Asking me which came first, my depression or my diabetes, is kind of like asking that age old question about the chicken and the egg. I think in the grand scheme of things it does not really matter which came first. All that really matters is that I have both. What I find true for me is that both illnesses seem to feed off of each other. When my blood glucose levels are out of control, the physical effects make me feel depressed, and when I feel depressed I have a hard time managing my diabetes. On the flip side, treating my depression can – and has – made my diabetes worse, and managing my diabetes is sometimes a depressing process.
Before I began treatment for my depression, I was not managing my diabetes like I was supposed to. A lot of the time, I was not bothering to check my blood glucose levels and would inject myself with an arbitrary amount of insulin. Anyone with diabetes knows what kind of trouble trouble this can lead to. Blood glucose levels bottoming out. More than once I found myself in an intensive care bed because of doing this. When I was not injecting myself with too much insulin, I was not bothering to inject myself at all. It was rare that my blood glucose levels were where they were supposed to be. Due to my mismanagement, they were either way too high or way too low. I believe how these extremes made me feel physically added to my mental health decline.
After I began depression treatment – and I mentally started feeling better – I was no longer so carefree about checking my blood glucose levels. I tested myself four to six times a day, and strictly followed my insulin dosing directions. I was feeling better all the way around. Then I had an asthma flare that resulted in me being admitted to the hospital and placed on IV steroids. All those steroids sent my blood glucose levels soaring. The doctor treating me in the hospital became very concerned about the levels and gave the nurses instructions to give me insulin injections every four hours. When I was released from the hospital, I had to continue the every four hour injection schedule until I was no longer taking oral steroids. Even at night there was no relief from this schedule. It did not take long for all these extra injections to begin to get to me. I felt the return of some of my depression symptoms.
With the return of some of my depression symptoms, my diabetes management was affected. I actually went through a stage of rebellion. I made choices to not see the doctor who was treating me for my diabetes, and did not schedule the blood work that he had ordered. I wish now that I had not allowed my depression symptoms to affect my diabetes management. In some ways, I paid a heavy price for my period of rebellion.
Many depression medications have the potential to raise blood glucose levels. This happens because antidepressants can inhibit the production of insulin in a person’s body. This can lead to a Type II Diabetes diagnosis for some people, or make it difficult or impossible for many diabetics to properly manage their diabetes. Another reason this happens is that many anti-depressants cause intense feelings of hunger – especially for carbohydrates – leading to weight gain. This weight gain can increase a person’s risk for developing Type II Diabetes and it can also hinder proper management of diabetes.
My poor choices to not see my medical doctor – and to not have the blood work I was supposed to – left my doctors in the dark about how the depression medications were affecting me physically. They had no idea how bad my blood glucose levels were getting, and I was not going to tell them. All I cared about at the time, was being able to keep taking the antidepressant that had worked so well on my brain. The nurse – that was supposed to monitor things like this – left the mental health treatment center I go to, making it very easy to continue hiding what was going on.
All of my poor decisions caught up to me on the day that I fainted and woke up with my face firmly planted on asphalt. The day after that happened, I had to go to the mental health treatment center. My face looked bad and caught the attention of the new nurse. After a quick exam – in which she discovered that my blood glucose was over 400 – she made me go to the emergency room. When I arrived there I was treated with IV insulin and also for dehydration. The doctor told me that the dehydration had probably been caused by the massive sweating my anti-depressant caused as well as from my extremely high blood glucose levels. That trip to the emergency room was a wake up call for me. I realized that no matter how much I wanted to continue taking the depression medication that had worked so well, I could not any longer.
I got my blood work done, saw my medical doctor, and made my psychiatrist aware of what was happening to me physically. My psychiatrist had me discontinue the antidepressant that was causing the high glucose readings, and we are now in the process of finding a new one. Since discontinuing that medication I have felt better than I have in a long time. It is a shame that it took a face plant to jump start me into action.
This whole process has served as a stark reminder that my mental health is directly affected by my physical health and that my physical health is affected by my mental health. If there is a lesson that can be learned from my experience, it is that ignoring one aspect of your health for the sake of another can be detrimental to all aspects of your health.