Diagnosing dissociative identity disorder (DID) is done with two things in mind:

1. ruling out other possible diagnoses
2. ruling in dissociative identity disorder (DID)

In fact, ruling out other diagnoses is so critical to a dissociative identity disorder diagnosis, that one might even say that diagnosis of dissociative identity disorder is an exclusionary process. It is because so many other mental health disorders must be considered first that most people do not receive a DID diagnosis promptly. It's estimated that people with DID spend seven years in the mental health system prior to receiving the correct diagnosis (What’s It Like Living with Dissociative Identity Disorder).

When Diagnosing DID, What Else Could It Be?

Many of the signs and symptoms of dissociative identity disorder overlap with other psychiatric disorders. For example, auditory hallucinations are common in DID as well as in schizophrenia. In clinicians not well educated in dissociative identity disorder, an incorrect diagnosis of schizophrenia is common.

Additionally, in a study by Tezcan et al of patients with dissociative disorders, all patients suffered from an additional disorder. Comorbid disorders, as they are known, make the diagnosis of underlying dissociative identity disorder more difficult.

When diagnosing dissociative identity disorder, the following need to be ruled out:

• Temporal lobe epilepsy – dissociation is more common in temporal lobe epilepsy than in any other neurological disorder.
• Schizophrenic disorders – as mentioned, some symptoms do overlap but there are several ways to tell the difference between schizophrenia and DID. One of which is that people with schizophrenia hear voices from outside their heads whereas in DID, the voices heard are from within.
• Borderline personality disorder – according to two studies, people with DID commonly have a comorbid borderline personality disorder; however, not all do. In the case where both disorders are present, DID is likely to be treated first as working with alternate personalities provides an avenue of therapy that is not available when treating the individual only as a whole.
• Malingering – malingerers make up or inflate symptoms to seem sick when they are not due to secondary gain (because there's some advantage for the patient). This is ruled out based on an individual's circumstances.
• Dissociative amnesic disorder – it can be difficult to differentiate between these two disorders but, according to Medscape, "With other dissociative amnesic disorders, behavior may be complex, but recovery is often complete, recurrences are less common, and the onset of amnesic spells may be intimately related to stressful events or to ingestion or intoxication."

How Is Dissociative Identity Disorder Diagnosed?

Diagnosing dissociative identity disorder must always be done by a mental health professional such as a psychiatrist or psychologist, preferably one with experience with dissociative disorders. An initial assessment may be done by a general practitioner (family doctor) with referral to a psychiatrist or psychologist once other conditions have been ruled out (Read about famous dissociative identity disorder cases).

A dissociative identity disorder assessment will start with a complete psychological and physical health history. While there is no specific test for dissociative identity disorder, medical tests may be ordered to help rule out other causes of dissociative symptoms such as a neurological disorder, medication side effects or intoxication.

Once other causes of dissociative symptoms have been ruled out, a specially designed interview and personality assessment tools are used to evaluate a person for a dissociative identity disorder diagnosis.

article references

Diabetes and OCD are connected. The most obvious way is that living with both illnesses is stressful, each making the other more difficult. For example, most people with diabetes worry about their blood sugar levels, but for those also living with OCD, the obsession grows until it consumes their lives.

The association between obsessive-compulsive disorder and diabetes relates to the experience of dealing with each illness. Also, researchers have begun to discover that the connection runs deeper ("Challenges in Managing Diabetes When Living with OCD"). Metabolic problems in diabetes and OCD symptoms affect each other; therefore, functions like obsessing over your blood sugar levels relate to thoughts, emotions, behaviors—as well as biology and physiology (Konstantinos et al., 2012). This look at the experience of living with these conditions can help you better understand yourself or a loved one.

Diabetes and OCD: What are They?

Diabetes is an illness in which the body can’t control its own blood glucose (sugar). After you eat, carbohydrates are digested into glucose. Normally, insulin is released by the pancreas to help the glucose enter the cells of the body for energy. In type 1 diabetes, the body doesn’t make insulin, whereas in type 2 diabetes, the body either doesn’t uses its insulin efficiently or doesn’t make enough. In either case, glucose stays in the blood. This leads to serious damage throughout the body, so people with diabetes must monitor their blood sugar levels, possibly take medication like insulin, watch nutrition, exercise, and other lifestyle components.

Obsessive-compulsive disorder is a mental illness involving repetitive, often intrusive thoughts (obsessions). These obsessions are based on fear and anxiety and simultaneously cause fear and anxiety. Compulsions are behaviors that are done to alleviate the stress and anxiety caused by the obsessions ("Diabetes and Anxiety: There’s Plenty to Be Anxious About").

When someone lives with both diabetes and OCD, they have things going on in both their brain and body that converge into a perfect storm:

• Fear
• Self-blame
• Imagined horrible consequences of every thought, emotion, spoken word, and action or non-action

A major component of diabetes treatment is blood sugar monitoring and management. It’s common for anyone living with diabetes to experience fear, self-blame, and imagined horrible consequences of such things as improper blood sugar control, but for someone who also lives with OCD, these anxieties skyrocket and can shut them down.

Obsessions About Blood Sugar Levels: Beyond Overthinking

With OCD, some worries aren’t reality-based and can be refuted more easily than others. The anxieties about diabetes and its health consequences, though, are very real. Typical fears about problems related to blood sugar levels, amounts of insulin and other medication, nutrition, health complications, and overall lifestyle take hold and become constant obsessions for someone with diabetes and OCD.

