Many people with type 2 diabetes can control their blood glucose by following a careful diet and exercise program, losing excess weight, and taking oral medication. However, the longer a person has type 2 diabetes, the more likely he or she will need insulin injections, either alone or together with oral medications.
Gestational diabetes develops during pregnancy. Like type 2 diabetes, it occurs more often in African Americans, American Indians, Hispanic Americans, and people with a family history of diabetes. Though it usually disappears after delivery, the mother is at increased risk of getting type 2 diabetes later in life.
Managing Diabetes
Research has shown that tight glucose control is the best way to prevent serious complications of diabetes, so the goal of diabetes management is to keep blood glucose levels as close to the normal range as possible. Healthy eating, physical activity, insulin injections, or using an insulin pump are basic therapies for type 1 diabetes. Blood glucose levels must be monitored through frequent checking. In recent years, research has led to better ways to manage type 2 diabetes and treat its complications with improved monitoring of blood glucose, new drugs, and weight control management. Blood pressure drugs called ACE (angiotensin-converting enzyme) inhibitors help to prevent or delay heart and kidney disease.
People with diabetes try to keep blood glucose (also called blood sugar) from rising too high or falling too low. When blood glucose levels drop too low from some medicinesa condition called hypoglycemiaa person can become nervous, shaky, and confused. Judgment can be impaired, and if the level is low enough, a person can faint. High levels of blood glucose, called hyperglycemia, cause tissue damage and lead to debilitating complications. Associated with acute long-term complications, the disease can lead to blindness, heart and blood vessel disease, strokes, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy. Because a large part of the population is aging and Americans are increasingly overweight and sedentary, the prevalence of diabetes is predicted to increase.
Researchers continue to search for the causes of diabetes and ways to prevent and cure the disorder. Scientists are looking for genes that contribute to the different forms of diabetes, are testing new drugs, and are using bioengineering techniques to try to create artificial beta cells that secrete insulin.
Getting Help for Depression
While there are many different treatments for depression, they must be carefully chosen by a trained professional based on the circumstances of the person and family. Prescription antidepressant medications are generally well-tolerated and safe for people with diabetes. Specific types of psychotherapy, or “talk” therapy, also can relieve depression. However, recovery from depression takes time. Antidepressant medications can take several weeks to work and may need to be combined with ongoing psychotherapy. Not everyone responds to treatment in the same way. Prescriptions and dosing may need to be adjusted.
In people who have diabetes and depression, scientists report that psychotherapy and antidepressant medications have positive effects on both mood and glycemic control. Additional trials will help us better understand the links between depression and diabetes and the behavioral and physiologic mechanisms by which improvement in depression fosters better adherence to diabetes treatment and healthier lives.
Treatment for depression in the context of diabetes should be managed by a mental health professionalfor example, a psychiatrist, psychologist, or clinical social workerwho is in close communication with the physician providing the diabetes care. This is especially important when antidepressant medication is needed or prescribed, so that potentially harmful drug interactions can be avoided. In some cases, a mental health professional that specializes in treating individuals with depression and co-occurring physical illnesses such as diabetes may be available. People with diabetes who develop depression, as well as people in treatment for depression who subsequently develop diabetes, should make sure to tell any physician they visit about the full range of medications they are taking.
Use of herbal supplements of any kind should be discussed with a physician before they are tried. Recently, scientists have discovered that St. John’s wort, an herbal remedy sold over-the-counter and promoted as a treatment for mild depression, can have harmful interactions with some other medications.
Other mental disorders, such as bipolar disorder (also known as manic depression) and anxiety disorders, may occur in people with diabetes, and they too can be effectively treated.
Remember, depression is a treatable disorder. Depression can be treated in addition to whatever other illnesses a person might have, including diabetes. If you think you may be depressed or know someone who is, don’t lose hope. Seek help for depression.
