Diabetes and depression are some of the most disabling and widespread illnesses today. Yet how much do we really know about the complexity of these two conditions, how they interact with one another, and how they’re treated when they co-exist?
Diabetes and depression are some of the most disabling and widespread illnesses today. Yet how much do we really know about the complexity of these two conditions, how they interact with one another, and how they’re treated when they co-exist? In this Listen Well episode, hostDr. Mo Alsuwaidan explores the biological, psychological, and social impact on the individual, with input from two expert guests in the area — Professor of Medicine and Therapeutics at the Chinese University of Hong Kong, Juliana Chan, and guest advocate Sairekha Sureshkumar, co-founder of communities and platforms for persons living with diabetes.
Disclaimer:
This podcast is provided for educational purposes and is not intended to replace discussions with your healthcare provider. All decisions regarding your care must be made with a healthcare professional, considering the unique characteristics of your personal situation. The opinions expressed are the opinions of the individuals recorded and not the opinions of Viatris. Individuals featured in this podcast may have participated in the past or may be current members of an advisory group for Viatris.
Dr. Mo Alsuwaidan:
Welcome back to Listen Well, I'm Dr. Mo Alsuwaidan. On today's episode, we'll be talking about two very common illnesses that all of you have probably heard about, but many of us don't know the details of; diabetes and depression.
Dr. Mo Alsuwaidan:
How do these two illnesses link? How do they correlate? Is it more common to have one if you have the other? Do they make each other worse? And how do we treat them when they exist together?
Dr. Mo Alsuwaidan:
I'm honored to be joined by two expert guests in this area — Professor Juliana Chan, who is a Professor of Medicine and Therapeutics at the Chinese University of Hong Kong. She's an endocrinologist with a special interest in using data and team approaches to prevent and manage diabetes.
Dr. Mo Alsuwaidan:
We're also joined by Sairekha Sureshkumar, who is an expert through her lived experience. She's an attorney based in Mumbai, India. She specializes in workplace discrimination and she has co-founded communities and platforms for persons living with diabetes.
Dr. Mo Alsuwaidan:
Diabetes and depression are such common conditions that affect all of us. If not personally, then with someone we know or love. There's so much to talk about and so much to learn in this episode. So, I hope you're ready to listen well.
Dr. Mo Alsuwaidan:
It's a great pleasure to have two wonderful guests with us today; Professor Juliana Chan, and Sairekha Sureshkumar.
Dr. Mo Alsuwaidan:
Professor Chan, I wanted to start off with a really important question. Diabetes is a very well-known illness to a lot of people in terms of the name. I'm sure anyone who knows anything about health has heard the term diabetes, but I wonder if people actually know what it is. So, can you tell us a little bit about what diabetes is?
Juliana Chan:
Well, diabetes is a condition when somebody cannot control their blood glucose within a narrow range at all times. So, glucose is very important. It is our energy source, and that has to be kept at a very narrow level; 5, 6, 7, 8 at all times. Too high, too low, we have a problem. And people with diabetes, they cannot maintain that glucose level.
Dr. Mo Alsuwaidan:
And I guess that's why people say high blood sugar. So, they're referring to higher glucose in the blood?
Juliana Chan:
Life is all about your energy and your energy comes from sugar. So, everything that you eat, it's actually turned into sugar and it circulates in the blood stream. And then what happens is your body will secrete something called insulin. It's a hormone, which is actually from the pancreas, which is behind the stomach. So, this little hormone will also go into the blood stream.
Juliana Chan:
Just like a key, it will actually turn the door of the cell open. And then the glucose can go into the cell and then the cell can use the sugar. So, if you do not have the key, then actually the sugar is stuck in the bloodstream, just like in the conduit.
Juliana Chan:
You've got too much sugar stuck in your conduit or the road, then it destroyed it. So, the cell cannot use the sugar. And they have problem right, if you don't have the sugar. And while at the same time the blood vessel is stuffed with this sugar and it can destroy the blood vessels.
