Measurements of Depression and Diabetes

It's often reported that diabetics are more likely to be depressed. However, it's really hard to believe that measures of depression are accurate with regards to diabetes.

I just read a study on depression in type 2 diabetics right before starting insulin, and after 6 months on insulin, that reported that insulin (and especially the drop in A1c) lowered rates of depression.

To measure depression, they used the PHQ-9 scale, which I've taken myself at an awful lot of doctor visits. It was developed by Pfizer to help market antidepressants.

Here's how I would have scored the day before I went on insulin:

Q1: Over the last two weeks, how often have you had little interest or pleasure in doing things?

A: Well- I am still interested but it hurts to move, so not much pleasure. Let's say every day (3 points)

Q2: Over the last two weeks, how often have you felt down, depressed, or hopeless?

A: I felt desperate and determined, so I'll say not at all (0 points)

Q3: Over the last two weeks, how often have you had trouble falling asleep, staying asleep, or slept too much?

A: Well gee whiz, I can't sleep when I'm being eaten alive by thirst, and every time I do fall asleep, the need to pee wakes me up. Every single night! (3 points)

Q4: How often have you had trouble with having little to no energy?

A: Every minute of every day (3 points).

Q5: How often have you had an unusually big or little appetite?

A: I'm starving! (3 points)

Q6: Feeling bad about yourself- that you are a failure and have let yourself or others down?

A: Not all of the time, but I feel unable to meet my obligations. Let's say "several days" (1 point)

Q7: Trouble concentrating on things, such as reading the newspaper.

A: I lost the ability to keep concentrating enough to count to 20 roughly three weeks before my diagnosis. (3 points).

Q8: Moving slowly, or the opposite,  being fidgety.

A: Well, okay, I'm autistic anyways, so this is one I continue to score positively on. But at the time of diagnosis, it had gotten hard to walk, and people were noticing. 3 points.

Q9: Thoughts of hurting and/or killing yourself.

A: Actually, for the first time in many years, I STOPPED having these thoughts shortly before I was diagnosed. 0 points.

Bonus Question: How difficult have these things made it for you to do your work and get along with people?

A: Really difficult.

According to the study I just read on type 2 diabetes, a score of 15-19 qualified as moderately severe (20 was severe depression). 

And yet, I was not depressed, just in DKA. 

The article said every 1 point drop in A1c lowered score by an average of 40%. I say yeah, that's cause the high A1cs mess with memory, energy, sleep, and hunger, not because they cause depression. It's not pathological to feel exhausted and hungry if you're high.

Why I Won't Be Recommending Afrezza

Inhaled insulin is once again on the market, but I have four good reasons not to use it. Here they are:

-Dosing is in increments of 4 units. So for your breakfast insulin, you can take 4 units, 8 units, 12 units, 16 units, 20 units, or 24 units. Or none. And for corrections, you have the same options. I'm sorry, 4 units is way too big of an increment. I like to be able to treat highs of 220 when I go to bed, and 4 units would be overkill (big overkill).

-No clinical trials were done with diabetics whose A1cs were below 7. When enrolling patients for trials, Afrezza was tried only in diabetics with A1cs above 7% (and below 10%). Afrezza was compared to using an inhaler that didn't contain a medication (in T2s) and to injected Novolog (in T1s). 6 months later, 27% of Novolog users got A1cs at or below 7% - twice as many as with Afrezza (13% got down there on Afrezza). Additionally, the average drop in A1c over the six months was 0.40% on Novolog vs 0.19% on Afrezza, which is statistically significant.
I'm not sure how much of this difference is because Novolog can be dosed in smaller increments.

-Afrezza has a significant risk of causing reduction in lung function. I like my lungs. Admittedly, it probably doesn't cause lipodystrophy, and it might be a reasonable choice for people with severe lipodystrophy and fairly high insulin needs.

-Although I have not seen any proof of what Afrezza will cost, estimates put it in the neighborhood of $100-$200/month without insurance. The discount card makes it cost $30/month with non-governmental insurance. I pay $24.88 per vial of Regular.