Diabetes and Anger -- Is There a Deeper Connection?

Two years ago, I wrote a blog post about diabetes and anger. In that post, I explored a lot of the day to day reasons why a person with diabetes might feel anger, and frustration. In fact, there are many reasons why a person with diabetes would, indeed, become angry. Those reasons can be varied, including anger at oneself for 'failing' to prevent the disease, to anger at family for not understanding or patrolling/policing the person with diabetes' behavior, etc. These are common types of anger: the anger that results from struggling to cope with a new and changing environment, for which we might have little control. (You can check out that blog post link, above, for a more in depth look at that topic.)

However, little did I realize that I was going to get such a huge response from the public -- but not about anger in this usual, common sense -- but anger in the chronic and mental health sense. Folks from all over the country have poured out their hearts to me in sheer frustration and worry over their loved ones, from sons to spouses, to friends. From lay people, to mental health professionals as well.

I must emphasize here, that I am NOT a mental health professional. I am not a medical expert of any kind, or a scientist. I am just a person with diabetes, with a blog. A person who loves learning every day, researching my own condition, and learning how to live and cope with it. Anything I say here is information you must take to your own clinician, or consult with your own mental health professional. It is also information that anyone can research on their own: never take my word for anything. Always be a skeptic.

Now that we have gotten that out of the way, let's start with the ways in which diabetes can clinically affect our moods.

Day to Day Blood Glucose Swings

When our blood sugars are not within normal or euglycemic boundaries (i.e., between 70-120 mg/dL, or 3.9-6.7 mmol/L), our mood and emotions will be altered. In some extreme cases, a person who, for example, experiences severe low blood sugar may become angry and even combative, or violent, or may seem 'drunk.' A person who experiences high blood sugar may experience sadness and depression, inability to concentrate, fatigue, etc. The root of all these glucose related mood swings has to deal with their association with the neurotransmitters in our brains, and how those in turn, communicate messages to our nerve cells about mood, appetite, and even sleep. Dealing with these states of mind is challenging, and can be tiring for the person with diabetes, as well as bring on a short temper. To top it off, having a negative disposition may also bring on bad blood glucose numbers, creating a vicious cycle that feeds off itself.

Chronic Mood Swings

The problem with being on this persistent 'roller coaster' of high and low blood glucose swings is that it can be bring about permanent, and chronic, mental health problems. Problems such as clinical depression, anxiety, anger, and a whole host of mental health conditions, like bipolar disorder.

According to a study on "Diabetes and Psychiatric Disorders," by the Indian Journal of Endocrinology and Metabolism, "Diabetes and psychiatric disorders share a bidirectional association -- both influencing each other in multiple ways." So much so, that apparently scientists back in the late 1800s found diabetes to be a disease which had been present in families with a pronounced history of mental health problems, so that insulin shock therapy was used as a treatment for mental health disorders even as shortly as insulin was isolated for the first time.  (Yes, insulin has a role in mental health, and even in the development of such diseases as Alzheimer's.)

This study further points out that there are several ways in which both diabetes and mental health problems can show up:

• As two parallel conditions, which developed independently of each other, with no apparent connection;
• As a complication of the diabetes, or as a complication of the mental health problem: type 2 diabetes may lead to depression, as well as depression may lead to type 2 diabetes, for example;
• As a product of hypoglycemia or hyperglycemia (and ketoacidosis), such as the development of chronic anxiety;
• And as a result of taking various medications for treating mental health -- many of these medications can lead to a triggering of a type 2 diabetes diagnosis. 

In my personal and anecdotal experience, I am a person who suffers from dysthymia. Dysthymia is a type of low grade, long term depression, which can subside and be in the background, for much of one's life. It is much milder than regular depression. However, in situations in which I have had an undiagnosed, and chronic health condition, such as hypothyroidism, or type 2 diabetes -- the imbalances in health provoked episodes of severe depression. The conditions influenced my depression and worsened it. In this way, uncontrolled diabetes can worsen or complicate a mental health condition that is already present, making overcoming of both conditions a challenge. 

