The relationship between diabetic nerve pain and depression is direct ("What Is Diabetic Nerve Pain? – Symptoms, Causes, Treatments"). Diabetic neuropathy, or nerve damage, because of high amounts of sugar in the blood (hyperglycemia) can cause pain. When it does, this nerve pain can lead to depression. One study found that almost 28 percent of people with diabetic nerve pain developed depression (Gore, et al., 2005).  A 2016 report asserts that people with diabetic nerve pain have a depression rate that is four times that of people with diabetes but without pain (Davenport, 2016).

Diabetic nerve pain and depression go beyond occurring together. These conditions move together, a further indication that they are directly linked. When pain is mild, so, too is depression in those that are experiencing it. When pain is severe, depression symptoms worsen and become more debilitating.

Intense nerve pain and depression affect someone’s ability to function. They’re more likely to experience a decrease in both physical and emotional functioning as well as sleep problems. The overall quality of life is lower for someone living with neuropathy and diabetes than it is for others, even those also living with diabetes alone.

Let’s explore more about the relationship between depression and diabetic nerve pain.

The Relationship Between Diabetic Nerve Pain and Depression

Pain and diabetes are practically synonymous. Physical pain (due to consequences of the disease) and emotional pain (due to limitations, loss, and decreased quality of life) plague people with diabetes nearly every day of their lives. Just some of the difficult or downright painful things they may deal with daily are

• Blood sugar monitoring via self-administered blood tests
• Insulin treatment (everyone with type 1 diabetes and some with type 2 diabetes)
• Damage to any system of the body and resulting pain, problems
• Painful foot problems, including risk of amputation
• Unsteadiness and risk of falls
• Nerve pain

Of all of these, it is nerve pain that is most directly connected to depression ("What Treatment for Diabetic Nerve Pain Is Available?"). When someone experiences nerve damage due to hyperglycemia, the pain can range from mild to nearly debilitating. People describe this type of pain as tingling, numbness, a painful cold sensation, or electric shock-like. Tingling and numbness haven’t been linked to depression. Shocking, shooting, or that sensation of painful coldness, however, are directly linked. The worse this type of pain, the deeper the depression experienced.

Why the relationship between depression and diabetic nerve pain? It appears that the link might reside in the brain. Structures in the brain like the amygdala, hypothalamus, and anterior cingulate gyrus as well as neurotransmitters like serotonin and norepinephrine are, together, at work in pain, depression, and anxiety.

When structures and neurotransmitters regulate pain as well as emotions and mood, there can be an overlap so that when nerve pain is high, depression is also more intense.
 
In addition to the biology and functioning of the brain, other factors contribute to the development of depression when someone has diabetic neuropathy ("Anxiety and Diabetic Neuropathy: What Helps?"). Some risk factors that have been identified include:

• The presence of other long-term complications of diabetes
• Being female
• Feeling a lack of control over diabetes treatment and lifestyle
• The belief that you don’t have the ability to deal positively with this disease

No matter how bad the nerve damage, how intense the pain, and how severe the depression, treatment is available. Nerve damage is irreversible; however, pain can be managed. Depression, too, can be fully overcome or managed so that it is no longer as bothersome.

Treatment of Depression and Diabetic Nerve Pain

Because both pain and depression can become severe and debilitating, it’s important to identify and treat these conditions as early as possible. Regular check-ups with your doctor are helpful in catching pain and depression. The doctor might give you questionnaires to help narrow your symptoms, and together, you’ll both watch carefully for early nerve damage and depression.

Once symptoms begin to appear, it’s important to begin treating the whole person:

• Diabetes
• Neuropathy
• Depression
• Other mental health concerns
• Sleep (problems are common)
• Pain
• Lifestyle and quality of life

Typical treatments include

• Diabetes medication
• Medication for nerve pain, commonly topical analgesics)
• Depression medication (no single type has emerged as the most effective)
• Proper nutrition
• Blood sugar control
• Lifestyle changes such as exercise, stopping smoking, limiting or eliminating alcohol consumption
• Mental health therapy

Diabetic nerve pain and depression can limit lives, and they can be hard to treat. By being alert for your symptoms and changes, though, you can start treatment as early as possible. You can reduce pain and depression symptoms and be ready to engage in your life once again.

Ed. Note: More research is needed to fully understand the connection between these conditions. Study results have been mixed; many show a strong correlation between depression and nerve pain in diabetes, while other outcomes are less certain. For now, it’s cautiously accepted that these two conditions are related. The information here is based on the results of research studies and is therefore reliable. Future research may modify currently accepted information, however.

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Living with dissociative identity disorder (DID) can create confusing and distressing times. People with DID experience amnesia and "waking up" in one personality only to find that another personality has previously done something he or she would consider completely out of character. These situations are very difficult to understand and successfully coping with dissociative identity disorder requires significant treatment (Dissociative Identity Disorder Treatment Challenging).

Living with Dissociative Identity Disorder Before Diagnosis

Before diagnosis, people living with dissociative identity disorder often have no idea what is happening to them. B.J., a woman with DID explains:

"I convinced myself that the things that happened to me, that were completely baffling and unexplainable, happened to everyone. Didn't everyone lose track of time, belongings, people? Didn't everyone find things in their possession they couldn't recall buying, or money spent they couldn't recall spending? Didn't everyone have such drastic extremes in desire and goals? Didn't everyone regularly run into people whose names and faces couldn't be placed?"

