in ‘all or nothing’ terms?
Step 5: Come up with an Alternative, Balanced Thought
• I have tried but just because I haven’t got the result I wanted it doesn’t
mean that I’m a failure.
• If a friend was feeling this way I’d help her think about what she could
do differently next time, or suggest she phone her diabetes nurse to
ask for advice.
You’re Not Alone
When you first begin to examine your thinking styles it is likely to feel
unfamiliar, however like any skill you have learned, with practice it will feel
easier until you are naturally having more supportive, constructive thinking
styles. However, many people gain from the support of a Psychologist or
Counsellor, so you might like to talk to your GP about a NHS referral or
investigate seeking a private therapist for yourself.
Other ways to manage your thinking
As well as CBT there are other ways you can help yourself through
depression. Becoming more physically active can have a positive impact
on your diabetes control as well as your mood. Finding time to relax can
be very helpful. But equally important is that you find ways to increase your
pleasurable activities – life with diabetes can be hard work so make sure you
have time to inject a bit of fun into your life!