Diabetes and Anger -- Is There a Deeper Connection?

Two years ago, I wrote a blog post about diabetes and anger. In that post, I explored a lot of the day to day reasons why a person with diabetes might feel anger, and frustration. In fact, there are many reasons why a person with diabetes would, indeed, become angry. Those reasons can be varied, including anger at oneself for 'failing' to prevent the disease, to anger at family for not understanding or patrolling/policing the person with diabetes' behavior, etc. These are common types of anger: the anger that results from struggling to cope with a new and changing environment, for which we might have little control. (You can check out that blog post link, above, for a more in depth look at that topic.)

However, little did I realize that I was going to get such a huge response from the public -- but not about anger in this usual, common sense -- but anger in the chronic and mental health sense. Folks from all over the country have poured out their hearts to me in sheer frustration and worry over their loved ones, from sons to spouses, to friends. From lay people, to mental health professionals as well.

I must emphasize here, that I am NOT a mental health professional. I am not a medical expert of any kind, or a scientist. I am just a person with diabetes, with a blog. A person who loves learning every day, researching my own condition, and learning how to live and cope with it. Anything I say here is information you must take to your own clinician, or consult with your own mental health professional. It is also information that anyone can research on their own: never take my word for anything. Always be a skeptic.

Now that we have gotten that out of the way, let's start with the ways in which diabetes can clinically affect our moods.

Day to Day Blood Glucose Swings

When our blood sugars are not within normal or euglycemic boundaries (i.e., between 70-120 mg/dL, or 3.9-6.7 mmol/L), our mood and emotions will be altered. In some extreme cases, a person who, for example, experiences severe low blood sugar may become angry and even combative, or violent, or may seem 'drunk.' A person who experiences high blood sugar may experience sadness and depression, inability to concentrate, fatigue, etc. The root of all these glucose related mood swings has to deal with their association with the neurotransmitters in our brains, and how those in turn, communicate messages to our nerve cells about mood, appetite, and even sleep. Dealing with these states of mind is challenging, and can be tiring for the person with diabetes, as well as bring on a short temper. To top it off, having a negative disposition may also bring on bad blood glucose numbers, creating a vicious cycle that feeds off itself.

Chronic Mood Swings

The problem with being on this persistent 'roller coaster' of high and low blood glucose swings is that it can be bring about permanent, and chronic, mental health problems. Problems such as clinical depression, anxiety, anger, and a whole host of mental health conditions, like bipolar disorder.

According to a study on "Diabetes and Psychiatric Disorders," by the Indian Journal of Endocrinology and Metabolism, "Diabetes and psychiatric disorders share a bidirectional association -- both influencing each other in multiple ways." So much so, that apparently scientists back in the late 1800s found diabetes to be a disease which had been present in families with a pronounced history of mental health problems, so that insulin shock therapy was used as a treatment for mental health disorders even as shortly as insulin was isolated for the first time.  (Yes, insulin has a role in mental health, and even in the development of such diseases as Alzheimer's.)

This study further points out that there are several ways in which both diabetes and mental health problems can show up:

• As two parallel conditions, which developed independently of each other, with no apparent connection;
• As a complication of the diabetes, or as a complication of the mental health problem: type 2 diabetes may lead to depression, as well as depression may lead to type 2 diabetes, for example;
• As a product of hypoglycemia or hyperglycemia (and ketoacidosis), such as the development of chronic anxiety;
• And as a result of taking various medications for treating mental health -- many of these medications can lead to a triggering of a type 2 diabetes diagnosis. 

In my personal and anecdotal experience, I am a person who suffers from dysthymia. Dysthymia is a type of low grade, long term depression, which can subside and be in the background, for much of one's life. It is much milder than regular depression. However, in situations in which I have had an undiagnosed, and chronic health condition, such as hypothyroidism, or type 2 diabetes -- the imbalances in health provoked episodes of severe depression. The conditions influenced my depression and worsened it. In this way, uncontrolled diabetes can worsen or complicate a mental health condition that is already present, making overcoming of both conditions a challenge. 

