Old Zhang turned 60 years old this year, retired from the original call of duty. After retiring, suddenly no one to follow the command, the heart can not mention how lost. Want to go to where no one is no longer surrounded by the front and back, no driver immediately drive to send, no one door-to-door gifts, warm and fuzzy, old Zhang felt abandoned by his friends and colleagues in the past. His lover, who is from a technical background, understands very well what will happen to him after his retirement as an administrative cadre, and has been encouraging him to go out and make new friends, but it’s not easy! Old Zhang all day at home, looking forward to old people to see him, left hope did not come, right hope did not come, the old Zhang angry at first straight curse mother, and then gradually do not like to talk, people are very tired, also woke up very early in the morning, at first people become fat, but not long and thin, become a love of water, urine also became more. It took 5 months. The old partner is anxious, rush to take him to the hospital to check the body, a check can be a big deal, high blood sugar, fasting more than 10mmol / L ah, to know the old Zhang annual physical examination, but also do bun meal to see the post-prandial blood sugar, never had a problem, the family is not diabetic, this is what happened? The doctor diagnosed him with diabetes and said it was related to the old man’s emotional depression. Depression can also lead to diabetes? Old Zhang and his partner said they could not get around this corner. Read: Depression is a mental disorder characterized by a significant and persistent depression. Type 2 diabetes is a metabolic disorder characterized by hyperglycemia, caused by defective insulin secretion or insulin resistance. Studies have shown that depression and depression-related symptoms not only constitute a major risk factor for the development of type 2 diabetes, but also have a complex and significant impact on the psychological and physiological functions, the occurrence of complications, blood glucose regulation and treatment of type 2 diabetes patients. Old Zhang was depressed after retirement and suffered from depression, which in turn led to diabetes. I. Why does depression lead to diabetes? Why does depression lead to the development of diabetes? Research findings show that depressed patients eat irregularly, have increased body mass and reduced physical activity, which causes obesity and insulin resistance and increases the risk of developing type 2 diabetes. Depression-induced increases in neuroendocrine such as adrenocortical axis or autonomic nervous system activity also cause insulin resistance syndrome in patients with abdominal fat deposition, elevated plasma triglycerides and insulin, and decreased insulin sensitivity, all of which are risk factors for the development of type 2 diabetes. In addition, the low socioeconomic status of most depressed patients and the use of antidepressants also predispose patients to type 2 diabetes. Second, the relationship between diabetes and depression As mentioned earlier, depression and symptoms associated with depression can lead to the development of diabetes. In contrast, studies have found that: the prevalence of depression in diabetic patients is significantly higher than in non-diabetic populations (Chinese guidelines for the prevention and treatment of type 2 diabetes 2007), and the mortality rate of diabetic patients suffering from depression is 54% higher than that of diabetic patients who do not suffer from depression. It is believed that the increase in blood glucose in type 2 diabetic patients leads to stress-like reactions in the body, resulting in an increase in plasma cortisol, glucagon, and growth hormone, and that long-term hyperglycemia triggers changes in cortisol activity, which in turn act on the patient and cause depression and depressive mood. At the same time, poor glycemic control, strict diets, exercise requirements and high treatment costs in type 2 diabetic patients are also highly likely to lead to depression. Diabetic patients with depression have significantly higher rates of poor glycemic control and microvascular and macrovascular complications than non-depressed diabetic patients. There is evidence that depression, anxiety and other negative emotions reduce the ability of diabetic patients to self-manage and compliance with medical advice, the ability to deal with interpersonal relationships and the ability to take care of themselves, these effects can lead to the deterioration of the patient’s condition. Third, the treatment of depression: Although depression is already a very common disease, however, in the country, a large proportion of depressed patients have not been detected by doctors and patients themselves for a long time. The treatment rate for schizophrenia can still reach 30%, while the current treatment rate for depression in China is only 5%. Most people do not recognize depression, are afraid to face it, and do not know how to treat it. Most studies have shown that psychotherapy and antidepressant medication have a significant positive effect on patients’ mood and blood sugar control. 