Dr. Mo Alsuwaidan:
Now, you mentioned that it can be very silent and later on, affect other organs or systems in the body. What kind of symptoms would they actually have when they develop diabetes?
Juliana Chan:
Whether you eat or you don't eat, your body has a mechanisms ok, to make sure the sugar stays at this 5, 6, 7, 8. This is the number that you need to remember. And when it spills over a certain level particular like when it goes beyond 10, it will start spilling into the urine.
Juliana Chan:
These people will actually start having a lot of urine. And as a result, they feel thirsty. At the same time, because the cells are not getting the sugar, they feel hungry. And so, they have these three symptoms; they feel hungry, they feel thirsty, and they have a lot of urine.
Juliana Chan:
Now, in certain situation, because the cells still need the sugar, because the cells are just machines — and so what happen is they start burning that fat and that's when they start losing weight.
Juliana Chan:
So, if you're somebody who are very obese and then suddenly, they lose weight, that's not very good news, if they are not intentionally losing weight, because they cannot use their sugar. Now, if you start burning your fat too much, then you might have a problem. So, people who have like Type I diabetes, they really have no insulin. They really just have to rely on the fat in order to get energy.
Juliana Chan:
So, when you burn fat, you get ketones and this is actually toxic if you have too much. And so, that's why people who got Type I diabetes, they must be using insulin in order not to have these ketosis. Having too much ketone in the body.
Juliana Chan:
For Type II diabetes, the majority of people, they actually still have a bit of insulin, but the insulin is not working very well. And so, as a result, you can be very silent. They may or may not have symptoms, but the sugar is always above those high level. And so, after a period of time, they may present with complications like a heart attack or an eye problem.
Dr. Mo Alsuwaidan:
In psychiatry and mental health, one of the commonest things I see is depression. And even though people talk about depression, a lot of individuals don't understand the details and the complexity of depression, because it really goes, I'm sure as you know, beyond sadness.
Dr. Mo Alsuwaidan:
It involves other emotional feelings, like loss of interest, but also, issues in the brain like cognition or memory impairment, concentration difficulties, and things in the body like changes in sleep or appetite or energy, and changes in your thoughts around guilt and the meaning of life and wanting to be alive or not. And it's such a widespread and such a disabling illness.
Dr. Mo Alsuwaidan:
And that brings me to what we're talking about today, which is the link between these two common and complex illnesses. What can you tell us about the coexistence of both depression and diabetes, and how they relate to each other?
Juliana Chan:
Now, first and foremost, diabetes is a very complex disease and there are people who are very thin, they stillget diabetes. There are people who are overweight, they don't get it. People are young people are middle-aged, people are old. You have people who are, lean, who are obese, or they might have you know complications or no complications. So, everybody's kind of different.
Juliana Chan:
The key point is it's almost like a thermostat. If the thermostat is not working, which is your insulin is not working, then your sugar is all over the place. And that is when you eat, you don't eat, okay, whatever you eat, when you eat, okay, you're happy, you're not happy, You do exercise , you don't do exercise — or for example, you sleep well, you don't sleep well, or you know you don't feel happy or happy — all this could actually start make your blood sugar all over the place.
Juliana Chan:
So, as a result people with diabetes, they really have to change. They have to learn so much how to regulate their lifestyle. And they also very often, they may need to take medications or in certain situations, they may even have to do injections in order to keep the sugar within a reasonable level.
Juliana Chan:
So, that it's not like a yoyo all over the place, but that requires a lot of discipline. They have to prick the finger and then to try and find out what the sugar is like. And then to think about it, why my sugar is like that. So, it can be very burdensome.
Juliana Chan:
So really when people get diabetes, then that whole process of taking medications, taking shots or monitoring, and then learning what to eat, and exercise — it's really a lot to take.
Juliana Chan:
So, I think it is very understandable why people feel anxious, stressed, and even depressed. Now, the point is this emotion would also increase your sugar this is really like an energy-demanding stage — it's stressful, your body says, well, this is a stress you're fighting, so I give you more sugar.