The relentless obsessions often involve a constant, nagging feeling that something isn’t quite right.

• What if my blood sugar levels are too high? Too low?
• What if I did my last reading wrong and my glucose levels are dangerously off?
• What if I did my last reading correctly but the machine didn’t work right?
• What if the reading was correct but a minute later my blood sugar spiked or plummeted?

These obsessive worries don’t stop, and pressure builds to do something to alleviate them. The person needs reassurance and begins to think obsessively about checking their blood sugar. The urge builds until they must check their blood sugar. Blood sugar levels become both an obsession (the thought) and a compulsion (the act of checking).

Checking and re-checking, worrying about every fluctuation no matter how minor, can consume someone’s day—and very life. According to the Mayo Clinic (2018), most people need to check their blood sugar between three and 10 times per day (some with type 2 who aren’t using insulin often don’t need to check). Someone with OCD might check their glucose levels 25, 50, or more times per day.

The Consequences of Obsessive Blood Sugar Testing

Too often, for someone with diabetes and OCD, life is lived for the disease. Worry and fear about health problems are all-consuming. Part of OCD is a high need for control; thus, compulsively checking and monitoring aspects of diabetes like blood sugar, lifestyle, nutrition, amount of insulin delivered takes over all other activities.

Obsessions and compulsions limit life, interfere with happiness, and increase stress and anxiety. Both OCD and diabetes are manageable in a healthy way. Work with your doctor and therapist to change your thinking and approach to diabetes management. These healthcare professionals can help you set limits and testing guidelines.

Monitoring blood sugar levels is healthy. Obsessing and compulsively checking, though, are physically and mentally unhealthy. With help, you can learn to manage not just your blood sugar but your diabetes as whole and OCD. You can regain control of your life.

article references

A diabetes diagnosis must come from a doctor or other qualified medical professional because of the nature of the illness. Diabetes is a disease in which, because of problems with the hormone insulin, glucose (sugar created during digestion) can’t enter the cells of the body but instead stays in the bloodstream. Blood sugar builds to unhealthy levels, a condition called hyperglycemia. The only way to know your blood sugar levels is through blood tests in a medical lab ordered by your doctor. Let’s look at the types of tests used for a diabetes diagnosis.

Types of Tests Used to Diagnose Diabetes

A common question is, How do they test for diabetes? Doctors order different types of lab tests to diagnose type 1 and type 2 diabetes ("What Is the Difference Between Type 1 and Type 2 Diabetes?"). These include:

• Glycated hemoglobin test (more commonly referred to as the A1C)
• Random (or casual) plasma glucose test
• Fasting plasma glucose test (FPG)
• Oral glucose tolerance test (OGTT)

While all tests measure hyperglycemia, each one has a slightly different procedure and diabetes diagnosis criteria, or an acceptable range of blood sugar levels.

Diabetes Diagnostic Tests Explained

Knowing about these tests and diabetes diagnostic criteria can help you mentally prepare for diabetes testing and thus reduce anxiety about the process.

The A1C examines how much blood glucose has been attached to hemoglobin over the past two to three months. This is different from other tests. Most tests measure the amount of glucose in the bloodstream during the test. An A1C test identifies trends by looking at how much glucose is attached to hemoglobin, a protein in red blood cells. The result is measured in percentages.

In the A1C test to diagnose diabetes:

• A sample of your blood is drawn
• You don’t have to fast (go without eating or drinking)
• You don’t have to drink a glucose solution
• If the result is 6.5 percent or higher after two tests, a diabetes diagnosis is given
• A result of 5.7 and 6.4 percent indicates prediabetes
• Anything below 5.7 percent is considered normal

The random plasma glucose test measures the amount of glucose in the blood at the time of the test. This test:

• Involves the drawing of a blood sample
• Is done any time of day
• Is random in that it isn’t planned around the timing of meals.
• Diagnoses diabetes in the blood sugar level is 200 mg/dL (milligrams per deciliter) or higher

The fasting plasma glucose test is another test that measures blood sugar levels. In this test,

• Blood is drawn after fasting (usually first thing in the morning)
• If the blood test shows that the blood glucose level is 126 mg/DL or higher, a diabetes diagnosis is given
• A reading between 100 mg/dL and 125 ml/dL indicates prediabetes
• Lower than 100 mg/dL is normal

The oral glucose tolerance test is another test to determine if hyperglycemia is present and high enough for a diagnosis of diabetes. In the OGTT,

• After 8 hours of fasting, usually overnight, blood is drawn to measure the fasting blood sugar level
• The person being tested drinks a glucose solution
• Blood is drawn periodically over the next two hours to see how blood glucose levels react
• At the end of the test, a blood glucose level of 200 ml/dL leads to a diabetes diagnosis
• Blood sugar levels between 140 and 199 mg/dL indicate prediabetes
• Healthy blood sugar levels are under 140 mg/dL                                                                                                                                                                                                               

The glucose challenge test and glucose tolerance test are used to diagnose gestational diabetes, or diabetes that a woman develops during pregnancy and ends within six weeks after delivery. This test is routinely given during a prenatal check-up, typically during weeks 24-28 of pregnancy.