Others living with dissociative identity disorder experience nightmares, hallucinations and other symptoms but still do their best to fit in with everyone else:

"I started having nightmares most nights. I would wake up and the sheets would be wet and I'd be really hot, even though it was a cold night. In the day, I kept seeing things that I knew weren't really there ... The shoes belonged to someone who was constantly causing me problems, even treating me as if I wasn't even human at times. I couldn't even acknowledge that it was abusive behavior. I was so sure that I was going "crazy" and that nothing could be done about it, so I might as well pretend to be normal.

"In the end, I just couldn't carry on anymore and spent almost a year either in bed or on the sofa. I was suicidal for a time. My heart was racing and I kept having panic attacks. Even simple things like food shopping were awful and I kept avoiding people I knew and places linked with the trauma. Anytime someone got close to me in a shop, I'd be terrified. Nothing made sense."

The effects of the deep and severe trauma that causes dissociative identity disorder in most do not disappear, no matter how much a person with DID pretends to fit in. It tends to eventually lead to depression, crises, hospitalizations and even suicide attempts. What's more is that people with DID tend to be misdiagnosed for years before they discover they have been living with dissociative identity disorder all along.

Living with DID After Diagnosis

While living with DID can be confusing and not make sense, being diagnosed can feel "crazy" too and people often blame themselves for their DID symptoms. One person with dissociative identity disorder says,

"When I was first told I had it, I just didn't want to believe it. It was really frightening: my symptoms didn't sense, I thought I was "crazy", I felt out of control and I worried the other identities might hurt people. Now that I know it's just a psychological defense to trauma and most of my identities are young children ... The identities are all a part of "me", even if it doesn't feel that way."

Coping with Dissociative Identity Disorder

Coping with dissociative identity disorder takes many forms but the goal is to lessen symptoms and the pain of living with DID. One person with DID says:

"What I notice the most is regularly dissociating or disconnecting from the outside world and from emotions, which happens when another identity takes over. I don't notice time passing. This amnesia can last for minutes or days at a time. It's no longer frightening; managing my stress levels and having plenty of free time rather than over-committing to things helps a lot. I still lose time but it's in short chunks and doesn't interfere with life, like losing days did. I have many ways of keeping organized to help with the gaps in memory and the other identities do too. We write things down a lot and have several alarm clocks to make sure we get to appointments and work (I keep checking which day it is too)."

"The time loss doesn't seem so bad now. Sometimes I can remember afterwards what another identity did although it's hazy, a bit like recalling parts of a drunken night out, but other times I know what is happening at the time. I can't stop them doing harmful things to me and there have been some scary moments but now we are all co-operating and I've learnt I can trust them. If they do anything scary, there is always a good reason for it, and usually they let me know when there is a problem so we can work on it before they "act out". I used to try and stay in charge and fight or criticize them, but that just made them feel worse."

Another person with dissociative identity disorder says:

"I saw a counselor through a local charity and steadily got better, and medication reduced the symptoms too. I started writing a journal and drawing the flashbacks ... Things aren't perfect but now I have my life back. I understand the abuse was not my fault."

What's important to remember is that people do recover from dissociative identity disorder and coping with DID is possible.

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Diabetic necrosis is the death of tissues in the body, and it causes serious consequences that can sometimes include the amputation of limbs, fingers, or toes. This necrosis definition alone can cause anxiety ("Diabetes and Anxiety: There’s Plenty to Be Anxious About"). While diabetic necrosis is frightening, you do have some control over diabetes, tissue death and anxiety.

What is Necrosis?

Necrosis is closely related to gangrene. Like necrosis, gangrene is the death of tissue or organs. The two terms are often used interchangeably, but they’re not quite the same. What’s necrosis? Very simply put, necrosis is a process while gangrene is an event, the result. When you see an open, oozing sore or dry, shriveled skin, you are seeing gangrene. The process of necrosis involves:

• Damages at the cellular level
• Large- or small tissue or organ damage
• Biochemical changes that lead to tissue injury
• Inflammation in the body that furthers damage
• Scarring that also aggravates and leads to more damage in the area
• Tissue death and loss

Here we’re looking at the big picture, so we’ll use the term “necrosis.”

What Causes Diabetic Necrosis?

Diabetes is a disease that involves problems with blood sugar levels. Under normal circumstances, the glucose, or sugar, created in the process of digestion is carried in the bloodstream throughout the body and is delivered to cells. In a healthy body, insulin greets glucose and escorts it into the cells. In diabetes, there is a problem with insulin, so glucose remains in the bloodstream and builds. It is this high blood sugar (hyperglycemia) that can cause necrosis.

Necrosis from diabetes is because of high blood sugar. Hyperglycemia damages nerves and blood vessels and reduces blood flow. These conditions can cause a host of health problems, including necrosis.

This example illustrates how diabetic necrosis happens. Because feet are a very common location of tissue death, this example uses the foot. Similar processes occur in other areas of the body.