Juliana Chan:
So, that got into kind of a vicious cycle. So, the more stressed they are, then the more difficult the blood sugar becomes. And so, you can't really just say, "We'll give you the pills, get on with it." You really need a very holistic approach to understand the emotion of the person, how do we help them live with diabetes, et cetera.
Dr. Mo Alsuwaidan:
You know, Juliana, I want to come back in a bit to a little more about the biology of how they link back and forth diabetes and depression, and also, some of the statistics worldwide. But I do want to ask Sairekha as a person with lived experience, what was it like for you being diagnosed with diabetes and how did it affect your emotional, mental life?
Sairekha Sureshkumar:
You know, Mo, I wish they prepare you for something like this. I was a kid. I was about 11 when I was diagnosed. So, I honestly had no idea what was going to be from there. Quite frankly, the way all my family and everyone was so serious, and they were talking in hushed whispers on how to manage this, I went around telling the entire neighborhood, I think I have cancer because my parents are sort of plotting behind my back and taking me to these doctors. And then they used to give me these insulin injections, but of course, there was a learning curve.
Sairekha Sureshkumar:
Growing up, of course, I came from a time where there was a lot of shame associated with a girl or a lady or a girl child growing up with diabetes because in India, which is of course, a more traditional country and you arranged marriages are a whole thing, families sort of believe that if a girl or a daughter has diabetes, you can't get married, it can hamper your prospects, you won't get hired.
There is so much of stigma around it. So, there's, I think a lot of shame that developed — an association with the condition comes from there where you don't feel comfortable coming to a public forum and talking about your conditions. So, there was so much of unlearning that came from there.
Sairekha Sureshkumar:
So, yeah, but I think more than my childhood, my real challenges as the years passed, like this is my 27th year of living with this condition. And this year, after two years of the pandemic, I woke up one fine morning and I couldn't look at my CGM anymore. I couldn't look at graphs, I couldn't look at anymore data; I don't want to deal with this.
Sairekha Sureshkumar:
And let me give you some quick context as to why is it such a cognitive burden; I mean, while of course like Dr. Chan so beautifully explained, the thing about living with a chronic medical condition like Type I diabetes, is that you are literally sort of overcompensating for your dead pancreas. So, you're taking a billion decisions every hour of the day.
Sairekha Sureshkumar:
So, to give you an instance; if I have to eat a sandwich, and if you were to eat a sandwich, you'd just eat a sandwich and not think too much about it. I have to guesstimate the exact amount of carbohydrates in that sandwich, then I have to test my blood sugars.
Sairekha Sureshkumar:
And then now, I have to take an executive decision based on how many units of insulin. And that includes considering my hormonal cycles, whether I'm going to exercise in the hour, my stress levels, God knows whatnot.
Sairekha Sureshkumar:
And I do this day in and day out, 6, 7, 8, 9, 10 times a day. So, this goes into two points; I had this whole phase where I had such a horrible relationship with food. I felt so much of guilt-eating, there were all these feelings around eating because I felt like that led to that whole burnout. So, I realized this year that I had diabetes burnout.
Sairekha Sureshkumar:
And again, the first point of thing is you reach out to your endocrinologist who simply just says, "Listen, there's so much on your plate, why don't you take it easy? Why don't you cut back?" And then there's so much of anger — for something that comes from there saying, "No, why should I cut back? I'm great at what I do. I have this amazing career, I'm so smart. I have this great life.
Sairekha Sureshkumar:
So, yeah, I mean, this was my first burnout, so to say, and it was very real, it was overwhelming. It was confusing. I had to work through so much of anger and thank God for my therapist because we are all for the better.
Dr. Mo Alsuwaidan:
Does the burnout — because the way you describe that, I've never heard it described that way, but it makes a lot of sense. Because for me, as you said, I just eat the sandwich and then all the decisions around my sugar state are being made in the background automatically. You have to take over for that.
Dr. Mo Alsuwaidan:
So, burnout is such a good way of putting it. Has that burnout at any point led to kind of more intense feelings of depression or a period of depression. If so, what was that like?