• The glucose challenge test happens first
• The woman drinks a glucose solution
• Blood is drawn one hour later to measure blood sugar levels
• If the reading is above 126 mg/dL, a follow-up test is needed
• The follow-up glucose tolerance test is the same as before but with a solution containing a higher concentration of glucose
• Blood sugar levels are checked hourly for three hours
• If at least two of the hourly readings are above 126, gestational diabetes is diagnosed

There is one more important answer to the question How do you diagnose diabetes? The answer? More than once. As with any type of medical testing, there can be interferences that affect the results. Some prescription medications, being under extreme stress, and even trauma can influence test results. Your doctor will likely verify your prescription medications as well as talk with you about lifestyle factors before ordering blood glucose tests.

In many cases, if a test indicates hyperglycemia, it’s repeated on a second day to ensure that a positive result for diabetes is consistent and wasn’t an error. Then, if you are given a diabetes diagnosis, you can begin to treat diabetes immediately and take charge of your health and wellbeing ("What Are Diabetes Treatment Guidelines?").

article references

Background:

Pica is an eating disorder typically defined as the persistent eating of nonnutritive substances for a period of at least 1 month at an age in which this behavior is developmentally inappropriate (eg, >18-24 mo). The definition occasionally is broadened to include the mouthing of nonnutritive substances. Individuals presenting with pica have been reported to mouth and/or ingest a wide variety of nonfood substances, including, but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, and burnt matches.

Although pica is observed most frequently in children, it is the most common eating disorder seen in individuals with developmental disabilities. In some societies, pica is a culturally sanctioned practice and is not considered to be pathologic. Pica may be benign, or it may have life-threatening consequences.

In children aged 18 months to 2 years, the ingestion and mouthing of nonnutritive substances is common and is not considered to be pathologic. Consider pica when the behavior is inappropriate to the developmental level of the individual, is not part of a culturally sanctioned practice, and does not occur exclusively during the course of another mental disorder (eg, schizophrenia). If pica is associated with mental retardation or pervasive developmental disorder, it must be sufficiently severe to warrant independent clinical attention. In such patients, pica typically is considered to be a secondary diagnosis. Furthermore, the pica must last for a period of at least 1 month.

Pathophysiology:

Pica is a serious behavioral problem because it can result in significant medical sequelae. The nature and amount of the ingested substance determine the medical sequelae. Pica has been shown to be a predisposing factor in accidental ingestion of poisons, particularly in lead poisoning. The ingestion of bizarre or unusual substances also has resulted in other potentially life-threatening toxicities, such as hyperkalemia following cautopyreiophagia (ingestion of burnt match heads).

Exposure to infectious agents via ingestion of contaminated substances is another potential health hazard associated with pica, the nature of which varies with the content of the ingested material. In particular, geophagia (soil or clay ingestion) has been associated with soil-borne parasitic infections, such as toxoplasmosis and toxocariasis. Gastrointestinal (GI) tract complications, including mechanical bowel problems, constipation, ulcerations, perforations, and intestinal obstructions, have resulted from pica.

Frequency:

• In the US: Prevalence of pica is unknown because the disorder often is unrecognized and underreported. Although prevalence rates vary depending on the definition of pica, the characteristics of the population sampled, and the methods used for data collection, pica is reported most commonly in children and in individuals with mental retardation. Children with mental retardation and autism are affected more frequently than children without these conditions. Among individuals with mental retardation, pica is the most common eating disorder. In this population, the risk for and severity of pica increases with increasing severity of mental retardation.
• Internationally: Pica occurs throughout the world. Geophagia is the most common form of pica in people who live in poverty and people who live in the tropics and in tribe-oriented societies. Pica is a widespread practice in western Kenya, southern Africa, and India. Pica has been reported in Australia, Canada, Israel, Iran, Uganda, Wales, and Jamaica. In some countries, Uganda for example, soil is available for purchase for the purpose of ingestion.

Mortality/Morbidity:

• Ingestion of poisons: Lead toxicity is the most common type of poisoning associated with pica. Lead has neurologic, hematologic, endocrine, cardiovascular, and renal effects. Lead encephalopathy is a potentially fatal complication of severe lead poisoning, presenting with headache, vomiting, seizures, coma, and respiratory arrest. Ingestion of high doses of lead can cause significant intellectual impairment and behavioral and learning problems. Studies also have demonstrated that neuropsychologic dysfunction and deficits in neurologic development can result from very low lead levels, even levels once believed to be safe.
• Exposure to infectious agents: A variety of infections and parasitic infestations, ranging from mild to severe, are associated with the ingestion of infectious agents via contaminated substances, such as feces or dirt. In particular, geophagia has been associated with soil-borne parasitic infections, such as toxocariasis, toxoplasmosis, and trichuriasis.
• GI tract effects: GI tract complications associated with pica range from mild (eg, constipation) to life threatening (eg, hemorrhages secondary to perforations or ulcerations). Sequelae in the GI tract may include mechanical bowel problems, constipation, ulcerations, perforations, and intestinal obstructions caused by bezoar formation and the presence of undigestible materials in the intestinal tract.
• Direct nutritional effects: Theories regarding the direct nutritional effects of pica are related to characteristics of specific ingested materials that either displace normal dietary intake or interfere with the absorption of necessary nutritional substances. Examples of nutritional effects that have been linked to severe cases of pica include iron and zinc deficiency syndromes; however, the data are only suggestive, and no firm empirical data exist supporting these theories.