1. Psychotherapy and diabetes education: First of all, it is important to know that depression is completely curable, and early treatment can avoid mental disability and chronicity. Therefore, the treatment of depression focuses on prevention, early recognition of the initial symptoms of depression, starting from the etiology, eliminating factors that directly cause or trigger depression, and also avoiding delaying the disease and causing serious consequences by treating depression as a syndromic condition. Depression is different from general depressed mood, the specific manifestations mainly include: 1. low mood, generally characterized by “heavy in the morning and light in the evening” and “heavy in spring and autumn but light in summer”; 2. slow thinking, that is, memory loss, slow brain response, etc.; 3. Reduced activity, reluctance to participate in social activities, and preference for solitude; 4. Anxiety and guilt (fear of adding burden to the family); 5. Sleep disorders, with early awakening as its typical manifestation; 6. However, many patients’ performance is not typical, as the core depressive symptoms are often hidden in other psychological and somatic symptoms, and somatic symptoms are most likely to cause misdiagnosis and even serious consequences. In addition, appropriate self-adjustment is necessary, including maintaining a calm mood, relieving mental burdens, living a regular life, and adhering to physical exercise. For diabetic patients, diabetes education should be given to alleviate the secretion of various glucose-raising hormones caused by factors such as anxiety and psychological stress to prevent or improve depression; for patients with diabetes combined with depression, they should be advised to adopt a healthy lifestyle to prevent diabetes complications and to find simple diabetes treatment plans. In addition, family treatment to make family members care for the patient as much as possible and provide a harmonious and pleasant living or working environment for the patient can help improve depressive symptoms and blood sugar control. And if the patient’s symptoms are still persistently not relieved through the above methods, it is necessary to go to the psychological or psychiatric clinic of the hospital to seek the help of professional doctors and choose medication. 2. Antidepressant medication Antidepressants can improve the depressed state of mind and glucose regulation in diabetic patients. Traditional antidepressants include monoamine oxidase (MAO) inhibitors, tricyclic drugs (TCA), and tetracyclic drugs, but they should be used with caution because they can lead to more side effects such as increased appetite, increased body mass, and increased blood glucose, making diabetes worse. The new generation of selective 5-hydroxytryptamine reuptake inhibitors (SSRIs) can slightly reduce serum glucose and body weight, with little effect on appetite, and are currently the drugs with the least side effects used to treat diabetes complicated by depression. Fluoxetine hydrochloride is preferred, 20-40mg/day, once in the morning in a single dose. If the patient does not sleep well, or if the existing anxiety symptoms are aggravated, alprazolam may be added, to be taken in the evening or 2 times/day. New antidepressants recently introduced include mirtazapine (increases release of norepinephrine and 5-hydroxytryptamine, antagonizes 5-hydroxytryptamine 2 receptors), venlafaxine (dual 5-hydroxytryptamine and norepinephrine reuptake inhibitor), moclobemide (monoamine oxidase inhibitors, MAOIs), and bupropion (norepinephrine potentiation and dopamine reuptake inhibition). However, information on the use of these new drugs in the elderly (including safety and efficacy) is very limited. For elderly patients with diabetes mellitus and depression like Zhang, treatment should also pay attention to the following: the relapse rate is high in the elderly and long-term maintenance therapy is needed; the use of antidepressant therapy in the elderly should pay attention to the principle of “low starting dose and slow increase” to prevent inadequate treatment caused by low dose of antidepressant therapy, which makes the disease chronic and prone to relapse. It is also easy to lead to relapse; pay attention to the past treatment history and family history: generally speaking, drugs that were effective in the past or effective in the family for patients with similar diseases are likely to be effective again. Old Zhang suffered from diabetes due to depression, the face of diabetes, I am afraid that depression will further aggravate, if you can not face their disease, not timely to channel, treatment, the consequences will be unimaginable. For all diabetic patients, from the beginning of diabetes should be beware of depression stalking, if you find yourself with the above depression symptoms, should not ignore, should be timely treatment, because depression in turn will affect blood sugar control, aggravate the diabetes condition, accelerate the emergence of complications.