People with diabetes cannot produce or properly use insulin, a hormone that helps the body utilize sugar for energy. The main sugar in the blood is glucose. Cells of the body need it to work properly. It is the fuel the body uses to carry out its daily functions. Glucose is made by the liver and also supplied by the food we eat. The pancreas makes insulin, which helps glucose enter the cells of the body. When this basic function fails, glucose remains in the blood rather than entering the cells where it is needed. The high amount of glucose in the blood results in diabetes.

Diabetes can have a number of complications that lead to serious medical conditions. Nerve damage, kidney disease, vision disorders, heart disease, and poor circulation (especially to the feet) are all possible.

Two main types of diabetes exist. Type 1 refers to a total lack of insulin. This insulin needs to be replaced in the body. People with type 2 diabetes either don't produce enough insulin or the insulin does not work properly. A combination of diet, lifestyle changes and medication is used to treat this type.

Signs of diabetes include fatigue, thirst, increased passing of urine, muscle cramps and a tingling sensation in the feet. Many people with diabetes do not have any symptoms. Diagnosis is made based on a blood test, usually during a routine check-up.

About schizophrenia

Schizophrenia is one of several psychotic disorders. It is a brain dysfunction that affects how a person sees and responds to the world. About one per cent of Canadians are affected.

Symptoms include withdrawal from reality, disorganized and irrational ways of thinking, false beliefs (delusions), hallucinations, and unusual behaviour.

Recent studies show that people with schizophrenia are at increased risk of type 2 diabetes. This is due in part to the types of medication used to treat schizophrenia, as well as lifestyle choices.

Causes

The causes of schizophrenia are not fully known or understood. Both genetic and environmental factors are thought to be involved. A close family member (child, brother, sister or parent) of someone with schizophrenia has a one in ten chance of developing the same illness. In those without a genetic tendency for schizophrenia, environmental causes may stimulate the condition. These factors include stressors like relationship problems, financial difficulties, social isolation, and grief. A viral infection during the mother's pregnancy or in early childhood, a lack of oxygen at the time of birth, or illegal or street drug use (such as marijuana, cocaine, ketamine and LSD) may also trigger a schizophrenia-like illness.

Symptoms

People diagnosed with schizophrenia see reality differently. They often seem to have a major loss of touch with reality. The symptoms are often referred to as positive or negative. Positive symptoms add a mental function that is not normally present, and can include:

hallucinations (seeing or hearing things that do not exist)
speaking in strange or confusing ways (disordered thoughts)
believing that others are trying to harm them (delusions)
feeling like they are constantly being watched (paranoia).

Negative symptoms involve the absence of a mental function that normally should be present. Examples include:

lack of motivation
feelings of depression or anxiety
less spontaneous movement
a flat (emotionless) facial expression.

As schizophrenia blurs what is real and imaginary, it becomes extremely difficult to manage the activities of daily life.

Not all people with schizophrenia experience the same symptoms. As well, not everyone responds the same way to medications used to treat schizophrenia. However, with treatment and support, many people with the condition live productively.

Severity

Those with severe schizophrenia can find it extremely challenging to manage diabetes along with mental illness. Some have such severe symptoms that they are still very ill even when taking strong antipsychotic drugs. They may lose contact with friends and family members, and even be homeless. It is nearly impossible for a homeless person to eat in a healthy way.

Shelters and hostels do not offer menus, and usually there is no choice in what is served. Often foods consist of sugars and starches, such as donuts and pastries, and food high in carbohydrates and calories. Faced with finding food or managing blood glucose, the basic need of hunger is met first. Someone sleeping on the street may even be finding meals in a trashcan.

Substance abuse

People with schizophrenia and diabetes are not immune to addictions. Relying on alcohol or drugs complicates treatment even further. The sugar in alcohol is extremely damaging to someone with diabetes. As well, using alcohol and drugs often prevents making good choices or getting help. It becomes more important to feed the habit than the body or mind.

Treatment

Managing schizophrenia includes medication as well as emotional and social support. Recovery involves combining these interventions.

Antipsychotic medications are the main class of drugs used to treat schizophrenia. These powerful medications are very helpful in controlling some severe symptoms of the illness. However, one side effect is increased appetite, which in turn increases food intake.

Our society is flooded with ads for quick, tasty, convenient food choices. It is hard enough for most of us to maintain a healthy diet and lifestyle, let alone someone who struggles with day-to-day living. Poor food choices that offer quick results, such as snacks and convenience foods, are often high in fat and sugar. Many people with schizophrenia choose to eat what is quick and easy rather than taking the time to cook. Others may not have the skills to shop and cook for themselves.

The role of diet and exercise

Symptoms of schizophrenia first appear in the late teens or early adulthood. Some young people have poor eating habits, preferring items like burgers, fries and full-sugar carbonated drinks. They tend to eat less fruit, vegetables and fibre, and have higher amounts of fat and sugar.

Given that many people with schizophrenia withdraw from social and family interactions, the convenience of fast food is appealing and uncomplicated.
Many people with schizophrenia have lifestyles with little physical exercise. Long periods spent watching television or playing video games add to an already inactive way of life. Once again, these activities are often linked with snacking on what is handy rather than healthy.

Finally, smoking is much more common among people with schizophrenia than in the general population. Nicotine can temporarily clear thoughts and improve understanding. This may be one reason people with schizophrenia choose to smoke. However, smoking increases the risk of high blood pressure and cardiac disease. The known risk that smoking places on heart health makes it a harmful lifestyle choice.

Managing schizophrenia and diabetes

The importance of treating both schizophrenia and diabetes cannot be emphasized too much. A holistic treatment plan is needed to reduce complications associated with diabetes. This would involve a medical and mental health team using the skills of many health disciplines. A psychiatrist and family doctor must prescribe medication to treat both conditions. Access to nursing, social work, recreational and occupational therapy, and independent living specialist care can provide the support needed to live life to the fullest.

Continued research of these conditions can only benefit people with both schizophrenia and diabetes. As each illness is studied and links discovered between the two, new treatments will become available. The main reason to treat any medical or mental illness is to enhance quality of life of those living with the condition.

Where to find support

If you or someone you know has symptoms of either diabetes or a psychotic disorder, talk to your doctor or another health care provider. The sooner diagnosis is made, the sooner changes needed to make life manageable can begin. Talk with your doctor or local health centre. Diabetes education programs can help you learn how to live with your diabetes. As well, mental health programs and organizations are available at local, provincial and federal levels.

Diabetes and schizophrenia Living with two challenging conditions

Diabetes and schizophrenia are serious, long-term illnesses. Both of these chronic conditions must be continually managed to experience the best life possible. Since having either condition calls for life changes, having both can be very challenging.

About diabetes

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