It could very well be that the sudden and deep mood changes many persons with diabetes have experienced were the result of these drastic, and long term changes in blood glucose influencing an already underlying mental health problem -- especially if the diabetes was left undiagnosed or untreated for an extended period of time. It is particularly difficult for a person with diabetes that is weighed down by these mood changes, to find the motivation and positive inclination to manage their health condition. Quality of life tends to be reduced, and so does optimism, which can lead to development of unsavory habits, such as uncontrolled diet, smoking and drinking -- habits which can exacerbate mental health problems and lack of control, to an already breaking point. 

How Do We Help? 

In my previous blog post on anger, I noted several ways in which we could be of support to a person who was being burdened every day by the management of their diabetes. Being a good listener, helping a person cook meals, and being empathetic, are all proper ways in which we can deal with a loved one's chronic health condition. The Behavioral Diabetes Institute provides resources for us to utilize when we are overcome by our day to day emotions when managing diabetes, and may feel burnt out, or depressed. 

However, there are situations in which we need to be more proactive in identifying the mental state of our loved ones. Understand that, outside of a rare and severe hypoglycemic event, violent and aggressive behaviors are NOT standard complications of diabetes. These are not typical or normal behaviors for a person with diabetes. (Grouchiness is.) If a person you love is experiencing warning signs of serious mental health problems, you might need to have a conversation with them about visiting a mental health professional. This is an intimidating task, and there are suggestions out there, on how to broach the subject. 

The National Alliance on Mental Illness (NAMI) has a good Resource Guide for Families Dealing with Mental Illness. In it, they address what to do for 'crisis intervention,' when a person's behavior is particularly violent, or out of control:

If the individual with mental illness is in danger of physical injury, if his or her behavior is out of control or others are in danger, it is important to know what steps to take. Plan ahead by locating available sources for help: your emergency phone number (911), police or sheriff department number, Community Mental Health crisis or emergency number, name and phone number of a mental health professional, friends or neighbors who may be of help, and the nearest NAMI affiliate. Keep these numbers posted by the telephone. 

Any behavior such as this, that falls outside of both a mental health disorder, or a severe hypoglycemic episode, is unjustified violence, and should never be tolerated. Do not put up with it. 

. . .

Mood swings can be a standard part of diabetes mellitus and its attendant blood glucose fluctuations. However, when chronically unregulated, these blood glucose fluctuations can bring about more serious mood disorders. These mood disorders are NOT a standard symptom of day to day diabetes management, and will usually not ameliorate on their own. If you are living with a person who has become unpredictable, or violent, due to a potential mental health disorder, please seek help from your local community mental health centers, a mental health professional, or from your family physician.

The Big EDUAD Timesulin Giveaway!

I know... I know... You wait weeks for a post then three come along all at once!

Those of you with memories as bad as mine will doubtless have forgotten that I wrote some time ago about Timesulin, an ingenious replacement insulin pen cap. While not a fully equipped dose memory device the Timesulin is brilliant in that it does solve the main challenge of "Did I take my insulin just now or not?".

There are different versions to fit the pens for most popular UK insulins and the device works by displaying how long it has been since the last dose was taken. A quick glance will tell you whether it was 5 minutes or 4 hours and Hey Presto! No more missed-dose vs double-dose conundrums.

Cleverly the device does not need to you interact with it in order to register the injection, it 'knows' when you take the lid off the pen. And even more clever, it allows you to take a quick peek at how much insulin is still in the cartridge without registering that as a dose. Which is a great touch and kinda lets you know that at least some of the people who developed it have T1 themselves.

The lovely folks at Timesulin have offered us three, yes THREE! Timesulin caps to you, dear readers. If you would like a chance of winning one, please just send your name by the end of January to mike[at]everydayupsanddowns.co.uk or leave a comment below. I'll put all the names in a hat and draw the three lucky winners on 1st February 2014, then Timesulin will send you whichever cap suits your insulin free of charge.

Good eh!

So drop me an email and good luck :)

Lantus 0.5 unit pen at last - Pendiq Intelligent Insulin Pen

Lantus 0.5 unit pen at last - Pendiq

I *love* the DOC.

No really.

I absolutely love, love, *love* the DOC.

