Preventing High Blood Sugars And Low Moods

People with diabetes have an increased risk of depression, which can affect their self-care

Managing diabetes can be a challenge even when you’re feeling good, physically and mentally. So what about when you’re not? Too often, the answer is a downward spiral.

“Self-care is the foundation for managing diabetes,” explains Pamela Eling RN, a Certified Diabetes Educator in the St. Joseph’s/Candler Center for Diabetes Management. “With depression, self-care becomes overwhelming, and this will add to the feeling of being out of control.”

Self-Care At Risk

For patients with diabetes, self-care includes:

  • Adherence to a healthy diet
  • Adequate exercise
  • Not smoking
  • Monitoring glucose
  • Taking medicines as prescribed
  • Keeping your doctor appointments
  • Keeping your dental, vision and podiatry appointments

All of these necessary tasks could be hampered by many symptoms of depression, such as loss of energy, trouble concentrating, mood swings, and change in eating habits.   

“If a patient is experiencing even just one symptom of depression, it can make the daily tasks of self-care a major challenge,” Eling says. One example of this is how low energy levels can make preparing a healthy meal seem like an impossible chore. Meanwhile, reaching for an unhealthy snack is easier and provides immediate gratification but also leads to a spike in blood sugar.

An Unhealthy Relationship

“The relationship between diabetes and depression can be characterized as a vicious cycle,” says Diabetes Educational Specialist Theresa George, RN. “Studies found that having depression may lead to an increased risk for type 2 diabetes, resulting from unhealthy behaviors such as a sedentary lifestyle, obesity, and smoking, and a high fat and cholesterol diet. On the other hand, studies also found that people with type 2 are twice as likely to develop depression as non-diabetics.”

Depression can cause poor glucose control, which can make a patient with diabetes feel that they are physically getting worse. This development only serves to worsen their overall mood. Patients may also become irritable with their family or their doctor, creating new feelings of guilt, frustration, or sadness.

“If a patient has diabetes and depression, the care and treatment for both needs to be addressed at the same time,” George says.

Breaking The Cycle

“We screen all of our patients for depression,” Eling says.  “We encourage patients to discuss how they feel not only with their diabetes educator but also with their physician, so that they can make sure the symptoms are not associated with medical causes. We can also make referrals with mental health professionals for treatment.”

Like diabetes, treatment for depression requires a multifaceted approach. Along with treatments such as cognitive behavioral therapy, interpersonal therapy, or antidepressant medication, positive changes in activity and diet have been shown to improve symptoms.

“Implementing lifestyle changes and being active on a regular basis promotes better control of diabetes and depression,” George says. “This circular relationship of the two conditions must be broken if patients are to see an improvement in health.”

Eating Smart

One of the most important aspects of the individual counseling and diabetes education provided by the staff of the St. Joseph’s/Candler Center for Diabetes Management is diet.

“A return to a healthy diet is absolutely a cornerstone for improving symptoms of depression and diabetes,” says Certified Diabetes Educator Aggie Cowan, RD. “The link is strong between high carbohydrate intake and the brain chemical serotonin, which affects our mood. So we when are depressed, we often consume refined carbs and fried foods which are unhealthy.  Instead, patients should try to reach for ‘smart’ carbs—the kind found in fruits, vegetables, legumes, and whole grains.”

Cowan also recommends making protein-rich breakfast, meals with oily fish like tuna and salmon, and other sources of omega-3 fatty acids such as flaxseed part of your daily routine.

“Choosing more of these healthy foods can result in better blood sugar control,” Cowan says. “It also often leads to weight loss and a more positive emotional response to the many demands of managing diabetes.”

*To learn more about the services in the St. Joseph’s/Candler Center for Diabetes Management, call 912-819-6146 or visit

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