Sairekha Sureshkumar:
My therapist calls it mild depression. She said it's not a full-blown thing. She just says it's a burnout, and there's a lot of mild anxiety. And let me explain that I think sometimes I got so anxious that I didn't want to deal with it. Like I was so overwhelmed.
Sairekha Sureshkumar:
So, there's so much of anxiety while I'm ignoring it, and there's so much of frustration while I'm dealing with it. So, it was a very negative space. I was overwhelmed. There were so many days when I would just look at a screen and blank out. So, yeah, that's when I reached out. I started getting help with people who would help me lessen the burden.
Juliana Chan:
Yeah, but on the other hand, I think the support is very important. I think probably Sairekha, you have a very good support team. Because I think if you have the healthcare professionals; not just the doctors, but like you say, the nutritionist, the dieticians sometimes, and also, understanding what actually gone wrong. And yet how can you adapt your lifestyle in order to sort of put things under control, and it can be done.
Juliana Chan:
But here, I think the emotion is very important. Helping people to kind of understand the pattern of the disease. Now, we have a lot of tools to help them. But also, not trying to aim at perfection because nothing is perfect, but really, trying to put things under control; every now and then have a bit of a break.
Juliana Chan:
I think these are really important messages that sometimes we, as healthcare professionals also want to impart upon the patients. But at the same time, we also have to recognize that sometimes, there's genuine depression behind it. And in those situations, I mean, there is this anxiety, the stress, and also, depression. And we know about 10 to 15% of people with diabetes might indeed actually have genuine depression.
Juliana Chan:
And I think we probably need to do something about it to break that vicious cycle. So, if they really are very, very low, they feel very, very sort of lack of energy, they lose interest, things that they normally want to do and don't want to do — so everything look very gray, their sleep is getting problems, they come off food or sometimes they really want a lot of food.
Juliana Chan:
So, these are really a major change in terms of the thinking and the acting, and start affecting their life in terms of the joy and pleasure and the work. I think those are the things that I think doctors should take notes of that. And maybe even sometimes medication is needed to break that vicious cycle.
Dr. Mo Alsuwaidan:
Just to come back to something you said Juliana, 10 to 15% of people — I mean, that's an important statistic and I've seen even higher numbers in some estimates.Beyond the psychological, are there biological reasons that diabetes leads more commonly to developing depression than someone who doesn't have diabetes?
Juliana Chan:
Yeah, I think certainly people with diabetes, we know there is a hormonal abnormality, so basically insulin is an important one. But sometimes, I think obesity is very often associated with some of the stress hormone changes, and we also understand that there might be a lot of low-grade inflammation going on because really, the high glucose, the high cholesterol or the high blood pressure, they're all sort of translated to some kind of small blood vessel damage.
Juliana Chan:
And then the body reacts by having inflammation. So, it is possible that there might be some inflammation you know in certain parts of the brain, which might also affect some of this chemicalwhich actually govern the mood.
Juliana Chan:
So, I think sure, there is actually a hormonal basis for some of these mood changes. And then it kind of get into a vicious cycle because so much of the behavior.
Juliana Chan:
We all have a very unique genetic profile from mom and from dad, and that kind of like shuffling your card - give some to you, give them to some siblings.
Juliana Chan:
This genetic profile is progressively being expressed over a life period. And so, some people might be a little bit more vulnerable in terms of their emotions.
Midroll - Dr. Shari Melamed:
Hello, my name is Dr. Shari Melamed. I am an endocrinologist, and the Global Medical Lead for Cardiovascular Disease and Diabetes at Viatris.
On today’s episode, we’re talking about mental health, diabetes, and comorbidities. With noncommunicable diseases or NCDs, which include many chronic diseases, and are responsible for seven out of every 10 deaths worldwide [WHO 2021 NCD pg.1A], we see a huge opportunity to help increase awareness, research, and support.
