Depression is a preventable side effect.

Five years after finding out the had non-insulin dependent diabetes, Warren discovered a distributing pattern. "I've been trying to ignore it, but the correlation is just too strong," he told a friend. "When my blood glucose level gets too high, I get depressed." His doctor had cautioned him about the many complications of diabetes, but depression wasn't on the list. Warren, then in his mid 30s, already had experienced "fairly regular bouts of depression" for a couple of years before he was diagnosed. He wondered if surging levels of glucose also had been responsible for those pre-diagnosis emotional lows.

Talking with other diabetics, Warren found that depression was a common experience. Daily exercise seemed to keep his blues at bay and his glucose level near normal, but he was concerned about his treatment options if he became severely depressed.

"It's a good idea for diabetics to monitor their feelings as well as blood glucose," suggests Linda Rhodes, assistant professor or psychiatry at The University of Texas Health Science Center at San Antonio. "People with diabetes should become aware of signs of depression [lingering sadness, withdrawal from friends and family, excessive guilt, etc.] and discuss any emotional problems with their doctors.

"Diabetics go to the eye doctor, the heart doctor, the foot doctor. If they're depressed, they figure there's one more thing wrong with them and hope it'll go away. But emotional problems don't always go away. Like physical complications, they may get worse if not addressed promptly. When you're depressed, you have little energy and things hurt more. You just don't feel well and blood glucose control suffers, resulting in an endless destructive cycle of depression and physical complications."

"Feeling fatigued, lethargic, and even depressed are common presenting signs of diabetes," explains Ralph DeFronzo, chief of the diabetes division and deputy director of the Texas Diabetes Institute in San Antonio. "People with high blood glucose levels don't feel like dragging [themselves] out of bed in the morning. They don't feel well, but they don't know what's wrong. When we get these patients on treatment (diet, exercise, medication) and bring their blood glucose levels down, we often see a major change...