Just a quick glance at Twitter and I can be cheered, encouraged, supported, made to laugh and occasionally brought to tears all at once. Other times you go looking for some lightweight wit and wisdom, or just to see what folks are up to and suddenly discover some weighty new piece of research, campaign to fight for or better still... everyone's favourite diabetes benefit an exciting-sounding new gadget.

Before Artoo became my constant companion a couple of years ago, I wrote quite a few posts about Lantus basal insulin. I spent quite a bit of time trying to wrestle Lantus into submission, and eventually we got to the stage where we muddled along bearably, but it's fair to say that one of my main motivators for starting pump therapy was to get 'proper' basal coverage, that accurately reflected the ebb and flow of my body's rhythms over a 24 hour period.

Comparing notes with other users it seems I was not the only person to be frustrated by Sanofi's rather less than enthusiastic approach to insulin delivery. Most of the injection pens that fitted Lantus were, frankly, nasty. And none of them offered doses in increments smaller than 1 unit. This might be OK if you are on higher doses, but many T1s are quite sensitive to insulin. I'm not quite sure how small children cope, for example. The minimum dose adjustment could well be a significant percentage of the total.

The other pen-related problem I had fixed around the same time related to my terrible memory. It may be hard to believe it you do not live with diabetes yourself, but after a few thousand injections they can become so automatic that you barely think about them. Sometimes you have absolutely no idea whether you have injected your dose or not. I changed bolus (mealtime) insulin to Humalog to get hold of a pen with a 'dose memory' the Humapen Memoir so that if I was ever unsure I had some means of checking that didn't involve me having to write something down, which I was just as likely to forget to do... Or possibly even to remember to write it down, but then forget the actual injection. See what I mean about my memory? Hopeless! Sadly the Humapen Memoir has since been taken off the market and it looks like its development has been abandoned. So now the only memory-enabled pen available on prescription in the UK is the NovoPen Echo.

But...

Thanks to a Twitter conversation I chanced upon earlier this week, I now know there is an alternative. And a very interesting alternative it looks to be too.

Enter Pendiq, the Intelligent Insulin Pen

Pendiq is a new breed of injection device from Germany initially launched in 2011 and relaunched in 2012. Such is the ruthless efficiency of German engineering that this pen boasts not just 0.5u accuracy but increments of 0.1u (from 0.5u upwards). Delivery is unlike any other pen I am aware of - dial up the dose on the display, press the button and a precision motor delivers the insulin at 2/u per second. The pen stores and displays around 2 months worth of injection doses and timings on an LCD screen and the website boasts all sorts of download opportunities and compatibility with logging software such as SiDiary. The battery is rechargeable and the device seems to be compatible with 'standard' insulin pen needles. The Pendiq is compatible with Lilly and Sanofi-Aventis insulins, which means that both Lantus and Humalog doses are now available on MDI in 0.1u dose increments. Heck you can even choose from five funky colours!

Unfortunately there is a snag. Isn't there always? It seems the Pendiq is not currently available on prescription in the UK. It looks like you can buy it via the website, but with the shipping/delivery it will set you back almost €185 (around £150). So not cheap... by any means. You would also probably be wise to speak to your DSN/hospital/clinic to get there guidance if you were tempted to spring for one before you part with any cash.

If you'd like more information, visit www.pendiq.com

Nano technology, non-invasive BG monitoring and smart insulin

There are some diabetes-tech buzzwords that always attract my attention. Thanks to a tweet from Nick Guerin (@Typeaware) I was treated to a triple-whammy this morning.

We have come painfully close to a 'non-invasive' BG monitor (or even better CGM) once or twice before, but it is good to see that the search continues. To be honest the breathalyser-style BG monitor (which still uses a single-use 'strip') interests me less than Smart Insulin, which I think is probably my most favouritest 'wildest tech fantasy come true' product of all time ever - see here.

"A team at North Carolina State University believes so. Prof Zhen Gu and his team are working on a couple of different systems which may achieve this ideal – effectively creating an artificial replacement to the beta cells in the islets of the pancreas, which would normally release insulin to counter high glucose levels.