• Because of hyperglycemia, nerves are damaged (diabetic neuropathy)
• Nerve damage causes loss of feeling
• With no feeling, rocks in shoes, shoes rubbing skin, and nicks and cuts go unnoticed and thus untreated
• Lack of treatment can cause infection
• Infection quickly worsens because a lack of adequate blood flow inhibits healing
• The necrotic process has begun on all levels

Necrosis Symptoms

Necrosis from diabetes produces specific symptoms. When necrosis is internal, affecting muscles or organs, common symptoms are

• Swelling
• Pain that can be intense
• Persistent low-grade fever
• Feeling generally unwell
• Drowsiness
• Lethargy
• Nausea

Necrosis symptoms that occur when damage is external, on the skin, include:

• Extreme skin discoloration (such as brown, bronze, blue, purple, red, black)
• A distinct line between the healthy skin and the dying skin
• Severe pain, then numbness
• Foul-smelling pus leaking from a sore
• Cold skin
• Thin, shiny skin
• Skin that crackles when touched
• Blisters

Any area of the body, internal and external, can be affected by this deadly process. Necrosis of the skin is common in diabetes. Diabetic necrosis also frequently affects a foot or both feet. Necrosis on a toe or toes is also a widespread problem.

There is another important, and very common, effect of necrosis: anxiety.

Dealing with Anxiety Caused by Necrosis in Diabetes

Once the process of necrosis begins, it can’t be reversed, and it can’t be cured. Anxiety in necrosis is intense and very specific. It is fear-based and future-oriented. This is merely a sampling of the anxious thoughts associated with necrosis:

• What if I lose a part of myself because of amputation?
• Will I always be able to (fill in the blank with any activity, even small ones like walking to get the mail)?
• What if I develop necrosis and it keeps spreading?
• Will my family still want to be around me, or will I be too much of a burden?
• Will I die?

The anxiety that comes with necrosis can be debilitating. Given that nerve damage can prevent people from noticing little damage that can lead to infection and tissue death, people often feel extreme anxiety and even panic about developing something so serious that they can’t control.

As unlikely as it may seem at first, you do indeed have quite a bit of control over both diabetes and anxiety. You can act to prevent the development of necrosis:

• Manage your blood sugar to keep it within normal range.
• Maintain a healthy diet.
• Lose weight if necessary.
• Stop smoking if you smoke.
• Exercise daily.
• Check your body for cuts and sores (especially your feet).
• Always wear shoes and socks.
• Maintain blood flow to your lower extremities (elevate legs/feet, wear loose-fitting socks)
• Attend regular check-ups with your doctor and anyone else on your care team

By taking charge of your health and your life, you reduce your chances of developing necrosis, and this control is an empowering way to lower anxiety. Necrosis from diabetes isn’t inevitable.

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Prediabetes is a condition that you might not even know you have but is very important to pay attention to and manage to prevent full-blown diabetes.

Definition of Prediabetes

You may already know that there are three primary types of diabetes—type 1, type 2, and gestational—but what is prediabetes? A simple prediabetes definition is this: it’s not a disease, nor is it a type of diabetes; instead, prediabetes is a warning sign that your metabolism is off and that you’re at risk for developing type 2 diabetes.

When your body is diabetes-free, it is able to properly metabolize sugar into energy. When you eat carbohydrates, they break down into glucose (sugar) during digestion. Then, a hormone called insulin leads the glucose out of the bloodstream and into the cells. This process is called metabolism and gives cells the energy they need to function plus keeps glucose out of the bloodstream. Excess glucose in the bloodstream can lead to significant health problems.

In diabetes, the process goes awry because your body either can’t produce insulin (type 1 diabetes) or can’t use it efficiently (type 2 diabetes). In both cases, blood glucose levels remain dangerously high (hyperglycemia) without treatment.

Type 2 diabetes doesn’t develop overnight but instead builds gradually. The period in which blood glucose levels are climbing toward diabetic levels is considered prediabetes, also called impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). Prediabetes isn’t diabetes, but it’s a condition in which someone’s blood sugar levels are higher than normal but not yet high enough for type 2 diabetes. Understanding what prediabetes is can help you avoid and possibly even reverse it before it becomes type 2 diabetes.

Prediabetes Symptoms, Signs, and Risk Factors

If clear prediabetes symptoms and signs existed, it would be fairly easy to identify when your blood glucose levels were rising and then take action to return your metabolism to normal functioning. Unfortunately, in most cases, there are no signs or symptoms of prediabetes.

There is one possible sign that can appear. Some people with prediabetes will develop acanthosis—darkened skin on some parts of their body, usually the neck, armpits, knuckles, elbows, and knees. But in the majority of cases, prediabetes has no obvious signs or symptoms, which means that many people who have prediabetes don’t even know it.