Race:

Although no specific data exist regarding racial predilection, the practice is reported to be more common among certain cultural and geographic populations. For example, geophagia is accepted culturally among some families of African lineage and is reported to be problematic in 70% of the provinces in Turkey.

Sex:

Pica typically occurs in equal numbers of boys and girls; however, it is rare in adolescent and adult males of average intelligence who live in developed countries.

Age:

• Pica is observed more commonly during the second and third years of life and is considered developmentally inappropriate in children older than 18-24 months. Research suggests that pica occurs in 25-33% of young children and 20% of children seen in mental health clinics.
• A linear decrease in pica occurs with increasing age. Pica occasionally extends into adolescence but is rarely observed in adults who are not mentally disabled.
• Infants and children commonly ingest paint, plaster, string, hair, and cloth. Older children tend to ingest animal droppings, sand, insects, leaves, pebbles, and cigarette butts. Adolescents and adults most often ingest clay or soil.
• In young pregnant women, the onset of pica frequently occurs during their first pregnancy in late adolescence or early adulthood. Although the pica usually remits at the end of the pregnancy, it may continue intermittently for years.
• In individuals with mental retardation, pica occurs most often in those aged 10-20 years.

History:

• Clinical presentation is highly variable and is associated with the specific nature of the resulting medical conditions and the ingested substances.
• A reluctance to report the practice and secretiveness on the part of patients frequently interfere with accurate diagnosis and effective treatment.
• The broad range of complications arising from the various forms of pica and the delay in accurate diagnosis may result in mild-to-life-threatening sequelae.
• In poisoning or exposure to infectious agents, the reported symptoms are extremely variable and are related to the type of toxin or infectious agent ingested.
• GI tract complaints may include constipation, chronic or acute and/or diffuse or focused abdominal pain, nausea, vomiting, abdominal distention, and loss of appetite.
• Patients may withhold information regarding pica behavior and deny the presence of pica when questioned.

Physical:

The physical findings associated with pica are extremely variable and are related directly to the materials ingested and the subsequent medical consequences.

• Toxic ingestions: Lead toxicity is the most common poisoning associated with pica.
  • Physical manifestations are nonspecific and subtle, and most children with lead poisoning are asymptomatic.
  • Physical manifestations of lead poisoning can include neurologic (eg, irritability, lethargy, ataxia, incoordination, headache, cranial nerve paralysis, papilledema, encephalopathy, seizures, coma, death) and GI tract (eg, constipation, abdominal pain, colic, vomiting, anorexia, diarrhea) symptoms.
• Infections and parasitic infestations: Toxocariasis (visceral larva migrans, ocular larva migrans) is the most common soil-borne parasitic infection associated with pica.
  • Symptoms of toxocariasis are diverse and appear to be related to the number of larvae ingested and the organs to which the larvae migrate.
  • Physical findings associated with visceral larva migrains may include fever, hepatomegaly, malaise, coughing, myocarditis, and encephalitis.
  • Ocular larva migrans can result in retinal lesions and loss of vision.
• GI tract symptoms may be evident secondary to mechanical bowel problems, constipation, ulcerations, perforations, and intestinal obstructions caused by bezoar formation and the ingestion of undigestible materials into the intestinal tract.

Causes:

Although the etiology of pica is unknown, numerous hypotheses have been advanced to explain the phenomenon, ranging from psychosocial causes to causes of purely biochemical origin. Cultural, socioeconomic, organic, and psychodynamic factors have been implicated.

• Nutritional deficiencies:
  • Although firm empirical data supporting any of the nutritional deficiency etiologic hypotheses are absent, deficiencies in iron, calcium, zinc, and other nutrients (eg, thiamine, niacin, vitamins C and D) have been associated with pica.
  • In some patients with malnutrition who eat clay, iron deficiencies have been diagnosed, but the direction of this causal association is unclear. Whether the iron deficiency prompted the eating of clay or the inhibition of iron absorption caused by the ingestion of clay produced the iron deficiency is not known.
• Cultural and familial factors
  • In particular, the ingestion of clay or soil may be culturally based and is regarded as acceptable by various social groups.
  • Parents may proactively teach their children to eat these and other substances.
  • Pica behavior also may be learned via modeling and reinforcement.
• Stress: Maternal deprivation, parental separation, parental neglect, child abuse, and insufficient amounts of parent/child interactions have been associated with pica.
• Low socioeconomic status
  • The ingestion of paint is most common in children from low socioeconomic families and is associated with lack of parental supervision.
  • Malnutrition and hunger also may result in pica.
• Nondiscriminating oral behavior: In individuals with mental retardation, pica has been suggested to result from an inability to discriminate between food and nonfood items; however, this theory is not supported by findings of selection of pica items and the often aggressive search for nonfood items of choice.
• Learned behavior: In individuals with mental retardation and developmental disabilities in particular, the traditional view is that the occurrence of pica is a learned behavior maintained by the consequences of that behavior.
• Underlying biochemical disorder: The association of pica, iron deficiency and a number of pathophysiologic states with decreased activity of the dopamine system has raised the possibility of a correlation between diminished dopaminergic neurotransmission and the expression and maintenance of pica; however, specific pathogenesis resulting from any underlying biochemical disorders has not been identified empirically.
• Other risk factors
• Parent/child psychopathology
• Family disorganization
• Environmental deprivation
• Pregnancy
• Epilepsy
• Brain damage
• Mental retardation
• Developmental disorders

TREATMENT

Medical Care:

• Although pica in children often remits spontaneously, a multidisciplinary approach involving psychologists, social workers, and physicians is recommended for effective treatment.
• Development of the treatment plan must take into account the symptoms of pica and contributory factors, as well as the management of possible complications of the disorder.
• No medical treatment is specific in the treatment of patients with pica.