It could very well be that the sudden and deep mood changes many persons with diabetes have experienced were the result of these drastic, and long term changes in blood glucose influencing an already underlying mental health problem -- especially if the diabetes was left undiagnosed or untreated for an extended period of time. It is particularly difficult for a person with diabetes that is weighed down by these mood changes, to find the motivation and positive inclination to manage their health condition. Quality of life tends to be reduced, and so does optimism, which can lead to development of unsavory habits, such as uncontrolled diet, smoking and drinking -- habits which can exacerbate mental health problems and lack of control, to an already breaking point. 

How Do We Help? 

In my previous blog post on anger, I noted several ways in which we could be of support to a person who was being burdened every day by the management of their diabetes. Being a good listener, helping a person cook meals, and being empathetic, are all proper ways in which we can deal with a loved one's chronic health condition. The Behavioral Diabetes Institute provides resources for us to utilize when we are overcome by our day to day emotions when managing diabetes, and may feel burnt out, or depressed. 

However, there are situations in which we need to be more proactive in identifying the mental state of our loved ones. Understand that, outside of a rare and severe hypoglycemic event, violent and aggressive behaviors are NOT standard complications of diabetes. These are not typical or normal behaviors for a person with diabetes. (Grouchiness is.) If a person you love is experiencing warning signs of serious mental health problems, you might need to have a conversation with them about visiting a mental health professional. This is an intimidating task, and there are suggestions out there, on how to broach the subject. 

The National Alliance on Mental Illness (NAMI) has a good Resource Guide for Families Dealing with Mental Illness. In it, they address what to do for 'crisis intervention,' when a person's behavior is particularly violent, or out of control:

If the individual with mental illness is in danger of physical injury, if his or her behavior is out of control or others are in danger, it is important to know what steps to take. Plan ahead by locating available sources for help: your emergency phone number (911), police or sheriff department number, Community Mental Health crisis or emergency number, name and phone number of a mental health professional, friends or neighbors who may be of help, and the nearest NAMI affiliate. Keep these numbers posted by the telephone. 

Any behavior such as this, that falls outside of both a mental health disorder, or a severe hypoglycemic episode, is unjustified violence, and should never be tolerated. Do not put up with it. 

. . .

Mood swings can be a standard part of diabetes mellitus and its attendant blood glucose fluctuations. However, when chronically unregulated, these blood glucose fluctuations can bring about more serious mood disorders. These mood disorders are NOT a standard symptom of day to day diabetes management, and will usually not ameliorate on their own. If you are living with a person who has become unpredictable, or violent, due to a potential mental health disorder, please seek help from your local community mental health centers, a mental health professional, or from your family physician.

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The Most Annoying Person I have Learned to Love...

The day I lost my car... I became an avid pedestrian. Every local place became THE place to go for any goods and services. I really didn't want to lose my car, but the many months of being sick and at home, on leave from work and with no paycheck, left me struggling to make ends meet -- and well, car payments were not a priority. I let the car go.

Then shortly thereafter, I was diagnosed with type 2 diabetes. November 17th, 2009.

I thus began to get acquainted with a certain place a lot more often than I would have liked. A certain pharmacy. God, I hate pharmacies. I hate their smell, I hate their lights, I hate the waiting... and the lectures you get every time you get your prescription refilled as if you hadn't heard them before for like the billionth time. I've also never cared for the chit-chat. You know, the chit-chat cashiers always give you when you're ready to go. I'm sort of this anti-social who just wants to grab the crap she needs, and be on her way. No eye contact, no talking... bah humbug.

But, alas, there was Sally. (Sally is not her real name.)

Sally loves and loves to talk. Sally is very social. Sally always has something to say, and engages well with customers. Sally loves talking a little too much with her customers. I think she may have even gotten a bit in trouble for it before. It's not easy to leave Sally's side, by the register. Heck, she sometimes even comes over to you while you're in the isle to talk to you while you shop! She's always full of stories -- about the weather, about how things used to be in Ames, about her cat, about how things used to be in her hometown, about what's on sale, about what the best and most addicting snacks are, about her younger years when she used to have a career in social work, etc. Needless to say, Sally is very annoying.