While there are no symptoms of prediabetes, there are numerous risk factors. The presence of these risk factors could signify that someone might have prediabetes. These include:

• Obesity or overweight (fatty tissue makes the body more resistant to insulin)
• Waist size of over 40 inches in men and 35 in women (like weight, this can cause insulin resistance)
• Diet high in processed foods, sugary drinks, and red meat
• Sedentary lifestyle
• Smoking
• Prior gestational diabetes
• Age (diabetes risk increases over the age of 40)
• Family history of type 2

Certain medical conditions increase someone’s risk for prediabetes and, eventually, type 2 diabetes. Examples of such conditions:

• Obstructive sleep apnea or working nights or swinging shifts (all contribute to insulin resistance)
• Polycystic ovary syndrome
• High blood pressure
• Low levels of good cholesterol (HDL)
• High levels of triglycerides (fat in the bloodstream)
• Metabolic syndrome (at least three of these: high blood pressure, low HDL levels, high triglycerides, and obesity)

Diagnosing Prediabetes

Due to the lack of symptoms, people often discover that they have prediabetes by accident. When they visit the doctor for something else, the doctor may suspect prediabetes and order tests. A doctor’s suspicion comes from the above risk factors. The more someone has, the higher the likelihood that he or she has prediabetes. If you have some of the risk factors, you don’t have to wait for a doctor to investigate your health. You can make an appointment to check for prediabetes because there are tests for the condition.

Doctors choose one of three tests to check for prediabetes:

• Oral glucose tolerance test
• Fasting blood sugar levels test
• Hemoglobin A1c test

Each test is a slightly different measurement of blood glucose. If your level is higher than a normal blood glucose level but lower than what is required for a diabetes diagnosis, you will fit the criteria for prediabetes ("How to Diagnose Diabetes: Criteria, Tests for Diabetes Diagnosis").

Managing Prediabetes

If you have prediabetes, you aren’t doomed to develop diabetes. By managing certain aspects of your lifestyle, you can lower your blood sugar levels and reverse the condition. Many prediabetes treatment options exist, all of which involve addressing the above risk factors.

Perhaps the best way to treat prediabetes is to lose weight, eat nutritiously, and exercise. This will impact some of the other risk factors. The more areas you improve, the better your chances will be of returning blood sugar levels to normal and avoiding type 2 diabetes.  

Another good prediabetes definition is that prediabetes is a chance to develop a healthier lifestyle, feel great, and reduce your risk of diabetes.

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Whether antipsychotic medications cause diabetes is a legitimate concern. This type of medication is widely used to treat psychotic disorders like schizophrenia, bipolar disorder and a host of other conditions.

Antipsychotics can do a great deal of good, alleviating mental illness symptoms and increasing quality of life; however, people treated with antipsychotics have a higher risk than the general population of developing type 2 diabetes, a serious illness that can and does lead to many other health problems. Therefore, health professionals are investigating to determine if antipsychotic medications do cause diabetes.

Reasons Why Antipsychotic Medications May Cause Diabetes

A common side-effect of antipsychotics is weight gain. Overweight and obesity are top risk factors for type 2 diabetes. The weight gain associated with this type of psychiatric medication is significant. Thirty percent of the general population is obese, whereas, among people with schizophrenia who are taking antipsychotic medication, the obesity rate is 40-60 percent (Llorente, 2006). Because of this weight gain problem, developing new type 2 diabetes or worsening existing diabetes is a serious risk.

Also implicating antipsychotic-induced weight gain as a cause of diabetes is that 75 percent of diabetes diagnoses that happen after someone begins taking antipsychotics involve weight gain (Rosak, 2003). This number is too high to dismiss as coincidence.

That statistic also tells us something else: If 75 percent of new diabetes diagnoses involve weight gain, 25 percent involve other factors. There seems to be more to the association between diabetes and antipsychotic medication than weight gain. While exact causes are still under investigation, multiple studies have shown that lifestyle factors are noteworthy, such as:

• Inactivity
• Poor nutrition
• Tobacco use
• Non-adherence to any type of treatment
• Impaired insight (such as not understanding benefits and risks of medication)
• Poor access to medical and mental health care

If someone is living an unhealthy lifestyle, which is another risk factor for type 2 diabetes, and then begins mental illness treatment with antipsychotics, they could be at greater risk for diabetes than people with a similar lifestyle not taking antipsychotic medication. While researchers speculate that there are other factors at work in the development of diabetes—biological or genetic, for example—much more research is needed to confidently proclaim additional reasons why antipsychotics may cause diabetes.

Understanding the reasons behind antipsychotics and diabetes is complex. Not all antipsychotics are the same, nor do they carry equal risk of type 2 diabetes development.

Antipsychotics: Type Matters in Diabetes

Two classes of antipsychotics are available: conventional (typical) and atypical. Scientists, pharmacists, and doctors aren’t quite certain how each class works. It’s speculated that conventional antipsychotics block dopamine receptors in the brain while atypical drugs (the newer class) block multiple chemical receptors rather than just dopamine.

Of the two general classes, atypical antipsychotics are far more likely to cause or worsen diabetes. Common atypical antipsychotics include:

• aripiprazole (Abilify)
• asenapine (Saphris)
• clozapine (Clozaril, Clopine, CloZAPine Synthon, Denzapine, FazaClo, Zaponex)
• iloperidone (Fanapt)
• lurasidone (Latuda)
• olanzapine (Zyprexa)
• paliperidone (Invega)
• quentiapine (Seroquel)
• risperidone (Risperdal)
• ziprasidone (Geodon)

These carry different degrees of diabetes risk as determined by the amount of weight gain associated with each type. Amount of weight gain is unknown or undisclosed for some medications.

