How are you feeling?Coping with diabetes and depression

Introduction 3

What is diabetes? 4

Living with diabetes 5

What is depression? 9

Coming to terms with depression 12

Treatments 13

Psychological support and counselling 18

Support information for carers 20

Further information 22

About Diabetes UK 25

Become a member of Diabetes UK 26

Diabetes UK offices 27

Contents

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IntroductionBeing diagnosed and living with diabetes can affect people invery different ways. While some may find coping with diabeteshas very little impact on day-to-day life, others may find that ithas turned their lives upside down. Finding diabetes difficult tocope with does not mean that you are doing something wrong.Many people with diabetes who we speak to feel that at somepoint in their lives, their diabetes causes them to feel like theyare not coping. Many feel alone.

The physical impact of diabetes is well reported but theemotional impact is still not always recognised. Diabetes canhave an emotional impact, especially around diagnosis, startinginsulin, and on developing complications. Many people findtheir own personal way to deal with these feelings, but for somethey continue to struggle to come to terms with how theirdiabetes makes them feel. For some people with diabetes thesefeelings can develop into depression. Although people withdiabetes have a higher chance of showing signs of depression,not all people with diabetes who are finding it challengingdevelop depression.

In developing this booklet, Diabetes UK worked together withpeople who have diabetes, listening to the feelings andemotions they have experienced, how they cope, what effect ithas on their everyday lives and where they go for help. Diabetesand depression are closely related and this booklet aims to helpyou understand and cope with them better.

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What is diabetes?Diabetes is a common life-long condition where the amount of glucose in the blood is too high as the body cannot use it properly.This is because the pancreas does not produce any or not enoughinsulin or the insulin that is produced doesn’t work properly (knownas insulin resistance). Insulin helps glucose enter the body’s cells,where it is used for energy.

Glucose comes from digesting carbohydrate from various kinds offood and drink, including starchy foods such as breads, rice andpotatoes, fruit, some dairy products, sugar and other sweet foods.Glucose is also produced by the liver.

There are two main types of diabetes: Type 1 and Type 2.

Type 1 diabetes develops when the insulin-producing cells have beendestroyed and the body is unable to produce any insulin. Usually itappears before the age of 40, and especially in childhood. It istreated with insulin either by injection or pump, a healthy diet andregular physical activity.

Type 2 diabetes develops when the body doesn’t produce enoughinsulin or the insulin that is produced doesn’t work properly. Usuallyit appears in people aged over 40, though in South Asian and Blackpeople it can appear from the age of 25. It is becoming morecommon in children and young people of all ethnicities. Type 2diabetes is treated with a healthy diet and regular physical activity,but medication and/or insulin is often required.

The main symptoms of undiagnosed diabetes include passing urinefrequently (especially at night), increased thirst, extreme tiredness,unexplained weight loss, genital itching or regular episodes ofthrush, slow healing of wounds and blurred vision.

The main aim of diabetes treatment is to achieve blood glucose,blood pressure and blood fat levels (including cholesterol) within thetarget ranges agreed by you and your healthcare team. This,together with a healthy lifestyle, will reduce the risk of developingthe long-term complications of diabetes such as heart attack, stroke,amputation, blindness, kidney failure and nerve damage.

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Living with diabetesBeing diagnosedBeing diagnosed with diabetes can bea very difficult time. It is usual to havea mixture of feelings, particularly shockat being told you have diabetes, angerat how this could have happened to you,guilt – did you do something wrong? Notall people respond in the same way, somemay feel relief at finally being able to puta name to what has been causing themto feel so unwell. Diagnosis is often thetime when a lot of information is givenand this can leave people feeling overwhelmed andconfused. It is often at this point that you first find out aboutthe possible complications associated with diabetes and thiscan be frightening for anyone.

These responses and feelings are common and natural. Thereis no right or wrong way to react. It may be hard to absorbevery piece of information in the beginning. Emotions canaffect what you hear and how much you remember. Takeone step at a time. It may help to collect written informationto read later at your own pace.

If you forget something or are confused, don’t be afraidto ask your diabetes team to explain things to you again.

Diabetes is a serious condition – depression is too. They often come together.

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After diagnosisIn the weeks following diagnosis, emotions are often neglectedas you get to grips with new treatment routines and lifestyleadjustments. Nevertheless, feelings are just as important. They can be confusing and intense.