For people living with diabetes, access to a treatment, including insulin, is critical to their survival. The World Health Organization has set global targets to stop the rise of diabetes and obesity by 2025. [WHO 2021 Diabetes pg.2A]
Viatris is on a mission to support this WHO target, and also help address some of the world’s most pressing health challenges. In 2020, we did this by providing product donations when travel was restricted by the pandemic. We are also the founding sponsor of the NCD Academy, a free, web-based, educational platform for healthcare providers to improve the prevention and treatment of NCDs.
We hope you are finding this episode of Listen Well useful. Our team at Viatris is so pleased to be supporting Dr Mo on this podcast to help encourage discussions about important health topics. Our mission is to empower people worldwide to live healthier at every stage of life. Thanks for listening.
Dr. Mo Alsuwaidan:
Now, one of the things I wanted to talk about is does the relationship go both ways? So, we talked about how people with diabetes can develop depression, but do people with depression have a higher rate of developing diabetes?
Juliana Chan:
Yes, I think despite directional association, so people with depression are at risk of actually having diabetes and similarly people with diabetes are at risk of having depression. So, people with depression, due to imbalance of these neurotransmissions, so we have all these chemicals in the brain that governs your mood. So, some of them are happy hormones, some of them are sadness hormones, some of them are satisfaction hormones. Some of them "I'll give you this drive" hormone.
Juliana Chan:
And it's very complex, and this imbalance of these chemicals will give you this kind of mood and different kind of psychiatric illnesses. But of course, the mood determines your behavior. So, if you're depressed, for example, then it might manifest as a behavior in terms of actually physical inactivity. So, you're withdrawn, for example, you don't want to go out, for example.
Juliana Chan:
So, it's a very complex situation. And so, once they actually got them ... and then of course, on top of these stress hormones, this imbalance neurotransmitters, then what about your beta cell reserve. So, we now also know that actually your beta cell, which is really the only hormone that will reduce glucose is also genetically determined.
Dr. Mo Alsuwaidan:
We're really talking about the kind of bidirectional relationship between depression and diabetes, and a lot of the things you said correlate so much with depression, because there's not one form of depression.
Dr. Mo Alsuwaidan:
There's so many different forms and there's so many different causes; biological, psychological. We touched on some of that for diabetes and just coming back to Sairekha, you mentioned briefly that some of the social causes or social obstacles or contributors like the stigma. What obstacles, or social aspects have you experienced with regards to diabetes and how that related to anxiety, burnout or depression?
Sairekha Sureshkumar:
So personally of course, I've, again, been very, very lucky, but I've you know been a part of creating and I've been a part of a lot of diabetes communities in India. We sort of came together and we formed a lot of patient-led or persons living with diabetes-led communities. And we have so many, we have a dozen of those in India, and it's beautiful.
Sairekha Sureshkumar:
But circling back to your question, the genesis of that, and how does it relate is social stigma and discrimination. I mean, so I also, when I'm here, I'm bringing you know the experience of so many of our people from the community.
Sairekha Sureshkumar:
So, of course, there's so much of shame. There's so much of stigma associated with this, especially if you are a woman or a young woman, or even a young man, a lot of people in the arranged marriage system don't want to marry you. So, that of course, is something that causes great shame and great embarrassment and great stress to a lot of young people who still you know sort of struggle with that.
Sairekha Sureshkumar:
The other thing is workplace discrimination or discrimination in schools. And that's, again, something that you know the advocacy piece has come in and you know we're really fighting for that piece. So, for example, you wear a lot of devices. Like I'm wearing my CGM.
Sairekha Sureshkumar:
A CGM is a continuous glucose monitor. So, it's this little coin-sized device that you know I wear on my arm or I can wear it anywhere else in my body. Every five minutes, it sort of takes a blood glucose reading and it plots a graph. So, how Dr. Chan beautifully said, you need to be in that 5, 6, 7, 8, it always sort of it beeps if you're not you know within the range.