Atypical Antipsychotics with the Least Amount of Weight Gain

• aripiprazole
• ziprasidone

Atypical Antipsychotics Causing Moderate Weight Gain

• quetiapine
• risperidone

Atypical Antipsychotics Causing Excessive Weight Gain

Excessive weight gain means an increase of 10-30 percent of weight before beginning antipsychotics. Researchers include the following atypical antipsychotics in this category:

• chlorpromazine
• clozapine
• olanzapine

Atypical antipsychotics, weight gain, and diabetes appear to have a strong cause-and-effect relationship. This is problematic because of the wide use of these medications.

Who Takes Atypical Antipsychotics?

As their name implies, these pharmaceuticals treat psychotic disorders such as schizophrenia. They are used to treat many other mental disorders as well. You or a loved one might take an atypical antipsychotic for conditions like:

• Bipolar disorder
• Eating disorders
• Depression
• Anxiety
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Borderline personality disorder
• Autism
• Tic disorder
• Tourette’s syndrome
• Dementia (the psychological and behavioral symptoms)

Because they are used so extensively and carry a risk for the development or worsening of type 2 diabetes, both doctors and patients should take precautions. Anyone prescribed these medications should:

• Establish a record of baseline weight, blood sugar levels, and other health indicators
• Have regular screenings for diabetes risk factors
• Discuss with their healthcare provider their unique benefits and risks of taking the drug
• Develop a plan for creating and maintaining a healthy lifestyle. Including weight management

While evidence points to the possibility that atypical antipsychotics cause diabetes, this doesn’t mean that you should absolutely avoid them ("Are There Any Safe Antipsychotics in Diabetes Treatment?"). This type of medication does carry many benefits that often outweigh the risks, especially if the above precautions are taken. Also, more studies are needed to make definitive claims about atypical antipsychotics and diabetes. At this point, knowing the risks will help you monitor your health and lifestyle to minimize serious illness.

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Diabetes and mood swings go hand-in-hand.  Mood swings are so much a part of diabetes that when doctors are asked if diabetes causes mood swings, they don’t hesitate to answer with a solid and simple, “yes.” The more you understand about the connection between diabetes and mood swings, the better equipped you’ll be to recognize them and take action to manage both mood swings and diabetes.

Mood swings can occur throughout the day, and mood can even fluctuate from one minute to the next ("Diabetes and Irrational Behavior, Mental Confusion"). If you or someone you know has ever felt neutral or happy and then suddenly, without warning, become crabby and angry or sad and upset, know that these feelings aren’t overreactions and they most certainly aren’t character flaws. They are mood swings that come with diabetes.

With diabetes, mood swings can be your friend. They’re often the first sign that blood sugar levels are out of control. That said, mood swings aren’t at all friendly, and they can take a toll on your mental health. Knowing the reasons for them can help you take measures to attend to your diabetes and mood swings.

Diabetes and Mood Swings: Why Diabetes Causes Mood Swings

Changes in mood are part of diabetes, no matter the type. Type 1 and type 2 diabetes and mood swings have the same underlying causes. The climbing and crashing of moods aren’t arbitrary. They’re part of diabetes and have multiple causes:

• Blood glucose (sugar) fluctuations
• Diabetes distress
• Uncontrolled diabetes
• Depression

Blood sugar fluctuations, also known as glycemic variability, can directly cause mood swings. Mood swings that happen because of blood sugar spikes and dips are physiological in nature rather than emotion-based. Blood glucose can fluctuate whether diabetes is uncontrolled or well-managed.

In addition to physiological components, mood swings in diabetes have psychological causes. Depression and diabetes frequently co-occur. Further, the stressful nature of the disease contributes to variations in mood. Let’s take a closer look at the physiological and psychological reasons for the link between diabetes and mood swings.

Blood Sugar Levels and Mood Swings

Diabetes is a disease in which the body can’t regulate its source of energy, which is glucose. Glucose is created during the digestion process. It enters the bloodstream and travels throughout the body to enter the cells and provide energy. Glucose, though, can’t get into the cells on its own. It’s as if it doesn’t have a key. Insulin, a hormone made in the pancreas, is that key. Normally, insulin is made and released, and it escorts glucose into the cells. In diabetes, though, either the body doesn’t produce enough insulin (or even any at all), or the body doesn’t use the insulin efficiently.

A healthy blood sugar level falls between 70 and 140 mg/dL. Dropping below 70 mg/dL or spiking above 140 can cause mood swings. Something quite frustrating to those living with diabetes is that even blood sugar fluctuations within the healthy range can cause mood swings.

Low blood sugar (hypoglycemia) happens if someone doesn’t take enough insulin or doesn’t eat enough food to supply glucose. Alcohol consumption plays a role in hypoglycemia, too. Hypoglycemia causes mood swings because glucose is what the brain needs to function. Without enough of it, it suffers. Mood swings are a result. High blood sugar affects the brain, too; the excess sugar leaves it wired, irritable, and unable to concentrate.

Emotional fluctuations, even anger caused by diabetes and mood swings, aren’t necessarily part of a mood disorder. Instead, they’re a biological component of a serious disease. This doesn’t mean, however, that mood swings in diabetes are only biological. There is a strong psychological component to them as well ("What are the Effects of Diabetes on Mood Disorders?").