Consultations:

• Psychologist/Psychiatrist
  • Careful analysis of the function of pica behavior in individuals is critical to effective treatment.
  • Currently, behavioral strategies in treating pica have been most effective.
  • Among the behavioral strategies that have been effective are antecedent manipulation; discrimination training between edible and non-edible items; self-protection devices that prohibit placement of objects in the mouth; sensory reinforcement; differential reinforcement of other or incompatible behaviors, such as screening (covering eyes briefly), contingent aversive oral taste (lemon), contingent aversive smell sensation (ammonia), contingent aversive physical sensation (water mist), and brief physical restraint; and overcorrection (correct the environment, or practice appropriate alternative responses).
• Social worker
  • In toddlers and young children, pica behavior may provide environmental or sensory stimulation. Assistance in addressing these issues may prove beneficial, along with managing economic problems and/or deprivation and social isolation.
  • Assessment of cultural beliefs and traditions may reveal the need for education regarding the negative effects of pica.
  • Removal of toxic substances from the environment, particularly lead-based paint, is important.

Diet:

• Assessment of nutritional beliefs may be relevant in the treatment of some patients with pica.

• Address any identified nutritional deficiencies; however, nutritional and dietary approaches have demonstrated success related to the prevention of pica in only a very limited number of patients.

MEDICATION

Few studies have been performed using pharmacologic treatments for pica; however, the hypothesis that diminished dopaminergic neurotransmission is associated with the occurrence of pica suggests that drugs that enhance dopaminergic functioning may provide treatment alternatives in individuals with pica that is refractory to behavioral intervention. Medications used in the management of severe behavioral problems may have a positive impact on comorbid pica.

Further Outpatient Care:

• Treatment of pica is conducted primarily on an outpatient basis in consultation with multidisciplinary professionals as described above.

Prognosis:

• Pica frequently spontaneously remits in young children and pregnant women; however, it may persist for years if untreated, especially in individuals with mental retardation and developmental disabilities.

Patient Education:

• Educate patients regarding healthy nutritional practices

Diabetes treatment guidelines are recommendations made to help those with any type of diabetes be healthy and live a quality life. The American Diabetes Association’s Standards of Medical Care in Diabetes is a lengthy guide for medical professionals to follow when treating patients with diabetes. This formal diabetes treatment guideline addresses every aspect of diabetes as well as its health risk to all systems of the body. With these standards of care, your chances of successful diabetes treatment are high when you take an active role in your diabetes treatment and management. Read on to learn what to expect in diabetes treatment.

Diabetes Treatment: Who is Responsible for Treatment and Management?

When you or a loved one is first diagnosed, diabetes treatment plans will be created. In most cases, you will have a treatment team of professionals looking after all aspects of your care. Because diabetes carries risks like kidney failure, blindness, nerve damage, loss of lower limbs, and cardiovascular disease, diabetes treatment must address your whole self. Your treatment team may include such professionals as:

• Your primary care physician
• Diabetes educator
• Endocrinologist (a specialist in hormones, including insulin)
• Ophthalmologist or optometrist (eye doctor)
• Podiatrist (foot doctor; foot problems are common in diabetes)
• Dentist (mouth problems are also common in diabetes)
• Exercise physiologist (to help with an active lifestyle)
• Nutritionist (to help with a diabetes-friendly diet)
• Mental health therapist (to help you overcome depression, anxiety, stress, and other challenges that can accompany life with diabetes)

While every member of the team is equally important, the key member is you. The professionals on your team will help you define your diabetes treatment goals and work with you in creating your action steps, but you won’t see these people every day. You have the power to be healthy despite this disease by following the personal diabetes treatment guidelines outlined in your plan ("Are There Natural Diabetes Treatments?").

The Many Components of Diabetes Treatment

Managing diabetes and staying healthy involves a variety of diabetes treatment options ("How Do You Treat Diabetes? Medications, Diet, Stem Cells"). Expect to have most, if not all, of these in your individualized treatment plan developed by your care team:

• Blood glucose monitoring
• Medication, including insulin
• Healthy diet
• Exercise
• Foot monitoring (foot problems develop often, so daily inspections help you catch issues early)
• Check-ups as scheduled with your primary care doctor and other professionals on your team

Blood glucose monitoring forms the foundation of your daily care. Diabetes is a disease in which, because of a problem with the hormone insulin, glucose (sugar) stays in the bloodstream instead of moving into the cells of the body. The result is hyperglycemia, or high blood sugar. Hyperglycemia causes damage throughout the body; thus, it must be managed. Monitoring your blood sugar with a small device that takes a bit of blood and measures the glucose level at certain times throughout the day helps you know if you need to eat better, use insulin, exercise, or any combination of these.

