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I have heard that depression is more common in people with diabetes. Is this true?

Yes, it is true that people with diabetes (and with other long-term illnesses) can experience higher rates of depression. This can be due to factors relating to the diabetes itself, or it can be unrelated. There is no convincing evidence that the actual blood sugar level itself is reliably predictive of mood, even in those with a tendency to depression. The severity of the diabetes and its complications, as well as its impact upon a person's lifestyle and aspirations, can be an important predictor of depression. For some the impact may be major and for others much less so, even though the degree of severity of the diabetes is the same. It is important to remember that the vast majority of people in our society with treated diabetes (more than 15 million in the United States alone) are able to adjust to the disorder and have happy, productive, and rewarding lives. Some have even achieved astonishing things in all walks of life. Examples include the gold medal winning Olympic swimmer Gary Hall, the NBA basketball player Adam Morrison, and the actresses Halle Berry and Mary Tyler Moore and Supreme Court Justice Sonia Sotomayor, all of whom have lived with diabetes while achieving great success.

If you are experiencing unusual degrees of sadness, reduced enthusiasm or interest in life, or excessive stress that you perceive is related to your diabetes, your doctor or certified diabetes educator may be able to help you to identify resources that can help you cope. Some of these resources are discussed in Question 82. Many certified diabetes educators (CDEs) are trained to provide such psychosocial support. If you are truly suffering from depression, your diabetes may or may not be an underlying cause, even though it may seem that way. Your doctor or CDE will help you to identify whether expert professional psychological or psychiatric consultation is needed.

Fructose

A simple sugar found in honey, many fruits, and some vegetables.

How does the sugar in fruit drinks differ from the sugar in sodas?

The sugar in fruit juices is predominantly fructose, which is a disaccharide, meaning that it contains two molecules of glucose joined together and must be broken down to glucose in order to be absorbed, which may cause a delayed or muted effect on the blood sugar. Fruit juices will also contain a moderate amount of some vitamins and minerals. Sodas do not contain significant amounts of vitamins or minerals. The sugar in regular non-diet sodas is glucose, which is very readily absorbed and sweeter tasting. The amount of sugar in a standard 12-ounce can of regular soda is equivalent to about 9 teaspoons of table sugar (which is neither glucose nor fructose, but sucrose, another disaccharide) and therefore provides a large amount of calories, which can raise the blood sugar level very quickly. This is helpful if a low blood sugar reaction is being treated, but not a recommended part of the diabetic diet, as it causes a very sharp rise in blood glucose to levels above those recommended. This rise is hard to prevent with either pills or insulin, without giving- doses that will later lead to low blood sugar levels.

My doctor says I don't need to see a specialist for my diabetes. How do I know if my doctor is right?

At the time of writing, there are estimated to be about 16 million adults in the United States who are aware that they have diabetes. There are, however, only about 4000 certified adult diabetes specialists in clinical practice and not all of these are in full-time practice. Some, perhaps one in four, do not see patients with diabetes at all. This translates to one diabetes specialist for every 5000 people with diabetes. Those who are interested in learning more about the shortage of diabetes specialists in the United States can visit endo-society.org/advocacy/legislative/upload/A-Stewart-US-Endo-Workforce-A-Supply-Demand- Mismatch.pdf.

The average diabetes specialist carries a clinic census of several hundred active patients, each of whom he or she sees from two to several times per year. From these statistics, it is clear that the vast majority of people with diabetes will not be able to consult a specialist. However, not all people with diabetes need specialist input, and those who do will usually not require it for the majority of the course of the disease, especially in the case of type 2 diabetes. Much of the education necessary to effectively manage diabetes, especially that centering on glucose monitoring and diet and nutrition, is accessible by referral directly from your family doctor. Given its frequency, many family doctors see a considerable number of patients with diabetes and are competent in its routine management. They also generally make effective judgments as to when specialist consultation is advisable.

Some of the circumstances in which consultation with a diabetes specialist is often advisable are shown in Table 13.

 
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