Some days, when Rod and I used to go into the pharmacy together, we'd find ways to try and avoid Sally -- especially if we were in a hurry. Sometimes, we'd just want to shop in peace. Sometimes, we might have even gone to a different place altogether. But... in Iowa, politeness reigns. If we failed avoiding her, we'd still listen to Sally. Conversation began to get so involved... that now we'd be telling Sally our own woes.

Sally knew when I had no job or when I was underemployed with few hours, or when we were sick; when we had many, many struggles. Sally has often given us career advice, and even advocated for us.

In 2010, a devastating flood of epic proportions (the last of it's kind seen 500 years ago), hit Iowa. It affected the resources and properties of many folk. Our town lost a lot of water mains and pipes, and the water supply became contaminated. The advice was: purchase water, and if you're poor, please go to these local water dispensing sites we've set up. The problem was the water dispensing sites were SO far away, we couldn't get to them. Buses weren't going by certain areas either, because of flooding. Rod and I bought what little water we could, but then had no money left over for actual food. (And you know, with type 2 diabetes that's being treated with only diet, that's a rough ride... you have to seriously mind your carbohydrate consumption and you just can't survive on ramen noodles like someone else with a working pancreas could.)

Local Target store's parking lot, during the floods of 2010

I don't recall why we were at the pharmacy that day... but Sally asked about our day, and how we were faring with the floods, and well... we told her our woes, as had become usual. Sally, as it turns out, had been worried about us. Sally took us to the Red Cross -- Sally got us more water, and Sally took us to the supermarket and bought us food. Sally had endeared herself to us. Her quirky little self got into our hearts. She still, would sometimes, annoy the crap out of us... but our appreciation for her glossed over all that stuff. The stuff of being ourselves, squeaky wheels and all.

I don't believe in a god... and I don't believe that 'god' is love. I believe that LOVE is God. I believe WE are 'God' to one another, when we are in need, and our humanity calls... and we respond with love. And that day, when we needed her most, Sally WAS 'God.' Sally helped us see another healthy tomorrow... and not struggle for today. Sally was also... our advocate. Sally KNEW we had type 2 diabetes... Sally RESPONDED to those needs. (WE can be patient advocates to ANYONE with a chronic illness, with their needs, ANY given day of the week. The opportunities are everywhere. Look for them. THIS is also part of advocacy. Being the glue that connects everything... when all else has failed.) 

Now... about a few weeks ago, I started noticing something wrong in my daily trips to the pharmacy. I really didn't see Sally as often, anymore, and she didn't seem as chatty as her usual self, anymore either. She seemed tired, and I thought to myself, "She looks like she's aging pretty fast; she looks a lot older than she was a month ago." (I didn't say anything.) I really had begun to MISS my daily encounters with Sally, and that daily inconvenience of having to stop and talk to her... while in a hurry to God knows where. "Maybe she's just cut back on hours," I had wondered... or maybe she's got a second job...  or maybe she was spending more time with visiting family. (She always spoke fondly of family far away -- or with annoyance -- depending on who the family member was. lol)

But today, walking home from work, I heard a voice yelling at me from a block behind "Why are you walking in such a hurry?! I can't catch up with you!" I stopped, and turned around. I saw it was Sally... and I got a little annoyed that I had to stop, and wait for her... It had been a pretty tiring day for me, and my carpal tunnel was worse for the wear. Sally lives a block from where I live, and she wanted to chat while we walked. Fine, I could entertain this.

She asked me about ME, first. How I was doing... how Rod was doing. How we were coping along with life. She pointed to her new hair cut... and how she wanted it shorter, for it's getting so fine these days, it's harder to style. I don't really care, but I politely listen anyway... (Ever the eternal Oscar the Grouch.) Then she gently eases into the topic... The chemotherapy has been really hard... and Sally can't manage it anymore. I am one of the special, chosen people in her world, that she has decided to tell... and no one else. Sally only has 4 months left to live.

I politely listen... offer my company... offer to spend time with her when she's stir-crazy at home, if anything. Sally can't drive anymore, which is just the same... because honestly, I still don't have a car. We can ride the bus together, she says. It'll be good. It'll be fun.