Sairekha Sureshkumar:
So, it sort of helps you, it gives you a lot of data points to take these dosing decisions that I was telling you about earlier. So, these are aides, these are tech-driven or tech-based aides to manage diabetes very effectively. So, what happens is oftentimes, I'm walking around in the supermarket and somebody will make it a point to come and tap me on my shoulder and say, "There's something on your arm, what is it?"
Dr. Mo Alsuwaidan :
They think it's something stuck.
Sairekha Sureshkumar:
They think it's something stuck. So, I say, "It's a Wi-Fi hotspot, do you want to log into it? What do you think is it? You don't know me." So, there's that. And then there's so many times that people will probably in a crowded space come and ask me, "Why do you wear the curious pager?" The uninitiated, my insulin pump looks like a pager from the nineties.
Sairekha Sureshkumar:
So, that's of course the minor transgressions. You have microaggressions at work where if you have to take insulin at work, a lot of people struggle with colleagues being uncomfortable, or even in schools where you find kids who come back and tell you that teacher is not letting me take insulin in class. So, the kids bully me because I'm taking insulin in class.
Sairekha Sureshkumar:
So, these are all things that sort of really cause people to have ... so there are two ways of this; I mean, typically if that's the majority voice, then you're not going to look after yourself. You're not going to take that insulin shot. So, there is a domino effect of problems that comes with this kind of social pressures.
Sairekha Sureshkumar:
And then I hear of a lot of organizations where they ask you to make a health disclosure that are you living with this kind of a medical condition, and you say, "Oh, I have Type I diabetes," they immediately red flag the candidate, as you know some kind of a health insurance or some kind of a risk. And you find a lot of organizations who don't have diversity or inclusion policies who come and sort of attack and say, no.
Sairekha Sureshkumar:
You hear a lot of people, like recently there was something in the forums where I heard a young man said I got fired because I took sick days. Like he had COVID, then it got complicated with diabetes, he couldn't get back on his feet soon enough. And his organization fired him because it was a loss.
Dr. Mo Alsuwaidan:
And all this can affect someone's mental can affect someone's mental state. And I think we, as a society need to do better. How can we do better within the healthcare system? What kind of social challenges or obstacles have you seen within the healthcare system? I'm sure there's a lot of help from the healthcare system, but I'm sure the healthcare system can always improve and do better.
Sairekha Sureshkumar:
I think normalizing mental health component in diabetes management is going to be so important. I mean, I don't mean to criticize, we have wonderful network of doctors and there is a village, but this village needs a mental healthcare professional. It really does. Because you know getting someone somebody to talk to — like typically there is such a limitation of physical healthcare, diabetes doctor, and I don't mean Dr. Chan, you're wonderful.
Sairekha Sureshkumar:
But a lot of doctors, when you go to, first of all, the doctor-patient ratio in India is so high. Like I read somewhere that every 10,000 people with different ailments have access to one doctor.
Dr. Mo Alsuwaidan:
And it's such a common problem worldwide, actually.
Sairekha Sureshkumar:
Absolutely. So, you have 10 minutes with your healthcare professional and what do you expect your doctor to do in 10 minutes? So, I think having somebody who's also a mental healthcare professional associated with this village or forming a part of this village is so important.
Sairekha Sureshkumar:
Look, I'm privileged, so I'm completely grateful that I have the means to work for and you know afford this kind of healthcare. But I also, want to use this opportunity to highlight the financial anxiety that comes with affording the care that you need when you live with a chronic medical condition. This stuff is expensive. Therapy is expensive... and there is a policy gap through which all of this falls through.
Dr. Mo Alsuwaidan:
You know, as a practicing psychiatrist, I think you hit the nail on the head. And just coming back to that village metaphor, Dr. Chan works in her area of diabetes and endocrine, and I work in my area of psychiatry, but you need a whole system around you of nurse practitioners, physicians, assistants, family doctors, GPs — all of who need to be educated in the basics of diabetes care and also, the basics of mental healthcare, which is sorely lacking to minimize that issue of having just that 10-minute component.
