My daughter-in-law, now 34, was diagnosed about three years ago with diabetes. In the beginning, she handled this news relatively well. But the disease became worse and shortly after that I saw a change in her personality. She now thinks of herself as almost completely disabled by the disease even though her physical problems appear to be minimal. I know that chronic illness and injecting oneself with insulin everyday can be depressing. What can we do to help and at what point should she consult a mental health professional to deal with her physical illness?

It is not unusual to have a bad day or even a bad week once in a while. But if your daughter-in-law has persistent problems with symptoms such as sadness, general loss of interest in life, fatigue, feelings of worthlessness, or a change in appetite or sleep patterns, and these symptoms have been present most of the time for at least two weeks, she may very well be suffering from clinical depression. This condition is 2 to 3 times more common among people with diabetes (15% to 20%) than among the general population. Even though your daughter-in-law seems to be doing well physically, it’s possible that diabetes is affecting her in subtle physical ways that contribute to her low mood. Unfortunately, depression often goes unrecognized in those with diabetes, which increases the risk for poorer blood sugar control, non-compliance with treatment, and diabetes complications. The good news is that help is available. Recent studies have demonstrated that depression in persons with diabetes can be treated effectively by either medication or counseling, which can often lead to better diabetes control. I would urge your daughter-in-law to seek the help of a mental health professional who can evaluate the seriousness of her depression and recommend appropriate treatment. A visit to her primary care physician for a referral could be the place to start.

Candace Miller, MA
Center for the Study of Depression and Diabetes
Washington University School of Medicine
314-362-2415

Diabetes is a very demanding disease that requires a high level of self-management. This self-management is the process of making all parts of the diabetes care work together to achieve and maintain near-normal blood sugars. The person with diabetes provides 98% of his/her own health care and this care is at the very core of every daily decision. The day-to-day demands of diabetes can be overwhelming. Coping with diabetes requires a strong support system. Diabetes is a family affair. Every person with diabetes is different, and so is every family. How well a person copes may reflect the amount of support they receive from their family. The family must respect the special needs of a person with diabetes, while at the same time, not becoming the "diabetic police." Ask your daughter-in-law what would make her life with diabetes easier. Ask if you are doing anything to make her life with diabetes harder. Finally, remember that no one can really understand what it is like to have diabetes unless they also have it. Perhaps it would help to join a diabetes support group. Remember, support groups are for the person with the illness AND for family members. These groups can provide education as well as emotional support. Many hospitals offer support groups. Our program has received recognition from the American Diabetes Association. To locate a diabetes support group or program, call a hospital near you or the local American Diabetes Association affiliate at 314-822-5490.

Connie Walls, RN, BSN
Certified Diabetes Educator
Jefferson Memorial Hospital
Crystal City, MO
636-933-1113

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