"Our overall aim is to create 'smart delivery' systems for insulin provision," says Gu. "What I mean by that is that insulin is delivered at the right time, via a safe approach – avoiding too much or not enough dosage – and in a way which requires only small formulations."

One of the team's ideas in development is an injectable nanoscale sensory network, announcing earlier this year that such a system maintained normal blood sugar levels for up to 10 days in type 1 diabetic mice. The "nano-network" degrades to release insulin when glucose levels are high and the researchers are currently trying to optimise it to respond as quickly as pancreatic islet cells do naturally in the body, and to make it more biocompatible with human tissue."

And wouldn't you know it those pesky diabetic mice have beaten us to it again.

Full article is here:
TheGuardian.com - Nanomedicines set to revolutionise the treatment of diabetes

Do You Really Need a New Year's Resolution? Then Drink More Water...

Ask the average person to drink more water, and they'll make a face at you or come up with an excuse: "Water's so boring... it doesn't taste like anything."

I think that we're so used to eating, and overeating, that we don't feel right if we don't have something of 'substance' in our mouths all the time. We use that as an excuse and then it becomes so easy to avoid water, and get carried away drinking things like carbonated sodas, sports drinks, smoothies, teas, and coffee, etc., all throughout the day. We don't notice how these other beverages -- while sometimes possessing some benefits -- may be more detrimental than helpful, when they start replacing water. Some of them are even addictive, so much so, that leaving them may cause headaches or even migraines due to their caffeine content. Others are quite high in calories and sugar.

Now, don't get me wrong -- I don't mean anyone should drink X amount of water a day. The idea that we ought to consume x or y amount of water a day, came from an outdated notion of 'averages.' Today's wisdom is that people are all different, and as such, they should drink to thirst, to better meet their individual needs. It is a silly idea to suddenly make oneself consume so much water a day, as some kind of achievement -- as I have seen many fellow friends give themselves this challenge. Overconsumption of water depletes minerals and electrolytes which are necessary for a well balanced and healthy body, plus... it makes you visit the potty a lot more often than you really want.

Now, all this being said... it is not a bad idea to start adding more water to our days, and to start listening to those physical thirst signals. Here is something to know:  The feeling of thirst is very similar to hunger. If you are not having enough water in your day, and you are overeating -- it very well could be that you are not hungry at all, but simply thirsty. Try having a little bit of water, and wait to see if those 'hunger signals' are still there, or if they subside. 

Drinking a glass of water first thing in the morning will help your body get a kick start. Just like your body has spent the last 8 hours not eating, it has spent the last 8 hours not having water. The body needs to replenish fluids in order to perform its basic bodily functions, such as detoxing your system through urination, cell regeneration, and hormone production (which includes hormones which communicate hunger and satiety signals). 

Once you slowly add more water to your life, you may start to see some of these benefits: 

• A Better Mood. Being dehydrated can make us moody, cranky, even depressed. 
• Less Overeating. When you are well hydrated, there are less chances for you to confuse a thirst signal for a hunger signal, and will also feel your satiety signals more clearly. From personal anecdotal experience, I can say that when I have a diet soda with a meal, I will feel full and bloated on the carbonation, will then stop eating the meal thinking I am full, and then will start eating later out of feelings of hunger and lack of satisfaction. With water, I feel like I can fully enjoy a meal, and stop when satisfied.
• Better Glucose Levels. When we let ourselves get very dehydrated, our blood volume is decreased, and thus the concentration of glucose will increase. This can turn into a dangerous and vicious cycle -- especially if compounded with exercise, and higher blood glucose levels which also dehydrate the body even further. Water can help you sweat properly, release toxins, and keep a stable blood glucose level. 
• Younger Looking Skin. Simply put, when you're dehydrated, you look old and tired. Your cells don't have what they need to regenerate, or to have that healthy glow. Plus... you'll get dark circles under your eyes. Eww.  
• Less Swelling/Bloating. Swelling, bloating, puffiness... of the face, or of ankles, can all be defense mechanisms of the body to try to keep and retain fluids at all costs, because it's dehydrated. 
• Regularity. Water helps prevent constipation, and helps you flush out toxins. 
• Improved Muscle Health. Water can help our muscles and joints be more lubricated during exercise, as well as prevent them from cramping. After all, our muscles are mostly water.
• Less Headaches. One of the most common reasons for a headache is dehydration. Seriously. People just don't realize it. Do you know what a hangover is? DEHYDRATION. 
• Refreshment. When the outside temperature rises, drinking enough water can help our body feel refreshed, by keeping body temperature well regulated, through sweating. Drinking enough water can also help fend off heat stroke. 
• Better Sex!!!!! Yeah. You read it right. You can't perform right, if you're dehydrated. From erectile dysfunction to just losing steam in the middle of the action. 

