I have had major depressive disorder since I was in the 5th grade (maybe age 10 or 11?), and didn’t develop diabetes until age 43, so there is really no connection. BUT when I’m having a depressive episode, my diabetes control goes to hell on a skateboard (a handbasket is too slow), and last year, I almost killed myself doing that.
So I DO think that people with diabetes who are suffering with depression DO need serious help, and mere counseling about carbohydrates isn’t it. I’m not sure about CBT, either, because my depression does not COME from my thoughts, it CAUSES my thoughts. And the thoughts are not “bah, I don’t want to count my carbohydrates”, they are “if I eat enough carbohydrates, maybe I can kill myself.” I already know all the stuff about carb counting, Insulin:carb ratio, sensitivity factor, etc. and I have a pump and a CGM, but the mechanics of diabetes are NOT the problem. The problem is the deep feeling welling up from the pit of my stomach telling me not to do ANYTHING, because there is no reason for living, anyway.
It really bothers me that depression is not taken seriously. It is NOT the “blues” that everyone has from time to time, and it is NOT the fatalism that uneducated and miseducated people often feel about diabetes. It IS hanging on to life by your fingernails and taking every bit of energy you have to do it, which spares NOTHING for any other concerns.
I truly don’t think it is possible to control diabetes, unless you control depression first. Depression and Diabetes – The Deadly Duo. 4Ds. People who are severely depressed are DESPERATE for help; I didn’t get any, although I actually tried to get help, until I was nearly dead in the emergency room. And the lack of help was MOSTLY professionals not taking me seriously. Money spent on helping depressed diabetics early will surely save high medical costs, or death in the end.
All my medicines are free. I’m over 60 as well as diabetic, however, The NHS won’t prescribe test strips for well controlled diabetics beyond 3 packs per year. they believe one test per week to be sufficient. I don’t even get those 3 packs, because my health centre doesn’t prescribe them. I have asked and got no-where. I simply buy direct from the supplier. a pharmacy would charge almost double. This is common in England and Diabetes UK is trying to change the stuation. However the NHS budgets one year at a time, so they save millions this way in the short term and don’t consider the longer time-frame.
It’s ridiculous, but most T2s not on insulin are in this trap here. Health authorities are cross that testing is costing them more than medication in diabetes care. I even know of children on pumps who have their strips rationed to cut cost.
I think that a lot of this goes in hand with the refusal of endocrinologists to deal with other specialties while they are treating us. If you talk about food, go see a dietician. If you are depressed, see a psychiatrist, during my recent spate of cardiac stuff, for which I now owe the %$^&*(# local hospital $488 in COPAYS for TESTS all of which came back NEGATIVE, “you should go see a cardiologist” for more $$ and less engagement with the possibility that “maybe O.D.ing on insulin can cause heart arhythmias?” which I was forced to conclude myself as my doctor seeing threshold had peaked.
It’s like you need a “manager” to run the medical show but he’s simply not there. The endo won’t tell the dietician to “shut up about the 60G of carbs for breakfast, he has DP”, the dietician certainly, not being a doctor, because food isn’t all that important (SARCASM, I think food may be “the missing link” in diabetes management, due to it’s “control” by dieticians?), won’t tell the psychiatrist or the endo that “AcidRock is on a SeePotatoChip diet. If he sees potato chips, he is going to eat them” and the psychiatrist, while they may perceive how the other situations (food, diabetes, potato chip addiction…) are affecting the patient, isn’t going to tell anyone anything. It’s no wonder I am crazy?
I agree Natalie. It takes a fully qualified professional to recognize the various disorders. Clinical depression is a serious disease and anti-depressants can contribute to not only the weight gain that triggers Type 2 but suicidal thoughts as well. Managing diabetes wouldn’t help in such situations.
I’m not sure it takes “a” fully qualified professional as much as it would take a “team” who would be better able to communicate effectively about people with more than one thing going on at once. Doctors punting food to dietcians is particularly annoying to me but anyone who has had diabetes will have run into this and probably found it annoying?
They are acquainted but don’t necessarily know anything about it I have heard of some pretty strange advice given to PWD by someone who should know better. An RD may suggest lots of carbs but at least they point out what raises your blood sugar and how to count it. I have met and heard enough about different Docs I am not sure it would be a very good idea to have them give advice either. I think they are required to take 1 maybe 2 classes in nutrition throughout all their schooling.
I agree communication needs to be better but you can bet the RD is sending a note to the Doc. However, it is rare to find a Doc who reads it.
Getting advice from an RD that does not have DM most people who frequent this site would not find helpful. We already know more how to deal than really any person without DM could help with-especially you AR. It is a shame we can’t take a test on DM management that would allow us to write our own Rx’s for DM supplies.
Not sure what you are saying. I get the reluctance to see a dietician as it is usually a waste of time not to mention lost wages. Are you saying that Endos should be able to treat the food issues as well? I certainly agree with that. As I’m not on insulin, I wonder if the diet issues affect how the endo/nurse determines the settings for your pump? Just wondering.
You are correct Peetie, I’m saying that endos should OWN the food issue. Doctors take biochemistry classes and food is made out of chemicals so I’m reasonably certain that most of them would know as much about food, nutrition, etc. as we do, if not perhaps a shade more because our knowledge often naturally orients towards carbs/ diabetes management, maybe a bit more but well, it’s very haphazard for me? It drives me nuts (crazy, not the high protein snack…LOL) that when I go to the doctor (GP or endo…several different clinics in several different towns…) when I bring up food, they refer me to a dietician, who doesn’t know squat about insulin or any of that business.
