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[IP] re: rerun of article on DM and depression

Hi all

It has been requested that I repost this article, which ran in a special 
section called "You know you have diabetes when ..." I'm including the 
author's byline this time. She's a wonderful person and fantastic writer who 
is a reporter for a Chicago-area newspaper. And, as somebody said, she "walks 
the walk."


 Your 'honey' calls you 'sweetie' and you get upset

By Marcella Tardy
 "Is there anything diabetes doesn't affect?" you may ask forlornly. The
 short answer is: Even one's moods, outlook on life and ability to handle
 day-to-day challenges are affected by diabetes. Slow service at a restaurant
 or the energy spent rushing about on the morning the alarm clock failed to
 sound can drop blood sugar, causing the sufferer to slip into incoherence,
 turn unexpectedly belligerent, or be immobiized with dread. On the other
 hand, an infected tooth or the stress of a job interview can elevate blood
 sugar, causing fatigue. A fatigued person can become lethargic, downcast or
 ill tempered.
      "Diabetes is a complex, demanding, pretty overwhelming situation to
 with," said Shelley Johns, a clinical health psychologist whose clients
 include many with diabetes. "What other disease affects every minute of the
 day? Am I getting low? Am I getting high? (Before home blood tests there was
 no indication.) It's one of the most time-consuming diseases. Even cancer
 patients in chemotherapy get a break. It's not like that for diabetics.
 There's no vacation from this disease."
 Johns, 34, practices clinical psychology in Charleston, W.Va. She has a
 master's and is on the verge of completing her doctorate. Counseling is
 her second career. For three years she was a broadcast journalist with
      Her move into psychology owes in part to firsthand experience with the
 emotional trials and pitfalls of diabetes. She was diagnosed with the
 disease at age 12. "It was the day after Christmas," she said, recalling
 that she had lost a third of her body weight by then. After two weeks in the
 hospital and being treated with insulin injections, she regained her normal
 body weight to discover she didn't fit the clothes she'd been given as
 Christmas gifts.
      Nonetheless, she said, diabetes was not the ruin of her childhood. "I
 didn't really feel all that deprived," she said. "My mom was very, very good
 at trying to make sugar-free desserts." But diabetes belongs to the person
 who has it. "From the minute I was diagnosed," Johns said, "I felt I had to
 take care of this myself. I really took fast and quick ownership." Keeping
 diabetes a secret from schoolmates wasn't possible, she said. "After
 you've been carted off a time or two by the paramedics (because of low
 blood sugar), you do get a reputation for being different," she said. "I
 grew up feeling different. I didn't feel defective but I felt I had
 responsibilities that other kids had no clue about." Johns echoed the
 feelings of many people with diabetes: "It is a lonely disease," she said.
 "Nobody ever understands it."
      In her practice, she often works with patients who are struggling with
 emotional problems alongside, or even because of, their diabetes. "Two of
 the diagnoses that happen quite a bit with diabetes are depression and
 anxiety disorders," Johns said. "One of the main reasons that anxiety
 disorders are common is the symptoms of hypoglycemia (low blood sugar) are
 similar to a panic attack. Oftentimes, people are diagnosed with anxiety
 disorders. A lot of time, people are misdiagnosed."
     Likewise, depression is significantly more common in people with
     "Seven to 8 percent of the general population will experience a major
 depression sometime in their life," said Johns. "Depression is roughly three
 times more prevalent in people with diabetes. It doesn't matter if you're
 Type 1 or Type 2. It's a little more common in women."
       Although life with diabetes can get a person down, depression is a
 serious disorder. Diagnosable depression is a pervasive blue mood lasting
 two weeks or longer, Johns said. A person suffering clinical depression
 may also exhibit diminished interest or pleasure in activties, a state
 called anhedonia. A depressed person would also have four or more of the
 following symptoms: a significant appetite change, fatigue, feelings of
 hopelessness, sleep disturbances (either insomnia or oversleeping) poor
 concentration, recurrent thoughts of death or suicide, or body movements
 exhibiting either restless agitation or pon- derous slow-motion.
       "It's important to realize that diabetes doesn't necessarily cause
 depression and depression doesn't cause diabetes, but it may be a
 precipitating factor," Johns said. Either way, it can compound the suf-
 ferer's health problems. "The reason the emotional side of diabetes is so
 vital is because once you develop something like depression, it can have a
 negative influence on the way we handle this disease," Johns said. "You may
 not be as motivated to follow your exercise routine, to follow your diet."
 And so, a vicious circle is created.
 "This is why as health professionals, we address this aspect," Johns said.
 "I would encourage anyone with depression to get help from a mental health
 professional. If you have a cavity in your mouth, you get treated for it so
 you don't have to suffer unnecessarily, likewise with depression, anxiety
 or any other emotional problem. There are extremely effective treatments so
 people don't have to suffer with those either."
      Cognitive Behavioral Therapy, in which the therapist guides patients in
 coping and communications skills, usually provides the quickest and most
 effective psychological treatment for anxiety and depression, she said.
 Johns uses a motivational interviewing technique, asking the individual a
 series of questions that will help him or her decide what kinds of goals to
 work on. For some patients, medications may be necessary.
      Either way, she said, no one with diabetes should suffer needlessly.
 "People are realizing it's not weak people who seek help, but people
 who want to maximize the quality of their lives and people who don't wan
 to suffer unnecessarily."
      Johns has herself ridden the blues elevator to the bottom floor.
 her efforts over most, but not all, of her life thus far to maintain careful
 control of her blood sugar, she began developing complications -- including
 proliferative retinopathy (in 1992, her doctors threw up their hands and
 told her to prepare to go blind. For once the diabetes was unpredictable in
 her favor and the eye disease stopped its advance), the early stages of
 kidney disease and mild neuropathy (in her case, foot numbness).
       The biggest descent came when she developed gastroparesis, a
 malfunction of the nerves that control the digestive tract, which can
 cause the sufferer to experience frequent vomiting, persistent diarrhea
 and constipation. "That was the time I was more depressed," Johns said.
 "I lost the functioning of my body -- you do have a lot of loss with
 "I would go to doctors and they would tell me they couldn't do anything,"
 she said. They prescribed drugs. The drugs didn't work. "For four months,
 I could not eat solid foods. I was living on whole milk and Ensure Plus. I
 a third of my body weight," she said. "They thought I was dying."
       Johns managed to halt the advance of her complications with even
 tighter control made more achievable through the use of an insulin pump.
 Johns also stays active. She works out with weights and runs, walks, and
 practices kick boxing for aerobic exercise. But, she acknowledges, getting
 or not geting complications depends a lot on the luck of the draw from the
 gene pool. And so, some people whose blood sugars run regularly high
 may never suffer complications or suffer them only in mild form, while
 who have managed magnificent control of their blood sugars may still develop
      "I don't sit around and wait for (complications) to come," she said.
 "I'm going to maximize every minute that I'm blessed with. That was one of
 the reasons I went into what I went into. I knew I could be a psychologist
 whether I could see or not. I can do this in a wheelchair or I can do this

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