Dr. Mo Alsuwaidan:
I think in terms of time, I want to kind of shift to the last part of our talk today, which is treatment. Can you speak a little bit about co-treating diabetes and depression? So, not just treating diabetes, but when they actually come together as a comorbidity, which is our fancy medical term for basically saying they exist together, how is it treated?
Juliana Chan:
Yeah, I think you know really, we should be treating a person holistically. Not just the physical, but the mental health. And this is particularly important with diabetes because really, this person has to live with diabetes for the rest of their life.
Juliana Chan:
And you were just saying that actually a person sees a healthcare team maybe 15 minutes four times a year, which is actually just one hour. So, 8, 7, 6, 5 hours per year, she has to live with this diabetes in order to maintain this 5, 6, 7, 8.
Juliana Chan:
I tell my patient 5, 6, 7, 8, ok, but you have to live with this 8, 7, 6, 5 days, and I think hours, right? And I think healthcare team need to understand this. And education is very, very important.
Juliana Chan:
And then we also have to define the diabetes type, give them the right kind of medications. If it is Type I, you need to give basal-bolus or sometimes even pumps. And then to teach them how to really use all these tools properly. Most people can be educated. Really I do, I mean, I love education. We are all educators. We've all been exposed to education.
Juliana Chan:
Just imagine if a child doesn't go to school, he will do all the wrong things. So, I think the same thing, with diabetes, you have to educate them so that they need to learn. So, then for the medications — there're of course, six or seven types of oral medications. And then which is a predominant insulin resistant type, for example, which is the predominant insulin secretory insufficient type — there are medications that will address some of these issues.
Juliana Chan:
So, there are about 10 or 15% of patients that you give them everything, and they're still not control. I think that is the time when you really have to think; is this patient taking your drugs? Because all these drugs have been shown to be effective.
Juliana Chan:
If they take it, they should work. So, either they're not taking it, and maybe this is really one of the first manifestations that they're burnt-out, they're stressed or they're even depressed. They don't want to take their medication.
Juliana Chan:
Or also, they don't even come back for follow-up. Now, very importantly, you have to have a system to call these people back
Dr. Mo Alsuwaidan:
To re-engage with them, yes.
Juliana Chan:
Because if they don't come ... yeah, otherwise, in two years’ time, they come back with all the problems.
Dr. Mo Alsuwaidan:
Complications, yeah.
Juliana Chan:
And then of course, the counsel is important, understanding what are the barriers? Sometimes I can use some peers to help, the educators are fantastic. But every now and then, if these people are genuinely depressed, and as I said, then maybe you have to give them some antidepressants. And there are some very good antidepressants these days, which do not give you a lot of side effects. And so, these are really addressing some of the chemical insufficiency, which give rise to the mood problem.
Dr. Mo Alsuwaidan:
So, how do you make that decision about when do you refer a patient for therapy? When do you refer them to a psychiatrist? When do you give them an antidepressant? Just in your daily work, how do you think around that?
Juliana Chan:
I think if they really have you know a lot of sleep problem; for example, if they're very inertia, I think they really lose interest. You know, the sort of things that they usually like to go. They like to go shopping or they like to go to a movie or they like to do certain thing, and they're not doing it. Or they see no hope, for example they don't want to go to work, they don't want to go out.
Juliana Chan:
And I think those are the times that these are really affecting their life, and I would really seek help from my psychiatrist. Or they become very tearful for no reason; suddenly, they just become very tearful and they feel very useless. They seem to be a burden to everybody. They feel that they are ... not just have a lot of guilty feeling.
Juliana Chan:
And every now and then, you might have some like Sairekha, but if this is now very persistent and they can't get out of it right, even with your counseling, then I think that is the time we need some expert. And certainly, I think that's the time when you really do need some antidepressant to start release or breaking the cycle.
Juliana Chan:
And I think you know we need to tell people that they also have to understand that some of this are biological problem. It's not themselves. Just like I've got shortsightedness, I have to wear a glass. So, similarly, like you have an insulin problem, you have to get injections. For example, you have to take tablets.