So... as a baby step for being healthy, why not try having a a glass of water, just on its own, a few times a day? We can slowly wean ourselves from letting other types of beverages rule what we drink -- and soon the true refreshing nature of water becomes what we crave, without needing added flavors or additives, when we are truly thirsty. Trust me. It really does works. :) 

So if you're truly thirsty... put DOWN the diet Coke. Go have some water. You owe it to yourself, and to your health. 

Don't Fall for the New Year's Resolution Trap...

Every new year, I rail a little bit against the concept of New Year's resolutions -- that time of the year when everyone is suddenly dieting, ending bad habits, testing every day, taking all their medicines on time, and having a near heart attack after trying to jog for two blocks.

It's not that I don't want to see people succeed, but I feel that this time of the year isn't really ideal for making such changes. For one, our challenge becomes this public stage: all friends and family become aware of these resolutions, and we're expected to 'perform' like a good little child for someone else's praise. Often they might even police our behavior. On top of this, most people don't really have a basic grasp on how to approach these really big changes. People want to eradicate all unwanted behaviors, or install new ones, in one fell swoop. Considering that humans are creatures of habit -- and often, habits which have many emotional underpinnings, this is the stupidest idea that has ever occurred to anyone. And corporations LOVE IT, and feed on it -- and then constantly bombard us with New Year's resolution ads because we're sheep like that. This creates an environment where food, and the pressure to succeed and be perfect, is ever present on the mind: eating certain foods, and avoiding the foods we won't allow ourselves to have, being the size of that one skinny model eating yogurt, living on only cereal or soup, etc. It's a recipe for disappointment, and we really set ourselves up for it. Honestly, I'm surprised major women's groups have not denounced some of these ads as unhealthy, and gotten them off the air. I mean, are these corporations really suggesting I should live on nothing but cereal, or soup, to get skinny in a short amount of time? This is the root of anorexia right here, folks.

Now, do I think we shouldn't reevaluate anything in our lives, ever? No. But my perspective has always been that we ought to do more than just change some 'actions,' and instead change the emotional bonds and attachments behind ingrained behaviors. That we should first tackle the "bigger picture," if you would. For example: If we're having a problem with weight, perhaps we ought to focus for a while on not overeating (and all the reasons and emotions behind that, and what it entails), rather than drastically changing the particular foods we eat; or, if we're having a problem with being inactive, perhaps we ought to focus on finding enjoyment in some physical activity, like taking a walk around the block after a meal, and noticing how our body craves the movement, rather than focusing on meeting certain time limits and endurance levels; etc. Changing how we focus our minds around these challenges will allow us to address the problems at their root causes, and allow us to make further progress in establishing disciplined habits. Once we are focused on just eating the amount of food our bodies need (ie, eating to satiety signals) -- and not more than that -- we can perhaps consider trying new foods. Once we see that we enjoy walking, perhaps we can step up the pace.

So, really, when we look to make changes in our lives, we should be looking to slowly and completely change our state of mind, and not just some actions. Actions are simply the symptom of the deeper problem. The thing is... we can start this at any time of year -- we can start it whenever. And we don't have to let ANYONE know we're doing it. We can freely invite someone over to enjoy an evening walk after dinner, without ever having to let them know what we're doing. It is NOT about keeping ourselves accountable -- it is about finding enjoyment -- enjoying out body, the things it can do, and our lives.

So, in the New Year, resolve to give yourself the freedom to not resolve anything... but to give yourself and your actions, the love, respect, understanding, and attention which they deserve.

Happy New Year.