Psychological Cause of Diabetes and Mood Swings

When someone has diabetes, he or she must manually run the insulin-glucose process by continually monitoring blood sugar levels and taking the necessary steps to keep them within a healthy range. It doesn’t end. Self-managing diabetes is challenging and can cause diabetes distress, a state of mind arising from the worry, stress, and rigors of managing blood sugar.

Understandably, diabetes distress causes mood swings. The negative moods that are part of the swings can happen without warning. Common, and very normal, feelings can involve

• Anger
• Resentment
• Guilt
• Self-blame
• Excessive stress
• Irritability
• Sadness

Diabetes and mood swings can reduce the quality of life and lead to more negative moods. It’s not uncommon for someone to develop major depression when living with diabetes.

Mood swings are a part of diabetes. If they are interfering in your life, see your doctor, a diabetes educator, or a therapist specializing in diabetes. Yes, diabetes causes mood swings; however, diabetes and mood swings don’t have to ruin your life.

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Diabetes medication is used to treat most people with diabetes. So many different type 1 and type 2 diabetes medications exist that trying to figure out what they are can be overwhelming. The following complete list of diabetes medications can serve as a useful reference tool as you navigate the world of medication for diabetes.

Before diving into a diabetic medication list, it’s helpful to categorize both diabetes and general medication. Here, we’ll look at two types of diabetes: type 1 diabetes and type 2 diabetes ("What Is the Difference Between Type 1 and Type 2 Diabetes?"). There are also two types of medication: oral diabetes medications and injectable diabetes medications.  

Type 1 Diabetes Medication

The medication insulin is always needed in type 1 diabetes ("What Are Type 1 Diabetes Symptoms and Signs?"). This is because, with this disease, the immune system destroys insulin-producing beta cells in the pancreas. Without insulin as an escort, glucose (sugar) in the bloodstream can’t get into the cells and remains stuck in the bloodstream. Too much glucose in the bloodstream is called hyperglycemia, a dangerous health condition with many negative consequences. People who have type 1 diabetes must take insulin to survive.

Important information about insulin:

• It can be taken just once a day or several times per day depending on the individual.
• Some insulin medication is rapid-acting, working immediately.
• Other insulin is long-acting, working more slowly but lasting longer.
• Insulin can be injected with needles via syringe or pen.
• It can also be delivered with an insulin jet injector that sprays the medication into the body using high-pressure air rather than a needle.
• Some people use an insulin pump, a small machine connected to a small tube and needle that delivers insulin when needed.

Type 2 Diabetes Medication

Insulin is sometimes used to treat type 2 diabetes if the body isn’t producing enough insulin ("What Are Type 2 Diabetes Symptoms?"). Insulin isn’t the go-to medication for type 2, though. In type 2, the body is resistant to the insulin it makes, so glucose can’t get into the body’s cells. Glucose builds in the bloodstream, resulting in hyperglycemia. Medication for type 2 diabetes works in various ways to reduce hyperglycemia.

Nine types of oral diabetes medications, in pill or liquid form, exist to help regulate blood glucose levels.

• Alpha-glucosidase inhibitors prevent glucose spikes by slowing digestion of high-carbohydrate foods. Medication includes Glyset (miglitol) and Precose (acarbose).
• Biguanides lower the amount of glucose released by the liver. Medication includes Glucophage (metformin), Glucophage XR (metformin long-acting), and Riomet (metformin liquid).
• D-Phenylalanine derivative, the medication Starlix (nateglinide), helps the body make more insulin after meals.
• Dipeptidyl peptidase-4 (DPP-4) inhibitor, Januvia (sitagliptin phosphate) helps the body make more insulin after meals and keeps the liver from releasing stored glucose into blood.
• Meglitinide, the medication Prandin (repaglinide), helps the body make more insulin.
• Sulfonylureas help the pancreas make insulin and help the body use the insulin it makes more efficiently. Sulfonylureas include Amaryl (glimepiride), DiaBeta (glyburide), Diabinese (chlorpropamide), Glucotrol (glipizide), Glucotrol XL (glipizide long-acting), Glynase (glyburide), Micronase (glyburide), tolazamide, and tolbutamide.
• Thiazolidinediones help the body use insulin.  Medications are Actos (pioglitazone) and Avandia (rosiglitazone).
• Combination pills contain medication from any two of the above categories. Combo pills are Actoplus Met, Avandamet, Avandaryl, Duetact, Glucovance, Janumet, and Metaglip.
• SGLT-2 inhibitors work differently than the other eight medications in that they restrict glucose reabsorption in the kidneys. SGLT-2 inhibitors are canagliflozin, dapagliflozin, and empagliflozin.

In addition to oral diabetes medication, there are three types of non-insulin injectable diabetes medication.

• Amylin mimetic/Amylin analog slows food as it moves through the stomach and prevents the liver from releasing stored glucose. The medication is Symlin (pramlintide acetate).
• Incretin mimetics help the body make insulin, slow digestion and prevent the liver from releasing glucose. The medication is Byetta (exenatide).
• GLP-1 receptor agonists help the body produce insulin, keeps the liver from releasing glucose, and decreases appetite. There are five GLP-1 receptor agonists: Tanzeum (albiglutide), Trulicity (dulaglutide), Byetta (exenatide), Bydureon (exenatide extended release), and Victoza (liraglutide).