It’s essential that you take any diabetes medication prescribed by your doctor and take it as directed. If you have type 1 diabetes, you will take insulin because your body doesn’t make it on its own. If you have type 2, there’s a chance you will take insulin, but insulin isn’t automatically part of type 2 diabetes treatment.

Medications other than insulin are sometimes used to treat type 2 diabetes. If you have been prescribed medication as part of your treatment plan, make sure to take it.

A healthy diet and an active lifestyle with regular exercise are vital for health and wellbeing with diabetes. Eliminating fried, fatty, processed, and sugary foods is of the utmost importance. Eating plenty of protein, fiber, and foods with a low-mid rating on the glycemic index will help lower blood sugar.

The glycemic index is a scale ranging from one to 100 that rates how a specific food affects blood sugar. High numbers raise blood sugar, so aim for foods rated 55 and lower, such as:

• Most fruits
• Vegetables
• Beans
• Minimally refined pasta and grains
• Nuts
• Low-fat dairy products

In addition to diet, exercise helps your body operate better, including regulating its blood glucose levels. Exercise also promotes weight loss. Being overweight or obese is a contributing factor in type 2 diabetes, so eating well and losing weight promote lower blood glucose levels. Further, both diet and exercise give you more energy, a welcome improvement over the deep fatigue associated with diabetes. In diabetes, glucose can’t enter the cells of the body and thus can’t be used for energy. The result is exhaustion. Following a proper diet and exercise program will improve your overall health.

Diabetes treatment isn’t difficult, but it does require persistence. Your treatment plan is designed to let you live well with diabetes. Be active in your diabetes treatment and management, and you’ll benefit by feeling better and enjoying life.

article references

Two little-known but common effects of diabetes are irrational behavior and mental confusion. Diabetes impacts not only physical and mental health but behavioral health, too. The reasons for this are the hormone insulin and the levels of glucose, or sugar, in the bloodstream. Glucose powers the brain and is the force behind all of its functioning. In both type 1 and type 2 diabetes, the body can’t regulate its glucose levels, so glucose can soar too high or plummet too low. Diabetes and irrational behavior and mental confusion are among the dangerous consequences of blood sugar fluctuations.

Diabetes and Irrational Behavior, Mental Confusion: What They’re Like

In diabetes, irrational behavior happens because glucose levels that are too high (hyperglycemia) or, especially, too low (hypoglycemia) impede self-control. When people lack their normal level of self-control, they often:

• are impulsive
• disregard long-term consequences of their actions
• easily give in to temptation
• make poor decisions even when they’re aware of different choices

Irrational behavior in diabetes can reduce the quality of life if it happens often or affects major life areas like relationships and work. Mental confusion also has the potential to negatively affect someone’s life. Bouts of confusion, when they’re severe or long-lasting, can limit lifestyle and such things as freedom of movement and ability to work.

Signs of diabetes mental confusion include:

• forgetfulness, including forgetting what you’re doing while you’re doing it
• a sensation of brain fog
• losing important objects
• difficulty concentrating
• confusion
• long pauses during speech, as if you’ve lost your train of thought
• feeling like you can’t think
• disorientation
• sudden agitation ("Diabetic Rage: Can Diabetes Cause Aggressive Behavior?")
• difficulty doing ordinary tasks
• incoherent speech

Diabetes and irrational behavior, as well as mental confusion, have specific causes related to blood sugar levels and insulin. Knowing their cause can help you understand what’s happening when you or a loved one experiences these behaviors and emotions, and it can help you manage them as well.

Causes of Diabetes and Irrational Behavior, Mental Confusion

When someone without diabetes eats carbohydrates, the carbs are digested and transformed into glucose, the sugar that gives the entire body and brain energy. Glucose leaves the digestive system and enters the bloodstream to be delivered to the body’s cells. Glucose can’t get into the cells on its own. That’s where insulin comes into the picture. An organ called the pancreas makes and releases insulin to unlock the cells and let glucose in.

In diabetes, this process goes awry. Type 1 diabetes is a disease in which the immune system attacks the pancreas so it can’t make insulin. In type 2 diabetes, the body can make insulin, but it either doesn’t make enough or it can’t use its insulin efficiently. Either way, glucose remains in the bloodstream rather than entering cells of the body for fuel; consequently, blood sugar levels climb too high and cause problems.

Diabetes treatment involves manually regulating insulin and blood sugar. This is difficult, and sometimes blood sugar levels become off center. When they’re too high (above 140 mg/dL), too low (below 70 mg/dL), or remain in the normal range but swing up and down, blood sugar levels aren’t where they need to be for the brain to operate correctly. Irrational behavior and mental confusion can result.

These factors contribute to the development of hyperglycemia, hypoglycemia, and unstable spikes and dips:

• Taking too much diabetes medication, especially insulin
• Eating too little
• Waiting too long between snacks or meals
• Too little exercise
• Too much exercise
• Alcohol consumption
• Lack of sleep

Once you know the causes of the irrational behavior and mental confusion that can accompany diabetes, you can use your knowledge to prevent and treat these serious effects of hyperglycemia, hypoglycemia, and glucose fluctuations.