If you are taking insulin, it’s a “balancing act” and the food is just as important as the insulin to getting it right and should be managed by one conscious entity, not a team. It also infuriated me that I told the dietician that I was eating what I was eating (I don’t remember exactly what at that time…) b/c I wanted to lose weight and BCBS paid her like $200 to tell me 3x 45-60 and 3x15-30 because I was active. Sheesh.
Diet is central to diabetes management, regardless of type. It doesn’t make sense for an endo or PCP to completely farm it out. I would assume that a big part of a dieticians day is devoted to dealing with diabetics, so it would make sense for them to know more about insulin and its interactions with diet.
If they are dealing with PWD an RD SHOULD know about insulin. Sadly there are many out there that don’t. Even if they do, for most part it is an abstract idea for them. For us it is far more real- thus the frustrations over what they have to say.
In order for Docs to make enough money to make the clinic run they have to see people every 15 minutes. With 20-25 people they need to see a day with physical assessments, prescription writing, other issues besides DM where do you think a Doc is going to pull time to talk about diet? MAYBE an endo will have 5 extra minutes but I don’t see it for a PCP.
Its central to us but it’s not central to “them”, which is the problem I think?
I suspect that it may actually be as big of a problem as anything when you get right down to it? Almost everyone here has struggled with food whether it’s “I want to eat that but can’t” or “I ate that and am paying the price” or “I am content because I am not doing what the dietician said but what my empirical research told me to do”. None of us care whether or not our dieticians rate us as “noncompliant” but I bet if we went to a class of seniors in college on the cusp of being unleashed on the dietician profession, they would be quite alarmed by a number of us?
Maybe a way to fix it would be for an endo to be “allowed” to bill for a level 5 visit instead of a level 4 visit and talk about food or something like that?
For $200 would anything they would have said made you think it was worth your time? Hey AR go LC to loose? Hey AR eat x calories to loose weight? For that amount of money NO ONE could do anything besides cure me that would make me think it was worth it. That is my whole point. What could they tell you at this point that you don’t already have a line on?
I do see what you are saying AR but with the stories about Endo’s and PCP’s that I have heard on this site as well as things I have seen working, I think you may be trading one thing for a whole new set of problems and more than likely a higher amount of $. Docs bill more for insurance and usually charge more to the patient. My opinion is if an RD wants to work with PWD the should be required to be a CDE and CDE’s need to be vetted more intensly to get that credential. Either that or scrap the whole system and PWD should be the only one’s to help other PWD.
I notice, AR, that you use the word “team” somewhat negatively, and I can certainly understand that. My PCP has referred me to a gastroenterologist and a cardiologist who I now see regularly and take meds from and the PCP never asked for the results of those visits and wouldn’t know what meds I take if I didn’t periodically hand him an updated list. But “team” when it works is an amazing thing. I have worked in team settings where people were located in the same site; each person worked from their own perspective and then shared information on a regular basis regarding their mutual clients, both 1:1 and in staff meetings. In some settings it worked with a Case Manager who functioned as person who overseed it all (even though, ironically they are the lowest paid and educated) by referring the client for specific services and following up with the individual providers. It works very well! But I think the mental health field is somewhat ahead of the physical health field in having co-located teams who work closely together.
I’ve never gone to any of these “Diabetes Centers” some people talk about. Isn’t that what these are? How well does it work for the PWD’s benefit?
I do sort of see my docs as a team, but I’M the leader. Which means I am careful to update each of them about what’s going on with the others each time I see them. They’re not exactly cooperative, in that they say “UmHmm” but I suspect they forget what I say as soon as the words are out of my mouth. However, I hope that by telling them stuff, they WILL pay attention to the stuff that affects what THEY are doing.
I also look up every single new drug I am given, looking not only for potential side effects, but also drug interactions. Theoretically, both the doc and the pharmacist should be looking for that, but I don’t entirely trust them, because there are SO many drugs, and I don’t think the human brain can hold that much information. So I’m ultra careful. And so far, so good.
I’m not at all worried for myself – it’s the people who don’t have the educational background, technology or ability to take the lead who end up with the worst outcomes – and they are the people the medical profession should be most concerned about.
Sort of makes you angry…I’d be very angry. Acting out is a sign of depression, and that woman was acting out. If we are to control ourselves and allow others to see that control, they should at least respect our abilities. I’m with you…there should be more spent on helping us control and manage our disease than paying out monies for things that we deal with because we are out of control Good for you!
Zoe: I think you have hit the nail on the head. There is no “team”. Why see an Endo if his only purpose is to write scripts? Why pawn someone off on a Dietician when they don’t work together and not one can put the pieces together? I see that Acid would fear yet another isolated therapist. Let’s face it, he does use the word “crazy” a lot (LOL) and I don’t think regular therapy visits would solve his problem. It sounds like he just wants to know how to optimize his insulin use.
I have participated in many meetings like the ones you describe although my role has been different. They were so productive because we always did everything we could to pull the pieces together. I guess on the health care scene it comes back to the same thing… $$$$
I have heard of some pretty strange advice given to PWD by someone who should know better. An RD may suggest lots of carbs but at least they point out what raises your blood sugar and how to count it. I have met and heard enough about different Docs I am not sure it would be a very good idea to have them give advice either. I think they are required to take 1 maybe 2 classes in nutrition throughout all their schooling.