I offer to walk her all the way to her place, but she declines. I give her my cell phone number. We say our goodbyes, and I go home. I reach the bathroom, and undress. I break down and cry, and cry... and cry...

I don't know Sally's real name. I've never asked.

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I Should Not Have Eaten SO MANY Carbs

The room is dark... though a few sprays of light come in through the windows; beams from the outdoor lamp posts invading my thoughts. The evening's navy watercolors wash the walls, and windows... and the sounds that would normally lull me to sleep, now keep me awake. The man's heavy breathing, the cat's snoring, the whistling of the wind through the glass panes, the neighbors upstairs finishing up whatever toiletry rituals.

The bed feels lumpy, unusually so, and I toss and turn. I toss on my left side, and I feel the burn shoot through my esophagus, damned acid reflux that never plays nice. I have to, somehow, find a way to straighten my arms, uncurl the wrists, unclutch the comforter. I never liked my thoughts, much, at this hour... Much like the acid reflux, they just never play nice. Irrational foreign invaders, like quixotic windmills, in my mind. I am scared, I admit. I am tired, and I'm scared.

I haven't exactly been taking the greatest care of myself, over the last month or so. Why can't I just find the will, the strength, and just keep going? Be perfect all the time? Why can't I just pick up, and do what mostly no other person (without a chronic illness) really does (but claims they do), and save my life? I see them eating crap all the time -- those skinny goody two shoes... I see them there. Living the chronic free life. Chronic. You'd think I was talking about pot. Save my life. I shouldn't have eaten so many carbs. I think of my dad. I think of kidneys. Gosh, I think I can feel my kidneys. Proteins, flushing, overpowering, disempowering. Would I even be able to know if there was something wrong with my kidneys? No. Not really. Not without insurance... though perhaps, though, through the Free Clinic.

But not my ovaries. No one cares about my ovaries. Ovaries are "luxuries." I think about what state mine must be in. My thoughts race, and travel, and warp, and twist... Planned Parenthood can't do anything about my ovaries... I think about women losing ovaries to cysts. Why the hell me? What the hell was so special about ME, in my family, that I had to be the one born with the woman-changing-into-a-man-disease. THIS IS SHIT. I think about that stupid woman from an old job... that woman who must've weighed about 400 lbs, yet she had no disease. No disease, but the obesity, of course. I don't blame her, one bit... I am jealous, I have to admit... But she'd sit there, and ask me dumb things. She'd ask me "Why is your scalp all shiny under the lights? It's so shiny!," and she'd giggle... Sigh... how the hell do you tell someone "Bitch, I am losing my hair, can't you get some manners, tact, and a sense of self??" I don't want to lose my hair... I don't. I am NOT my hair. Hair. I have waaaaaay too much facial hair. Goddamned PCOS. I am tired of plucking away the hair... I can't handle waxing, can't afford electrolysis, much less laser hair removal... So pluck, pluck, I must... What to do about all this crappy hair??? Every day... I am more and more a shadow of who I used to be... a woman with no hair on her head, and all the hair on her face. I constantly forget to take my medicine. Stupid Hypothyroidism, stupid PCOS. I. should. not. have. eaten. so. many. carbs.

I must toss onto my right side. I wonder if I'm losing my mind; a person without a proper job... ends up losing their mind. My back hurts, my breathing is hard. Anxiety builds, and I think about my current job. One to two days a week... Unloading trucks. I start to cry. I don't want a job, I tell myself. Employers are mean people, they persecute you, people want to run you over for their own fortune. Still, I must get a better job, another job, some kind of job... I wonder if I can have a job just ranting and raving craziness, like I do now... I think not. Those are reserved for people with more glamorous, yet crappier diseases. Diseases where people aren't to blame for their crap. There are crappier diseases? I don't know... I think about the new yogurt place, downtown. All the same yogurt, all a different flavor, all the same stuff. All the same crap.

Stuff. Too much overwhelming stuff. If I fall asleep, for just long enough, I can forget about some of this stuff. I can put depression back inside that box, and busy myself with life... but just for long enough.

I should not. have eaten. SO MANY CARBS.

Carbs, by basalt

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