New diabetes medication is always being researched and developed to help improve the quality of life of those with diabetes. Among the newest oral diabetes medications:

• Glyxambi
• Segluromet
• Steglatro
• Steglujan
• Synjardy
• Xigduo XR

New injectables include:

• Adlyxin
• Basaglar
• Ozempic
• Ryzodeg
• Soliqua
• Toujeo
• Tresiba
• Xultophy

With this dizzying amount of diabetes medication available, it’s natural to want to know which is the best diabetes medicine. Hundreds of studies and clinical trials have been conducted to answer that question, but there is no evidence that one medication is best. Each person is unique, and the medication that is best for one might not work well at all for another.

While there isn’t a single medication that stands out as the best, there is a treatment that is best—and it’s not medication. The best treatment, according to experts, is lifestyle. A healthy diet, activity and exercise, and weight management are even more important than medication in treating diabetes. You take the lead, and diabetes medication can support you ("Are There Natural Diabetes Treatments?").

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When depression causes insomnia, dealing with life can become increasingly difficult. If you find yourself having difficulty falling asleep, staying asleep, or both, you are likely experiencing insomnia. Likewise, if you are living with depression and frequently find yourself waking up very early in the morning, unable to fall back asleep, you could have both depression and insomnia. The combination of depression and insomnia can be miserable, but there are things you can do to improve both.

Insomnia in depression is common. It’s estimated that between 65 and 95 percent of people with major depression have sleep problems (Harvard Mental Health Letter, n.d.). Depression involves two general types of sleep problems: insomnia (sleeping too little) or hypersomnia (sleeping too much). In depression, insomnia is much more prevalent than hypersomnia, with 80 percent of people having insomnia (Jaret, n.d.).

Insomnia from depression can exacerbate mental health problems.

• Lack of sleep affects brain chemistry, throwing off neurotransmitters and causing or worsening depression.
• Lying awake, tossing and turning in exhaustion, almost always leads to a barrage of negative thoughts that feed on each other for hours and greet the dawn with you to start the day poorly.
• Insomnia with depression frequently causes anxiety, irritability, lethargy, exhaustion, concentration difficulties, and brain fog.

Depression and insomnia are able to create so many difficulties because they share neural pathways in the brain. Both also disrupt body rhythms making functioning difficult day and night. While this spells trouble for sleep and mood, there is a positive side to their link. You can do things to reduce depression and insomnia. Treating both together can be very effective, and there are tools and techniques you can develop to manage them.

Treating Insomnia and Depression

While they share brain activity, these disorders are two separate conditions with their own treatment approaches. When you and your doctor address each one, your mood and your sleep can improve. Therapy and medication are common treatment approaches to help both.

Medication is often used as treatment because mood and sleep problems are brain-based. Medication works to repair neurotransmitter levels and functioning. Many different types of antidepressant medications and sedative-hypnotic medications are available to treat these disorders. It is sometimes a process of trial-and-error to find the right combination and dosage to help your mood and your sleep. Working closely with your doctor can help you find what works for you.

Mental health therapy is also effective in helping both depression and insomnia. Research studies continue to show the effectiveness of cognitive-behavioral therapy for treating depression. Cognitive-behavioral therapy-Insomnia (CBT-I) is a newer therapeutic approach that has also been shown to effectively treat mood and sleep problems. Both involve addressing and replacing the negative thoughts that plague people with depression. CBT-I has a component that specifically addresses sleep. People learn sleep behaviors, techniques, and positive self-talk to fall asleep and stay asleep.

Tips for Managing Depression and Insomnia

When you work with a therapist to overcome depression and sleeping problems, you’ll gain tools for managing your mental health long-term. The following tips are a sampling of the techniques you might delve into more deeply in therapy. Together, they help you calm both your mind and your body, because mind and body are one unit. You can start using them now to begin to take control of your days and your nights.

• Keep a regular sleep schedule, going to bed and getting out of bed at the same times every day.
• Develop a sleep routine, doing the same things at the same time each night to signal your brain that rest is ahead.
• Create a calming sleep ritual that includes quiet, subdued activities like reading, yoga, meditating, or listening to peaceful, quiet music—and excludes electronics.
• Make your bedroom environment right for sleep, with a comfortable temperature, dim lights, inviting atmosphere, and no computers or televisions.
• Practice slow, deep breathing before bed and when you lie down.
• Write in a gratitude journal before you settle in, reflecting on one or two positives in your day.
• Replace negative thoughts with positive ones from your journal and simple affirmations such as this one: “I may be awake, but I’m relaxed and resting.”

What you do during the day makes a difference in your night, too.

• Move. Depression makes this difficult, but gentle exercise like walking or tai chi, done for even short periods of time, can improve sleep.
• Avoid daytime naps, or keep them less than 20 minutes.
• Refrain from consuming processed or sugary foods, caffeine, and alcohol

Depression and insomnia can be hard to deal with; however, it is possible to not just deal with them but overcome them. Be patient with yourself and consistent in your approach to treat and manage these insidious difficulties. You can feel better and take back your life.

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Why You Need Support for Depression

While medication and therapy are the cornerstones of depression treatment, depression support is also an integral part in successful depression recovery. Support might come from friends and family or, more formally, from depression support groups or online depression support.

