December 24, 2002
Diagnosis and Symptoms
Question from Craigsville, West Virginia, USA:
I suffer from major depression — recurrent and adjustive mood disorder. I have been under the care of a psychiatrist for nearly 10 years. Many antidepressants have been prescribed, and I am now taking a new antidepressant. I have neuropathy in hands and feet, have been considered as a sufferer of fibromyalgia, and both my knees have been replaced due to osteoarthritis.
I have high blood sugar levels when I test with my mom’s meter (120-200+ mg/dl [6.7-11.1 mmol/L] before meals, and I am aware that these are not safe readings. My mother just died in August, after having lived with me for over 20 years as a disabled widow. I am in a very depressed state and finding it hard to function as a teacher, and as a person. Frankly, I do not wish to go on living, so it is extremely difficult for me to care enough to take care of myself by avoiding unsafe practices, such as overeating.
I am obese at about 250 pounds, with a height of 5 feet 11 inches. A gastric bypass was performed in 1985, but I have regained all of the 100+ pounds I lost plus more. I am not supposed to do much walking as exercise, but it’s been the only type of activity I’ve ever been able to partly enjoy and continue at a near regular basis.
Although I don’t care if I die, I do not want to live in pain — physical, in addition to psychic. I am smart enough to realize that I am contributing to an early death, “killing myself slowly” by continuing to eat sweets, etc. as I do. Eating and sleeping have been my lifelong “drugs of choice”. With all this information, could you tell me when glucose levels would indicate a need for insulin? Would pills be preferable? I just can’t do it on my own. Heart attack and stroke are a big concern for me as I fear incapacitation may result rather than death, which would, of course, be worse than death to me.
Answer:
It sounds like you need to speak with a mental health professional to address the depression. Although you are on medication, is this helping you? I would also ask have you sought the help of a physician in the treatment of your blood sugars. Any sugars above 200 mg/dl [11.1 mmol/L] are considered abnormal and are consistent with having diabetes.
In order to determine whether you need insulin or pills, you need to see a physician. I can tell you that the depression and poor blood sugars go hand in hand. You cannot do anything for yourself if the depression beats you down. You cannot feel better if the sugars do not get under control. At this point, I feel you are probably in need of seeking medical help for your situation. The good news is that things can be done to help. Do not give up.
JTL
[Editor’s comment: Testing for diabetes should include blood sugar levels performed by a medical laboratory. The timing of the sample (fasting, random, or postprandial) would influence how high a level is considered abnormal. See Classification and Diagnosis of Diabetes for further information.
Home glucose testing, as in your case, might show elevated results, which would make the situation more urgent to get lab testing done to confirm the abnormal results.
WWQ]