The stress of a daily diabetes routine can also cause resentment.People often experience feelings of loss – the loss of their usuallife that didn’t include taking medication, injecting insulin, testingblood glucose levels and having a more structured lifestyle. Thereare no days off for some and they often feel that their diabeteshas taken over their lives. It is important to recognise the newdemands on your life, which may seem like an added burden to an already busy life. You may feel set apart from your friendsand family because of all the extra responsibility. Very oftenfamily and friends treat you differently because of your diabetes:“Are you sure you should be eating that?” or “Is that ok forpeople with diabetes?”. Talking to your diabetes care team and having the support of your family and friends can often help to ensure that you are in control of your diabetes and it isn’t controlling you or making you feel isolated.

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Dealing with diabetescomplicationsUnfortunately, peoplewith diabetes are at riskof developing long-termcomplications, such asdamage to the eyes, kidneys,nerves and heart. It is likelyto come as a shock to be toldyou are at risk of oneor more of thesecomplications. You mayfeel there is no hope for thefuture and it is usual for your first thoughts to be on the worst aspect.

Listening to other people’sexperiences can often help. It can be comforting tolisten to people who arealready living with diabetes

and all these emotions. Talking to others through diabetessupport or voluntary groups can help to see how others havelived healthy lives with diabetes, what their feelings are aboutcomplications and how they deal with them.

You may feel cheated if you have done all the right things andhave been working hard to get your diabetes under control and you develop complications. Having good diabetes controlreduces your risk of developing long-term complications butdoes not always remove the risk entirely.

“ Don’t ever give up – the rewards are worth fighting for. ”Person with diabetes

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Small steps that can help you

• Don’t isolate yourself because of your diabetes.

• It’s ok to feel like this; don’t be hard on yourself for how you are feeling.

• Try to continue to do things that you enjoy and give youpleasure. Just because you have diabetes does not mean you have to stop doing the things you enjoy.

• Set small and specific goals.

• Talk to your diabetes care team; let them know how you are feeling.

• Break down large tasks into small ones.

• Try to confide in someone – it’s usually better than being alone.Talk to your family and friends, they may be unaware of howyou are feeling.

• When someone asks: “How are you feeling?” don’t be afraid to tell them what you really feel.

• Read on…

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What is depression?

Things to look out for:

• feeling tired or having littleenergy

• crying all or some of the time

• lack of concentration

• not being able to sleep or over sleeping

• avoiding people

• little interest or pleasure indoing things

• finding it hard to function at work

• loss of appetite or eating too much

• physical aches and pains

• feelings of despair and hopelessness.

Depression can take different forms and affect peoplein different ways – it’s always best to get help.

Depressive feelings canaffect anyone. Although therate of depression is higherin people with diabetes, thisdoes not mean that if youhave diabetes you will getdepressed.

Depression is a seriouscondition which shouldn’tbe ignored and can betreated. It affects how youthink and feel about things.It is not a sign of personalweakness or failure. Youcannot simply ‘pull yourselftogether’. Without help,depression can last for along time but how long itlasts varies. Treatment can help.

Depression is very different from feelings of being fed up orsad, which can be a normal reaction for someone with diabetes.These feelings will usually pass as people learn and developways of dealing with them.

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Why does it matter?Coping with diabetes and depression can be turbulent andbecome a vicious cycle of events. Depression can get in the wayof looking after your diabetes for various reasons. For example,it can affect your food choices and your eating patterns, andwhether or not you take your medication. If you are depressedyou may feel exhausted and often anxious, which could meanthat testing blood glucose levels or taking your medication mayfeel like too much at times. Loss of appetite and overeating aresymptoms of depression which will affect diabetes control. Andstress caused by depression can also affect blood glucose levels.

“ Being diagnosed with diabetes was a depressing blow –losing a high-flying career and facing up to an unknownmedical condition. It was a great encouragement,however, to learn that diabetes is a controllable medicalcondition. As a result, it was possible to return to my dreamcareer. We can do anything we put our minds to.”

Person with diabetes

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Coming to terms with depression

Depression can be difficultto accept for many reasons.But remember that acceptinghelp for depression is the firststep. You may feel a sense of stigma and/or failure. Ifdiagnosed with depression,you may be reluctant to usemedication or to be referredto see a psychologist. Youmay not see the need forsupport for the depressionitself. However, once youhave tackled the first hurdleof accepting help, treatmentshould improve your qualityof life.