Treating Diabetes and Mental Confusion, Irrational Behavior

Just as it is for other effects of diabetes, prevention is the primary way to manage the behavioral effects of diabetes. Following the plan set by your doctor and, ideally, the diabetes care team is important. Regular blood sugar monitoring, proper nutrition, exercise, healthy weight maintenance, and stress management are crucial in controlling blood sugar levels. This, in turn, has a positive effect on the brain.

By being aware of the signs of mental confusion and irrational behaviors, you can catch a glucose problem before it gets out of hand. Further, by staying on top of your diabetes treatment and management, you can reduce the negative effects of diabetes on the brain and behavior.

article references

Parents should strive to take away some of the pressure weighing on their child and create opportunities for him to find activities he enjoys and feels good about doing.

Today's Children in a Pressure Cooker

"It used to be, a kid could get average grades, play kick-the-can, read a few books at the public library, and that would be good enough. Now being average has become stigmatized."

So says Dr. Abraham Havivi, a child psychiatrist in Los Angeles. Havivi believes the pressures of modern life have led to an increase in depression in children. Now, at the end of the 20th century, parents perceive that the gap between the "haves" and the "have-nots" is widening. Consequently, they try to ensure that their children will become part of the "haves" by urging kids to excel in the classroom, on the athletic field and in their social circles. Although parents have their children's best interests at heart, they may be unwittingly forcing kids to assume too much responsibility too soon.

Julie Drake, a former elementary school teacher who now works for the Los Angeles County Office of Education, adds that kids today have a lot more homework than their counterparts 10 or 20 years ago.

"It's not necessarily meaningful homework, plus they have dance lessons, sports lessons," says Drake. "There's not enough time to sit back and process the day's events."

Fifth-grade teacher, Carmen Dean, attributes the increase in childhood depression in part to our MTV culture.

"Boys are made to think they have to have a pretty babe, a big car, all this external stuff. Girls feel they have to live up to this impossible physical ideal, so immediately there's a sense of failure. It used to be 14- and 15-year-olds who were reacting to these messages. Now it's filtering down to the younger kids."

More comprehensive information on child depression symptoms and what a depressed child looks like in real life.

Situational Depression - In a Slump

It's normal for a preteen's burgeoning hormones and increasing need for autonomy to cause mood swings. Dr. Havivi says parents shouldn't overreact if, occasionally, their children get down on themselves. According to Havivi, kids commonly suffer from "situational depression" -- frustrations stemming from problems with school pressures or with friends. This kind of slump is short-lived and usually will lift without intervention.

Sixth-grader, Blake Clausen, experienced such a slump when he left the nurturing world of his small elementary school to begin seventh grade at a much larger junior high. A genial boy who adjusted remarkably well to his parents' divorce, his mother's subsequent remarriage and the birth of his half-sister, Blake found the first few weeks of junior high to be the most stressful time of his life.

"Suddenly, he has to change classrooms, he's expected to keep his notebooks a certain way, and he's passing eighth-graders with beards in the hall," says Blake's mother, Gina, looking a bit overwhelmed herself.

Blake readily admits the school pressures have affected his temperament.

"I'll be really happy one minute, then an hour later, I'll be in the worst mood, like if I forget my homework," he says.

Luckily, Blake's bad moods last no more than an hour. And after several weeks in junior high, he feels he's better able to handle the stress. He attributes part of this newfound ease to his parents' reassurances.

"They told me once I got used to the schoolwork, things would get better. And they did."

Does Your Child Have Clinical Depression?

Parents should be concerned about their child's depression if it continues for a long period of time and is so pervasive that it colors everything. This is clinical depression, which Dr. Havivi likens to wearing "gray-tinted glasses." He explains that the seriously depressed child feels that "everything is bad, nothing is fun, and no one likes him or her."

In assessing possible clinical depression in a preteen, Havivi examines the major areas of the child's life: family, social, academic and the interior world. Havivi says that most of the troubled preteens he sees don't have major depression. Instead, they're demoralized by frustrations in one of the primary areas. Once Havivi pinpoints the problem, he works with the family to devise an appropriate treatment. For instance, if a bright boy is making poor grades at a highly competitive school, his parents might consider transferring him to a school that provides a more nurturing environment. Or, if a teacher complains that a girl seems distracted by her constant doodling, the parents might want to enroll the child in an art class instead of inadvertently thwarting her creativity by insisting she quit doodling.

Depression Medications for Children

Dr. Havivi stresses that medication is last on his list of preferred depression treatments for children. Although the relatively new class of antidepressants -- selective serotonin reuptake inhibitors (SSRIs) which include Prozac, and Paxil -- are considered as safe for children as for adults, no one really knows if these drugs can cause subtle, long-range changes in a preteen's developing brain chemistry. Together with his patient and the family, Havivi weighs the risks and benefits of prescribing antidepressants. Is the child withdrawn, losing friends? Does she have low self-esteem? Is her concentration impaired to the point that she's failing school? If the child is suffering in each of these areas, then the potential benefits from depression medication could override the unknown risks.

Read important information about antidepressants for children.

How Adults Can Help

According to Dr. Havivi, parents should strive to take away some of the pressure weighing on their child and create opportunities for him to find activities he enjoys and feels good about doing. A child doesn't have to be wildly popular to be happy, but he does need at least one good friend. Parents also should encourage their child to be active; going to a movie or playing ball is more likely to make a child feel better than staying home alone doing nothing.

Dr. Havivi says the best thing parents can do for a depressed preteen is to talk to her.

