Self Serve
Depression may not be a primary symptom of d-i-a-b-e-t-e-s, but studies
have shown that many diabetics suffer from depression, which
sometimes interferes with self-care.
New research from Seattle’s Center for Health Studies sheds some
light on this problem, along with useful insights for anyone who’s
coping with both depression and the management of diabetes
symptoms.
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Not up to par
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The Center for Health Studies researchers designed a project to
examine the specific effects of depression on diabetics’ self-care,
adherence to medication and use of preventive services. These
factors were monitored with questionnaires given to more than
4,400 patients with diabetes (most were type 2 diabetics).
Researchers also collected data from the patients’ laboratory and
pharmacy records.
In the September 2004 issue of Diabetes Care, the Seattle team
reported the results of their analysis:
* Overall, diabetes self-care was less than optimal
* More than half of the subjects had a body mass index (BMI) of
30 or more (a BMI over 30 is considered obese)
* Nearly half of the subjects exercised only once each week or less
* Major depression was associated with a lack of physical activity,
poor dietary choices, and inattention to medication
The lead author of the study, Dr. Elizabeth H. B. Lin, told Reuters
Health that people who struggle unsuccessfully to manage diabetes
symptoms might find a solution through depression screening and
treatment.
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Sun time
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The Center for Health Studies results are not surprising, given the
many studies that show the importance of exercise and diet in
maintaining good mental health. But when people are caught in a
downward spiral of depression, they’re far less inclined to take
positive steps to help their situation. This is where vitamin D might
help diabetics get back on the track to a positive frame of mind.
In the e-Alert “Take the D Train” (9/15/04), I told you about two
key ways that vitamin D may benefit diabetics:
* In a study that analyzed the relation of vitamin D levels to insulin
sensitivity in a group of adults with normal glucose-tolerance,
those with the lowest levels of D were more prone to develop
symptoms of type 2 diabetes, including weaker pancreatic function
and greater insulin resistance.
* Depression during winter months was significantly reduced
among study subjects who took high daily doses of vitamin D
(4,000 IU) for a period of one year.
As I’ve noted before, the best source of vitamin D is a moderate
amount of sun exposure each day. But according to Jonathan V.
Wright, M.D., it’s impossible for most people to get enough
vitamin D from the sun alone. In fact, for many elderly people the
vitamin D deficiency problem is compounded because our skin
becomes less effective in producing vitamin D as we age.
When supplementing with vitamin D, Dr. Wright recommends
between 1,600 and 2,000 IU daily, and as much as 4,000 IU for
those over 40.
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A word of caution
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In the past few years, supplements containing the herb St. John’s
Wort have become very popular for many who need help in coping
with mild depression. But studies have indicated that St. John’s
Wort may accelerate the action of enzymes that help metabolize
drugs, making certain drugs less effective in lower doses.
Anyone taking medication should discuss the effects of St. John’s
Wort with their doctor before beginning a daily regimen. And of
course the same goes for vitamin D and any other supplements.
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Here’s a sticky one: Should patients with advanced Alzheimer’s
disease (AD) be allowed to vote?
With all the controversy surrounding tomorrow’s election, it’s easy
to overlook an issue like this. But it’s important because more than
4.5 million Americans currently suffer with some level of
dementia, and about one million of them live in swing states. And
as you know, this election is expected to be one of the closest races
in history. A couple million votes could easily make a substantial
difference.
Last week I caught a report on National Public Radio (NPR) in
which a correspondent visited a female Alzheimer’s patient in a
nursing home as she received voting assistance from county board
of elections representatives. At first I was impressed by the special
efforts they were making to ensure that AD patients like her could
vote. Since then I’ve realized that we are likely not doing nearly
enough.
One of the issues that stood out in the NPR report is the fact that in
many cases, administrators of assisted living facilities are making
the decisions about which patients are competent enough to vote.
However practical this might be in some cases, it strikes me as
fundamentally undemocratic.
Whether your mind has been fogged by dementia or too many
hours viewing political ads on TV, if you have a desire to vote and
the ability to express your choice, you have an absolute right to
vote. Once we start hand-picking voters, we’ve subverted the very
idea of a democracy.
To Your Good Health,
Jenny Thompson
Health Sciences Institute
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Sources:
“Relationship of Depression and Diabetes Self-Care, Medication
Adherence, and Preventive Care” Diabetes Care, Vol. 27, No. 9,
September 2004, ncbi.nlm.nih.gov
“Depression Derails Diabetics’ Self-Care” Will Boggs, M.D.,
Reuters Health, 9/13/04, reutershealth.com
“Voters With Dementia” Joseph Shapiro, National Public Radio,
Morning Edition, 10/28/04, npr.org