Going to the doctorIf you are anxious and nervous about talking to your doctorabout how you are feeling, write it down and take it with you,maybe going with a friend or family member. This can help youto find the right words. Your doctor will be able to refer you,if necessary, to someone specially trained to help you.

You might want to use Diabetes UK Careline which is a helplinerun by trained counsellors, or there may be a local voluntarygroup in your area to put you in touch with others who mightbe feeling just as you do.

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The Diabetes UK Carelinetelephone number is0845 120 2960. The Careline isopen 9am–5pm, Monday – Friday(see page 21 for moreinformation).

Recognising depressionYour doctor may want youto fill in a questionnaire to helphim/her find out if you havedeveloped depression.Questionnaires are available fromhealthcare teams to help you andyour doctor recognise if you havedepression.

TreatmentsThere are many different treatments available – discuss themwith your healthcare team and together you can work out whatis right for you.

Depression is an illness just like any other and justbecause you can’t see it doesn’t mean it’s not there.You should understand this and with the right helpyou can get better.

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Diet, physical activityand relaxationMissing valuable nutrients can make you feel tired andrun down. Eating a healthy,balanced diet is an importantpart of your diabetes controland will help with depression.Eating regularly is important too.

Physical activity also benefits both diabetes and depression. If you have been inactive, gentle activity such as walking isrecommended to begin with. Tension, stress and anxiety are all associated with depression. Physical activity also releasesendorphins (happy hormones) from the brain and can help to make you feel a lot better.

Relaxation time should be built into your everyday life. Yoga,reading, walking and listening to music can be beneficial, or find something that you enjoy doing.

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Medication for depressionThere are many different types of medication available fortreating depression. Most of them work by altering the waycertain chemicals work in the brain. These treatments can only be prescribed by your doctor. You may not feel betterimmediately – some can take up to three to four weeks tobegin to help. It is important to continue taking the prescribedmedication as advised by your doctor to either give them timeto start working or to prevent relapse, even if you feel asthough you have recovered.

Your healthcare team should carefully monitor your bloodglucose control when you are taking prescribed medicationfor depression. It may have an impact on your diabetes andso the dose of your diabetes medication may need adjusting.Medication can also affect your hypo awareness (when yourblood glucose levels are low), so more frequent blood glucosemonitoring may be needed.

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GeneralrecommendationsYou should let your doctoror pharmacist know that youhave diabetes, as well as anyadditional conditions such as epilepsy, glaucoma, liverdisease, kidney or prostateproblems.

Tell your pharmacist that you are on medication fordepression and diabetes if youneed to buy a medicine overthe counter.

If you are pregnant, breastfeeding or trying for a babytell your doctor or pharmacist.

Alcohol is not advised whentaking medication fordepression.

“ Don’t feel alone, embarrassed or guilty – depression isunderstood by health professionals and is treatable.”

Person with diabetes

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Complementary therapies Diabetes UK is unable to recommend the use of complementarytherapies, unless used on the advice of your healthcare team,as there is still a lack of clinical evidence of their effectivenessand safety for people with diabetes.

It is important to discuss any complementary therapy you areconsidering with your healthcare team. If you decide to use one,as with all treatments, advise your doctor of any side effects youexperience.

Never stop taking insulin or prescribed medication without theadvice of your doctor and continue blood glucose monitoringas advised. You should always inform your complementarytherapist of any medical conditions and prescribed medicationyou are taking. Some complementary therapies, such as herbal treatments, can affect how other medications work, eg St. John’s Wort can affect warfarin and the oral contraceptive pill.

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Psychological supportand counsellingAlthough medication may lift your mood it may not tackle anyunderlying causes of depression. Psychological interventions andcounselling can help you overcome your depression and preventrecurrences.

Cognitive behavioural therapy (CBT)This type of therapy challenges negative thought patterns and suggests ways to change your behaviour. It can help you to explore your thoughts and feelings.

Some people respond well to medication but ‘talkingtherapies’ can also be effective.

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Changing how you think can change how you feel. Research has shown that CBT is most effective for mild to moderate forms of depression and, when combined with anti-depressantmedication, it can also be effective in severe depression.Furthermore, CBT seems to reduce recurrences of depression.