"Conversation among families is most important, better than therapy," says Havivi. In these conversations, parents should practice "active listening": express interest in what their child thinks; validate her feelings, rather than minimize them. It's also helpful for parents to share what it was like for them at their child's age. But Havivi warns parents to maintain their boundaries and not project their own issues onto their child.

Carmen Dean and Julie Drake feel that teachers and school administrators should provide children a safe place to say how they think and feel. For example, teachers can set up social skills groups in classrooms. These groups can help kids whose inappropriate behavior may be alienating peers to discover what's hurtful, what feels good, how to compliment. Teachers also can tap into community resources that can benefit the entire family: outreach counseling and parenting classes.

Remarking on one of her fifth-grader's complaints that too often adults trivialize children's feelings, Dean says it doesn't take much effort on an adult's part to reach out to a troubled child, listen to him and really believe him. She quotes another student's number-one suggestion for parents: "If you spend time with us, it makes us feel you care about us."

Matt Schmoker is a survivor of anorexia. He speaks at schools and shares his life with students. Check out Schmoker's movie trailer called "The 36-Hour Miracle."

Three males share their stories of eating disorder recovery along with with male eating disorder expert, Dr. Nicholas Farrell, the Clinical Supervisor of Eating Disorder Services at Rogers Behavioral Health.

Dating with depression can be fraught with anxieties. Whether you’re trying to meet someone special or you’ve just struck up a new relationship, you may wonder whether you should tell the person you’re dating about your illness. We all do a certain amount of pretending when we first get to know someone. We want our new or prospective partners to see our good sides only. We want others to like us, so we try our best to bury the parts of us we don’t think are loveable. Putting your best foot forward is a natural part of dating, but how far should it go? Should you ever lie about your mental illness or hide your depression when you’re dating with depression?

The Challenges of Dating with Depression

Dating with depression comes with many challenges. Many people with depression experience symptoms such as fatigue, low self-esteem and sexual problems, all of which can surface when you’re dating someone new. You may wonder whether you should be upfront about the cause of these problems or hide your depression from the other person.

If that weren’t enough to deal with, you’re also at the mercy of your hormones when you first meet someone and fall in love. According to researcher Donatella Marazziti of the University of Pisa in Italy, the biological response in our bodies to being in love is similar to having taken cocaine. The nerve transmitters adrenaline and phenylethylamine increase when you are attracted to someone, sending you into emotional overdrive. Your serotonin levels also reduce, meaning you may experience more depression symptoms than usual. All of this can destabilize mood, create sleep problems and make you feel more paranoid than usual, which can be frightening for someone with depression.

Should You Hide Your Depression?

If you’re dating with depression, especially dating someone new, you might wonder how to hide your depression – or whether you even should. No one can tell you how much you need to disclose on a first, second or third date – that comes down to how comfortable you feel with the person and whether you think it’s necessary. However, when you’ve been seeing someone for a while, honesty is usually the best policy.

Not only will telling your partner about your depression help them understand you on a deeper level, but it will also make your life easier. This way, you can ask for help and support when you need it. If you're not sure your new partner will understand or support you in your depression, it's better to have that conversation sooner rather than later to avoid disappointment or frustrations down the line.

Reasons to Be Honest When Dating with Depression

In dating with depression, hiding your depression may only exacerbate your symptoms and make you feel removed from your partner. However, you should wait until you feel comfortable to open up to someone new about your depression.

If you’re dating someone new and wondering whether to tell them about your depression, here are some reasons why opening up is a good idea:

• Your partner will understand you better: Although you may not feel like depression is a part of who you are, it is still a part of your experience. Telling your partner about your illness will give him or her the chance to truly understand you, which can only bring you closer.
• You won’t have to lie: Lying in relationships is a deal-breaker for many people. Although it's understandable to want to hide your depression, there will come a time when it may become uncomfortable to lie. You may need to cancel or postpone plans when you're having a particularly bad day, for instance. Wouldn't it be better to be able to tell the truth rather than saying you have a headache?
• It may bring you closer together: Depression is extremely common, and most people have experienced it or they know someone who has. Disclosing your experience may well strengthen your bond and give you a shared experience you didn’t know you had.  
• Honesty helps destigmatize depression: The more people open up about mental illness, the less stigmatized it becomes.
• Depression can strengthen a relationship: You won't know how depression affects your relationship until you open up about it. You might be pleasantly surprised and not all relationships with depression are doomed to fail.
• Your partner will find out sooner or later: If your relationship continues, your partner will eventually need to know about your depression – especially if it is affecting your day-to-day life. It is better to find out now whether this new partner can provide the kind of love and support you’ll need to help you through tough times.

You can find in-depth, trusted information on depression on HealthyPlace. For local and online support groups, visit the Depression and Bipolar Support Alliance.

Take a Look at the Other Side: Dating Someone with Depression: Is That a Good Idea?

article references

Anorexia (some call it "Manorexia") afflicts a former male model who now weighs less than 100 pounds. 

Charles is 17. He has anorexia. He’s been going to an eating disorders unit at a hospital in London for the past year and a half. But in just a few months’ time, he’ll turn 18 and will have to leave for good. As he approaches the final weeks of his stay we follow him as he battles to meet his target weight, attempts to pass his GCSEs and returns to his old school to tell his friends his big secret.