Which Comes First?

"I was in shock. Most days, I couldn't take my insulin shot. I would just sit for hours. I tried to live what I thought was a 'normal' life. I did not take care of myself, and I did not control my diabetes….I felt hopeless, overwhelmed. I didn't know what to do, where to begin, where to turn. And I cried a lot."

Judy Abendschein was diagnosed with Type 1 diabetes at the age of eighteen. In the years that followed, Abendschein became suicidal and was eventually hospitalized. It seems clear that regardless of which came first — her diabetes or depression — each debilitating condition perpetually worsened the treatment of the other to the point of hospitalization.

For this reason, there are many theories that depression and diabetes interact in a circular manner. Poor control over one's diabetes (e.g. poor glycemic control) can be a risk factor for depression; likewise, depression symptoms (e.g. poor dietary habits) can result in poor diabetic control (see Figure 3).¹

Figure 3.  Diabetes and depression are often thought to interact in a circular manner.²

After researching various symptoms of diabetes and depression, I created the diagram above to depict how these symptoms may interact in a circular, i.e. causal, manner. Hopefully, by the end of these last sixty days of high school, I can attest to this theory — that each of these chronic conditions often impairs the proper treatment of the other. If this is indeed the case, I suppose the question of which condition comes first is irrelevant. With the presence of either one, prevention and detection of the other should be a priority; otherwise, a situation like Judy Abendschein's may arise.

Bottom line: diabetes and depression combine to form a potentially fatal mix.

Lalani.

¹American Diabetes Association. (2011). Living with diabetes. Retrieved from http://www.diabetes.org/living-with-diabetes/complications/mental-health/depression.html. 
²Burton, M. (1997). Depression and diabetes. (cover story). Countdown, 18(3), 20.