Long-term psychotherapy Long-term therapy can help people to learn more aboutthemselves, understand past and present relationships, andchange patterns of behaviour that may contribute to depressionor emotional difficulty. Usually continuing for a number ofmonths, sometimes years, it is often used to deal withpsychological difficulties that have been present for a number of years and requires a trusting relationship between the person and the therapist

CounsellingCounselling is about helping people to help themselves. It provides help and support to people who are worried andanxious. It is about being able to develop a trusting relationshipwith a counsellor to talk freely about your feelings. It providesinsight into what you are feeling, why you feel the way you doand how you can work through your feelings. If you decide thatyou want to see a counsellor, talk to your GP who can give youdetails of all the registered counsellors in your area.

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Support information for carersFamilies and friends can be a great source of support. However,caring for your partner, relative, friend or child can be hardwork, and as a carer you may not realise just how much thisis affecting you. This is particularly true if you are caring forsomeone with diabetes and depression. It is important thatcarers seek support themselves, see page 24 for details oforganisations who may be able to help.

Parent carersLearning that your child has diabetes is a traumatic event forany family. Adapting to and managing diabetes, and changesto family routine, can place a strain on family relationships.

Diabetes can fit into your lifestyle, but you may need help andsupport to do this. There may be some emotional or behaviouralproblems that you are finding difficult to manage on your own;

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perhaps your child is refusing to do blood glucose tests, isworried about being bullied at school, or anxious aboutchanging to an adult healthcare team. Don’t be afraid to askyour GP or healthcare team for help. They may also have accessto psychologists or counsellors.

Diabetes UK CarelineDiabetes UK Careline can provide confidential support andinformation on diabetes. The team are trained counsellors and cangive you the time you need to talk things through. To speak toone of our counsellors call 0845 120 2960 (or 020 7424 1000 andasked to be transferred to the Careline), 9am–5pm, Monday –Friday. Or email: careline@diabetes.org.uk

Diabetes UK runs a range of services for people withdiabetes and their families, including

• adult support days and weekends

• family days and weekends.

For more information contact our Care Support teamon 020 7424 1000.

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Age ConcernThe UK’s largest organisationworking with and for older people. The UK’s largestorganisation working with and for older people. Tel: 0800 00 99 66Website: www.ageconcern.org.uk

Depression AllianceThe leading UK charity for people affected by depression.Tel: 0845 123 2320Website:www.depressionalliance.orgEmail:information@depressionalliance.org

MindInfoLineMind is the leading mentalhealth charity in England and Wales. Tel: 0845 766 0163Website: www.mind.org.ukEmail: info@mind.org.uk

NHS24 (Scotland)Confidential telephonehealth advice andinformation service for people in Scotland.Tel: 08454 24 24 24

NHS DirectThe 24-hour nurse-led health telephone adviceservice run by the NHS.Tel: 0845 46 47Website: www.nhsdirect.nhs.uk

SanelineA charity raising men’s health awareness.Tel: 0845 767 8000Website:www.sane.org.uk/SANElineEmail: sanemail@sane.org.uk

Further information

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SamaritansConfidential emotionalsupport 24 hours a day.Tel: 08457 90 90 90Website:www.samaritans.org.ukEmail: Jo@samaritans.org.ukWrite to Samaritans at:ChrisP.O. Box 90 90Scotland FK8 2SA

Scottish Association of Mental HealthScotland’s leading mental health charity.Tel: 0800 917 3466Website: www.samh.org.ukEmail: info@samh.org.uk

The British Associationfor Counselling andPsychotherapyProfessional body. List oftrained counsellors andpsychotherapists available.Tel: 01455 883300Website: www.bacp.co.ukEmail: bacp@bacp.co.uk

Young MindsA national charity forimproving the mental health of all children and young people.Helpline Tel: 0808 802 5544

(calls are free from landlines and mobiles)

10am–1pm Monday and Friday1pm–4pm Tuesday and Thursday6pm–8pm Wednesday

Diabetes UK produces publications covering all aspect of diabetes.For a catalogue please call 0800 585 088 orvisit:www.diabetes.org.uk/OnlineShop Or visit Diabetes UK’swebsite for more information on diabetes and Diabetes UK:www.diabetes.org.uk

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Further information for carersCarers UKThe voice for carers.