Juliana Chan:
So, I think people need to feel that you know it is not their fault. Sometimes, there is a biological reason why people have depression, why they have actually got diabetes. And here, we have learned so much, we have solutions and that you know medication is probably one of them. So, we should not resist them.
Dr. Mo Alsuwaidan:
That's great. Sairekha, if I can, let me wrap up with your thoughts around this aspect. What advice would you give to people with diabetes or people who have loved ones with diabetes around engaging mental healthcare really kind of recognizing the signs of anxiety, burnout, or depression, and then engaging with the systems that can help them talking about it?
Sairekha Sureshkumar:
Two-word advice is be kind to yourself. But yeah, I mean, I think I'd like to sort of circle back to what Dr. Chan said earlier; listen to yourself. See, the ideal state, and we all know that is you know to feel drive, to feel driven, to be healthy, to look after yourself, to self-care, for survival. But if you don't feel driven, pay attention to your feelings.
Sairekha Sureshkumar:
If you are experiencing any kind of denial, anger, shame, despondency, or even anxiety — and see anxiety can come in so many forms, because you're constantly in a condition like Type I, you know you’re aware of your mortality. You're living in anticipation of what can this turn out to.
Sairekha Sureshkumar:
Like when I had COVID I was genuinely terrified, because there's so much of material around in terms of how persons with my kind of a condition can have complications post-COVID. So, this is real alright. So, process your feelings. And if you're finding it hard, talk to somebody who can take an executive decision on whether you require therapy or whether you require medication, because I would highly recommend that we take one less decision in this aspect.
Sairekha Sureshkumar:
But that said, I can never minimize the role that each of us can play in just ensuring that we are always maintaining the drive. So, personally, things that work for me have been threefold. I started moving more after the pandemic because I put on weight and I developed insulin resistance like Dr. Chan was explaining earlier.
Sairekha Sureshkumar:
So, I started moving more and that automatically made me feel better in my head. I did more yoga, I did more meditation, and that really sort of helped with my mood and you know it sort of increased my bandwidth. So, I had more bandwidth for looking after myself and continuing to work.
Sairekha Sureshkumar:
If you're in India and if you're listening to this, or if you love somebody who has diabetes and you're in India, you can go over to t1dfindia.org. We've come up with a cool tool called Community Finder, just put your pin and it'll put up whichever is the nearest diabetes community. You can meet so many people who are young and fun or you know across age bands who live with this condition, hang out with them, watch movies with them, you'll feel differently.
Sairekha Sureshkumar:
So, give back, join the community, get empowered, empower others. You know, there's so much good karma. And you know that itself has made such a huge shift in my own mental health. So, yeah, there's that.
Dr. Mo Alsuwaidan:
Thank you so much. That's amazing, and actually very practical advice for a lot of people listening. Sairekha, Juliana — there's a wealth of information we could keep talking about. But our time to talk has shifted now to the time to listen, and reminding our listeners of the title of our podcast; Listen Well.
Dr. Mo Alsuwaidan:
So, listen well to yourself — as Sairekha said, be kind to yourself. And I think we in the healthcare community have to listen well to our patients.
Dr. Mo Alsuwaidan:
And I think together, we can really make a shift in both of these complex illnesses that often come together so that we have a better healthcare outcome for individuals, society, and all of community. Thank you so much for joining us today, and have a great day.
Juliana Chan:
So, be happy and be healthy. Thank you.
Dr. Mo Alsuwaidan:
I think we've learned so much about these two very common conditions; diabetes and depression, and how they interact with each other. Interestingly, their biology has a lot of overlap. Beyond that, the psychology, both these conditions impact on an individual in terms of burnout, anxiety, feelings of low mood, feeling overwhelmed are so common.
Dr. Mo Alsuwaidan:
I want to conclude with a reminder to myself and to everyone, be kind to yourself. You are your own best health advocate. Reach out for help when you need it, because it is out there. And I look forward to the next time we meet and the next time we have an opportunity to listen well.