Contributor: Dr. Staci-Marie Norman, PharmD, DCES

Hello July! Where has the first half of the year gone? Although the months of "lockdown" have seemed long, it is amazing how fast we moved from February (when COVID announced it was here to stay) to the sunny, hot days of July. This month I had planned to talk about traveling with diabetes, but since very few of us are probably traveling this summer, I thought I'd focus on the topic of diabetes burnout. It actually seems more appropriate because, like me, you may be feeling quite burned out about life in the age of COVID, let alone handling diabetes and all that comes with trying to maintain target blood glucose levels.

Life can be stressful under the best of circumstances. Work, family, managing a household, running after kids, and now even simple things like running to the grocery store can cause stress. Between wearing a mask, going the right way down the aisles, staying 6 feet away from other shoppers - this all takes a toll on how we manage any health conditions in our lives, including diabetes. I reread a pamphlet that was given to my father at the Cleveland Clinic after his lung transplant. It stated that approximately a third of people with a chronic illness would develop depression due to the stress of managing the illness. More specifically, it said 25% of people with diabetes would have some period of depression during their life with diabetes. And many just chalk the symptoms up to diabetes because some are similar.

For example, weight gain or loss, fatigue, or loss of energy can be due to diabetes or to depression. More specific symptoms of depressions would include too much or too little sleep, problems with concentration, apathy, lack of feeling or emotion, feelings of worthlessness or guilt, and thoughts of death or suicide. But why is depression such a common partner to diabetes? Well, it is suggested that when a person has a chronic disease, they have a lot to adjust in their lives. They must come to terms with their condition and the treatment. There can be a period of mourning for the loss of health, and it can change the way a person sees themselves and how they relate to others. A certain amount of sadness is average, but for some people, their condition can trigger clinical depression. This can happen at any time. Some people can handle everything very well, but then another external stressor like the COVID pandemic occurs, which can trigger symptoms of depression.

Why would we worry about depression and diabetes? Along with the usual problems depression can bring, it can also impact the success of diabetes therapy. If you are not feeling very energetic, are you going to strap on those tennis shoes and go for a walk? How about fixing a healthy meal for yourself if you generally do not care? Will you take your medications and blood glucose multiple times a day with subpar concentration levels? You can see where depression could very quickly take a toll. There is good news! Depression is manageable, just like diabetes. But you must be open with your physician about how you are feeling to get the help you may need. In treating depression, there is "talk therapy" (or psychotherapy) and medications. It has been found the combination of these two types of therapy provides a more rapid and complete recovery than one or the other. The pharmacist in me wants to reassure you that there are many options for medications to treat depression. They all work by affecting different chemicals in the brain that seem to be at lower levels during depression. All antidepressant medications take 4-6 weeks to build up in your system enough to start seeing an effect. Most people do not recognize it themselves, but people around them will begin to see improvement in mood and energy. So, be patient! Give the medications a chance to work. If you aren't getting the results you are seeking or are having troublesome side effects, such as weight gain or lack of sex drive, talk to your doctor because there are many options and all work a little differently.

I hope you hang in there through the "new normal" that COVID-19 has brought to our lives. And I hope that you are taking the time to focus on you and your health and doing the little things that can make you feel better, like taking a walk or fixing a nice balanced meal (using the plate method I recommended last month). If you are feeling "down in the dumps", please reach out to your physician and have a candid conversation about depression. And if you are having thoughts of suicide, please reach out to someone who can help or call the national suicide prevention hotline at 1-800-273-8255. Because life is wonderful, and you should be able to enjoy all your many blessings!

Dr. Staci-Marie Norman, PharmD, DCES received her bachelors from Purdue University (’94) and her Doctor of Pharmacy from the University of Oklahoma (’96). In 2000 Dr. Norman added to her credentials by becoming a Certified Diabetes Care and Education Specialist. She is currently the Clinical Coordinator and staff pharmacist for Martin’s Pharmacy. Dr. Norman is a national faculty member for the American Pharmacist Association, teaching certificate programs in both diabetes and cardiovascular disease. She serves on the advisory board that oversees development and revision of these programs. Along with teaching and development responsibilities for APhA, Dr. Norman serves as a peer reviewer for research grants and publication submission. Dr. Norman has also spoken for Abbott, Bayer, Lilly, Mannkind, and Lifescan as a diabetes specialist.