CarersLine tel: 0808 808 7777

Open Wednesday – Thursday 10am–12pm and 2pm–4pm.

Website: www.carersuk.orgEmail: info@carersuk.org

Carers ScotlandTelephone number: as above

Website: www.carerscotland.org

Email: info@carerscotland.org

Carers Wales

Telephone number:as above

Website: www.carerswales.org

Email: info@carerswales.org

Princess Royal Trust for Carers

The largest provider of comprehensive carers support services in the UK.

Website: www.carers.org

England tel: 0844 800 4361

Email: info@carers.org

Scotland tel: 0141 221 5066

Email: infoscotland@carers.org

Wales tel: 01792 653344

Email: infowales@carers.org

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About Diabetes UKDiabetes UK is the charity for people with diabetes, their family, friends and carers. Our mission is to improve the lives of people with the condition and work towards a future without diabetes.

Diabetes UK stands up for the interests of people with diabetes by campaigning for better standards of care. We are one of themain funders of diabetes research in the UK which includesresearch into cause and prevention, care and treatment and findinga cure. We provide support and information to help peoplemanage their diabetes.

Did you know?There are 2.6 million people in the UK diagnosed with diabetes andup to 500,000 people who have the condition but don’t know it.

• Our website www.diabetes.org.ukhas over 5,000 visitors a day.

• We have a network of offices throughout the UK – see back cover.

• Diabetes UK Careline staff answer over 100 enquiries a day.

• We fund diabetes research, investing more than £6 million every year.

• We produce a wide range of magazines,books and leaflets covering all aspectsof diabetes.

All of this and more is made possible through donations, fundraising and membership of Diabetes UK.

How can you help?You can be actively involved in the work Diabetes UK does. For details call 020 7424 1000 or visit our website about: Diabetes Campaigners Network – www.diabetes.org.uk/campaignsFundraising ideas and events – www.diabetes.org.uk/fundraiseMake a donation – www.diabetes.org.uk/donate

Become a Supporting Member today;your support will make a real difference

Join our team and help us get closer to a future free fromdiabetes while improving the lives of everyone living withdiabetes, including your own.

Enjoy the benefits of being a Supporting MemberBeing a Diabetes UK Supporting Member entitles you to a rangeof benefits including:

• exclusive personalised Supporting Members area on our website

• our bi-monthly magazine Balance

• access to experienced counsellors on our confidential Diabetes UK Careline

• a wealth of reliable and expert publications on diabetes

• opportunities to make new friends living with the samecondition as you

• the latest updates and developments about diabetes from our researchers.

To join visit www.diabetes.org.uk/join

or call free on 0800 138 5605

For more information call our Supporter Services team on 0845 123 2399 during office hours.

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Diabetes UKNational and regional offices TelephoneCentral Office 020 7424 1000

Diabetes UK Cymru 029 2066 8276

Diabetes UK Northern Ireland 028 9066 6646

Diabetes UK Scotland 0141 245 6380

Diabetes UK Eastern 01376 501390

Diabetes UK East Midlands 0115 950 7147

Diabetes UK London 020 7424 1116

Diabetes UK Northern and Yorkshire 01325 488606

Diabetes UK North West 01925 653281

Diabetes UK South East 01372 720148

Diabetes UK South West 01823 324007

Diabetes UK West Midlands 01922 614500

Visit www.diabetes.org.uk/in_your_area for email addresses

Useful contactsBecome a Supporting Member 0800 138 5605

Supporter Services 0845 123 2399

Advocacy Service 020 7424 1840/1847

Publications orderline 0800 585 088

Diabetes UK Careline is here to give support and information aboutdiabetes: careline@diabetes.org.uk or call 0845 120 2960 (pleasecheck the costs of calls to 0845 numbers with your phone provider).Or call 020 7424 1000 and ask to be transferred to the Careline.

Diabetes UK welcomes feedback on this or any of its information. Please email infofeedback@diabetes.org.uk

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Published: December 2009To be reviewed: December 2010

9110/1109/b

The charity for people with diabetesMacleod House, 10 Parkway, London NW1 7AATelephone 020 7424 1000 Fax 020 7424 1001 Email info@diabetes.org.uk Website www.diabetes.org.ukA charity registered in England and Wales (no. 215199)and in Scotland (no. SC039136). © Diabetes UK 2009