Depression as a Barrier to Diabetes Self-Care

By Christina Psaros, Ph.D
Department of Psychiatry

Depression is a medical illness characterized by pervasive feelings of sadness and/or the inability to experience pleasure or joy. Other symptoms of depression include feeling tired or without energy, reduced appetite, difficulty concentrating or making decisions, feelings of worthlessness or guilt, and hopelessness. People with diabetes have relatively high rates of depression, which can interfere with their ability to manage their diabetes.

Effectively managing diabetes requires a number of complex steps that may include regular meetings with a health care provider, monitoring of blood sugar, taking medications, and adhering to diet and physical activity guidelines. Depression may interfere with some or all of these behaviors. For example, difficulty concentrating may make it difficult to remember to take medications. Feeling tired or without energy can make it difficult to engage in physical activity or prepare healthful meals, while changes in appetite may it difficult to eat healthful foods. Feelings of hopelessness can make people feel like giving up rather than continue with self-care efforts.

Help is available! Research shows that psychotherapy can help alleviate symptoms of depression and help individuals with diabetes better adhere to their self-care regimen. Antidepressant medications can help. Talk to your Certified Diabetes Educator or primary healthcare provider if you are struggling with your diabetes self-care or if you think you may be depressed. They may refer you to the Massachusetts General Hospital Behavioral Medicine Program, which consists of a team of psychologists specializing in helping individuals with chronic illnesses like diabetes. If you are interested in making an appointment yourself, call the Psychiatry Access Line at 617-724-5600 or visit our website.


Caring for Your Built-in Transport System

By Eileen B. Wyner, NP
Bulfinch Medical Group

I was just wondering…how many times a day do you think abEileen Wout your feet?  I’m willing to guess that you don’t think about our built-in transport system much at all. Our feet carry us around every day and it’s easy to take them for granted. Sometimes we’re good to them and wear comfortable sneakers; other times we force them into pointy high heels because they look so stylish. A person living with Diabetes needs to be more attentive to our natural transportation and so I’d like to share some points about foot care.

Diabetes can lead to many different types of foot complications including calluses, fungal infections and poorly healing ulcers that can lead to bacterial infections and amputation—these conditions can happen as a long term complication of Diabetes and may be more severe if blood sugars aren’t well controlled.   Neuropathy, a frequent complication for people living with Diabetes, occurs when blood sugars are poorly controlled over time and there is damage to the nerve fibers. Symptoms of neuropathy can include the sensation of tingling in the feet, decreased sensation to temperature and altered sensation to pain.  Peripheral vascular disease or PVD occurs when there is damage to the lower extremity blood vessels, while poor circulation can cause pain and contributes to poorly healing injuries. Both of these conditions may not be completely preventable but they are manageable and your self-care is an important part of this. You may want to see a vascular specialist if your symptoms are severe, and it’s very important to stop smoking if you are currently.

There are many steps that you can take to keep your feet healthy. It’s very important to self examine your feet each time you get out of the shower or bath. You may not feel things as you did in the past and you may have an injury to your foot that you didn’t feel when it happened.  Doing a self exam, you can see the injury and begin to take care of it. Check for signs of ingrown toenails, blisters, and calluses. Seek medical attention for any suspicious injuries and see a podiatrist twice a year for a full foot exam (they can also assist in caring for complications). If you are cutting your own toenails it’s important not to cut them too closely to the toe to avoid ingrown nails. Also, it’s best not to file the heels or calluses on your own as it’s easy to get abrasions that can lead to infection.  Keep your skin moist by using a skin cream on the foot (but not between the toes).  It’s fine to get pedicures, but there are a few “rules”:

  1. Avoid pedicures if you have poorly controlled blood sugars.
  2. If there is any question about how clean the salon is, DON’T GO THERE.
  3. Bring your own cuticle tools to any pedicure and manicure and clean them well yourself.
  4. Tell the technician that you have Diabetes and do not want your nails and cuticles cut too short.
  5. Do NOT have any calluses or corns filed down. See the podiatrist for this.

Another important step in keeping your feet healthy is keeping your blood sugars and A1C in good control. This will decrease the risk of infection and may help to improve pain of neuropathy.  Review your medications and diet with your healthcare team if you are having problems keeping up with either.  Be sure your shoes fit very well to avoid any blisters, ingrown toenails, or pain. Shoes and boots for the bad weather are equally as important to ensure sure your feet stay dry, especially inNew England snowy winters and rainy springs.

I always get the funniest looks when I talk to my patients about going barefoot.  People tell me they have carpet at home or only walk on the grass. I visibly cringe at that point. Tiny little particles in carpet, grass, beach sand and the ocean are all potential culprits for injury that can cause serious infections.  Remember, you may have decreased sensation in your feet so the splinter that would have made you howl 5 years ago can go undetected until a more serious problem presents itself. At the very least, socks with treads are essential for around the house, and beach shoes are a must for the beach and pools both indoor and out.

So tonight, take off your shoes, wiggle your toes and think of all the ways you can show appreciation for your built in transportation system. Give yourself a foot massage, prop them up on the couch, and treat yourself to reruns of Everybody Loves Raymond.  And tomorrow, set up an appointment with the podiatrist. Your feet will smile.