Depression support groups are primarily peer-run organizations although sometimes professionals are involved. Support groups for depression may be through a community organization, charity or faith group. People often find that being in a group of others going through the same mental health challenges can support their depression recovery in a way that formal treatments do not.

Depression Support Groups

The traditional form of depression support is through an in-person depression support group. Support groups are not group therapy but they do offer a safe space to explore issues around living with a mental illness.

Members in a depression support group get to talk about their particular challenges in living with depression. Then, other members of the support group for depression suggest helpful coping techniques and offer their support to the person. This builds a community of like-minded people all working to support each other’s treatment and recovery.^[i]

Organizations that run depression support groups may also offer additional services like:^[ii]

• Newsletters
• Educational sessions
• Libraries of information on depression
• Special events
• Advocacy groups

Online Depression Support

While depression support groups are available throughout North America, for a variety of reasons, a person may not be able to attend an in-person group. This is where online depression support can come in. Online depression support groups can offer similar types of support as traditional depression support groups but are available from the comfort of your own home.

Online depression support groups are typically forums where an individual can post a question, topic or concern and then others will respond to it with their own depression advice. Online depression support groups are typically moderated by peers but may also be moderated by the organization hosting the support group.

Live depression chat support may also be available with peers or with professionals. Depression chat support can also be found on places like Facebook and Twitter.

Where to Find Depression Support Groups

Many agencies offer depression support and there are also many sources of online depression support. Depression support groups can be found through:

• Depression and Bipolar Support Alliance (DBSA) – offers online support groups as well as in-person depression support groups, newsletters, educational sessions and special events
• Mental Health America – offers links to depression support groups as well as support groups for other mental health issues
• National Alliance on Mental Illness (NAMI) – offers multiple types of support groups as well as advocacy support and other resources

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Learn how to tell whether it's time to switch depression medications or just add other medications for depression onto what you are taking. And just how effective is therapy for depression?

Time to Switch Antidepressants

It took Emily, 34, three tries over 10 years before she finally found the right antidepressant. She took at increasingly higher dosages for five years until severe migraines forced a switch. Next came Effexor. Although her doctor kept increasing the dosage, it never worked very well for her. In 2006, she joined a clinical trial for Lexapro (escitalopram) and finally found the drug for her. Today she continues to take Lexapro at a high dosage as well as Wellbutrin (bupropion).

The whole experience was quite frustrating, she recalls. "With each pill, I thought I'd found the answer because I would feel significantly better right away." But as the initial improvement faded, she became more-and-more depressed. Unfortunately, her doctors didn't follow recommended guidelines for using antidepressants to treat depression, which call for referring to a psychiatrist after a patient fails two medications (making them "treatment resistant") and switching and/or adding medications much sooner. The result: Needless suffering.

As to which drug her doctors should have switched her to . . . well, there's no clear answer to that, says Dr. Gaynes. Generally, if you were taking an SSRI and handled it well in terms of side effects, your doctor can try you on a different SSRI. But if you've already failed two SSRIs, it is probably time to try another type of antidepressant or to consider adding a different type of medication.

Should You Switch Your Antidepressant Medication?

If the medication you take has side effects that interfere with your quality of life, that's a good reason to switch. Otherwise, consider the following:

1. Have you been taking your medication as directed for at least 8 weeks and still don't feel better?
2. Has your doctor increased the dosage of your medication at least once but you still don't feel better?

If you answered "yes" to either of these questions, it's time to talk to your doctor about switching.

Antidepressant Augmentation: Time to Add?

So when do you give up on switching your antidepressant medication and simply start adding a new medication for depression?

Again, there is no magic answer. In the STAR*D clinical trial, participants who opted to add another medication tended to be less severely depressed, said Dr. Gaynes. "That's not surprising; they tended to have done fairly well on the antidepressant, so they didn't want to start over with another. They just wanted to boost its effectiveness."

The most commonly used medications for augmentation are the antianxiety medication Buspar (buspirone), the antidepressant Wellbutrin, the antipsychotic Abilify (aripiprazole), lithium and thyroid hormone. Again, there appears to be little difference in their effectiveness.

One study comparing BuSpar and Wellbutrin as add-on therapy in patients who were still depressed after nearly three months on Celexa (citalopram) found both worked just as well at bringing patients to remission.^xiv Another found similar results whether patients augmented with lithium or thyroid hormone, although there were fewer side effects with the hormone.^xv

What About Therapy for Depression?

Cognitive behavioral therapy for the treatment of depression is an important option for anyone who doesn't respond to an initial antidepressant. In a study comparing cognitive therapy to either Wellbutrin or BuSpar augmentation, researchers found that adding any to Celexa resulted in similar rates of remission, although patients who received the medication reached remission an average of 15 days earlier. There were also no significant differences in time to remission in patients who were switched from Celexa to therapy or another antidepressant, although those taking medication had far more side effects than those receiving therapy.^xvi

Emily, 34, found that adding twice weekly therapy to her medication combo of Lexapro and Wellbutrin made a big difference in her depression. In fact, she's doing so well her psychiatrist recently recommended reducing her dosages. That makes her nervous.

"What if I'm not actually cured, but just feel better because of the medication?" she asked. It's an issue she's still working on. In the meantime, however, she says the combination of antidepressant medications and therapy have improved her quality of life daily. "I am so glad I finally found something that works, even if it took 10 years!"