www.diabeticretinopathy.org.uk

General

Eating disorders and mental health problems in diabetes

David Kinshuck

Introduction

Eating disorders and mental health problems are very common in diabetes. Such patients may develop serious retinopathy. Here are some examples of problems and helpful sites for patients.

A psychologist (or dietician or diabetes specialist nurse trained in psychological techniques) really needs to advise and help people with any of these problems, unless they are very mild. In North Birmingham we have very little support available from psychologists except for patients with the severest problems, but the WHO recommends a far greater availability and psychologists should be available to help everyone with diabetes.

 

Binge eating

This is common in type 1 diabetes, affecting 10% of men and 25% of women. See. Counselling helps...but discuss this with your doctor or nurse first; medical treatment is needed if you have a severe problem counselling & /binge eating

 

Missing insulin to lose weight

Many diabetics notice they may gain weight using insulin. There are a number of reasons for this, but they will include eating a diet high in refined carbohydrate and fat, and too little exercise. Patients, often teenage girls, then decide that they will miss insulin to help them lose weight. Missing insulin does help people lose weight, but the HbA1c rises often above 10%, and complications can follow.
This problem needs expert help from the diabetes team or an expert psychologist.

A diet high in refined carbohydrate & fat (like hamburgers, for example) seems to make people hungry and want to eat more, and so gain weight. Eating a much a diet with more fibre and less energy dense helps you feel full more quickly after eating far fewer calories. See young people & eating disorder & Children with diabetes.

 

Missing insulin

This is common. Again, expert advice is needed. This is more common at times of stress of if you are depressed. If anyone is on well designed insulin regime, such as lantus/rapid acting insulin, and their diabetes is not controlled with a high HbA1c, it is likely they are missing injections, possibly deliberately.

 

Depression as a consequence of diabetes.

Two screening questions for depression

This is common also. Expert advice is needed. See .  Score your depression, see the table below. It is more common if neuropathy or any other diabetic complication is present, or if a person has other medical problems.

Cognitive therapy is very helpful for depression, and has been highly recommended. If you are depressed, ask your doctor for this treatment. Depression needs to be treated to achieve good control (DC 09).

Diabetic patients who are depressed achieve better control and better health with Collaborative Care NEJM 2011. Essentially such patients benefit from care provided by diabetes nurses who are also trained in the treatment of depression (a short 2 day training program), with consultations every 2 weeks initially. Such care is sporadic in the UK.

 

A score to assess depression

Becks Depression Score See A twenty-one question survey completed by patient
Answers Interpretation of score Questions
  • scored on 0 to 3 scale
  • Minimal: 0,
  • Severe: 3
  • <15: Mild Depression
    Score
  • 15-30: moderate Depression
    Score
  • >30: Severe Depression
  • Sadness
  • Hopelessness
  • Past failure
  • Anhedonia
  • Guilt
  • Punishment
  • Self-dislike
  • Self-blame
  • Suicidal thoughts
  • crying
  • agitation
  • fatigue
  • loss of interest in activities
  • Indecisiveness
  • Worthlessness
  • Loss of energy
  • Insomnia
  • Irritability
  • Decreased appetite
  • diminished concentration
  • lack of interest in sex

 

Depression & eating disorders contributing to diabetes

Some anti-psychotic drugs contribute to diabetes. But more importantly number-wise is the fact that many forms of over eating or obsessional eating (such as eating lots of chocolate) may contribute to obesity and thereby type 2 diabetes.

Many people eat when they get fed up, but when this causes obesity naturally it can lead to diabetes. In theory many eating disorders can be prevented.
If you like to eat when you are fed up, stick to fruit or salads or other high fibre food. If you start to become overweight then expert help early will prevent more serious problems later.

Depression may have a profound influence on diabetes and its complications. For instance

 

Other problems contributing

Many mental health conditions exacerbate diabetes. For instance, agoraphobia most can be treated with cognitive therapy, though the more severe conditions may need drug treatment in addition.

 

Not accepting diabetes

This is common. This can lead to many problems. Many people deny they have diabetes, and do not make a major effort to control it. As a result, they develop serious retinopathy and poor sight.  Psychological treatment is needed form a psychologist at an early stage. Unfortunately many such people refuse to consult a psychologist...this is a major public health problem.

 

5 steps to happiness

  1. connecting with friends and family
  2. learn something new
  3. be active
  4. take notice.. enjoy the present
  5. helping friends & strangers
  6. from guardian.co.uk

Stopping smoking