Wil Dubois

 PWDS: You. Are. Here.

Welcome to another edition of our "curiously strong" diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and educator Wil Dubois.

Last week, Wil offered some insight to a woman with type 1 who's battling her "Evil Low Blood Sugar Twins," as it were. This week, Wil follows up with her about the psychosocial side of blood sugar swings that can sometimes lead to distress, depression and even something called "depersonalization order." Read on...

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}


Shelly, type 1 from California, also wrote: For a while now I’ve felt like I’m not here, I’ve felt like I’m in my body and everything around me is slower. I feel like I’m in a dream almost, I look at myself in the mirror sometimes and I even wonder if I’m still here. I sometimes panic when I have a job interview or when someone is speaking to me directly face-on because I feel like I’m acting weird and I’m not sure where to look, but I’ve kind of settled down to the fact that I come across fine. I sometimes just look like my mind is elsewhere, I look at my hands and feel as if they aren’t my own. I’ve been to the doctors twice about this but they’ve put it down to stress. I’ve also spoken to my diabetic team but I feel as if it was always pushed to the side, and now that I’ve moved on to the adult diabetic clinic, I rarely see them as often. I’ve typed these symptoms into Google and "depersonalization disorder" is something that comes up and I’ve read over and over and it’s exactly how I feel. Things that cause it are depression, stress and a few other things. I’ve always felt down about my diabetes and was wondering if depersonalization disorder or depression is linked with diabetes?


Wil@Ask D’Mine answers: OK, we talked about the dangers of Dr. Google not long ago, but in this case I can hardly blame you for wanting a second opinion after being brushed off twice by your doc and once by your diabetes team. And I’m glad you came to me for a third opinion.

Well, Dr. Google aside, depersonalization disorder is a real thing. It’s officially classified as a neurotic disorder, which is defined as a functional mental disorder (as opposed to a psychosis, where reality is distorted). Neuroses commonly arise out of defense mechanisms for underlying stress.

Any stress in your life, Shelly?

You are right that what you are feeling matches the symptoms of depersonalization disorder (DPD). Folks with DPD often report that they experience their lives in a dream-like state, or as if they were watching a movie of it — standing outside of their bodies like observers of the drama. For what it’s worth, anxiety attacks and panic attacks seem to go hand in hand with DPD, as well as depression.

The best guess is that between 1-2% of the population suffers from DPD. It is most commonly linked to childhood abuse, psychological trauma from war, natural disaster, or torture, and bad LSD trips. Could the struggle with type 1 diabetes rise to the level of torture or surviving a natural disaster? Maybe. While many of the DPD triggers are certainly more horrific than diabetes, they are transient. And while diabetes carries less of an impact, it’s one that never lets up, never let’s go, never provides a break. It’s probably a miracle we’re not all neurotic. 

Or maybe we all are, just in varying degrees.

Experts say heavy cannabis use in adolescence increases the risk of DPD too, but this is more likely in boys than in girls.

The biological underpinnings of DPD are still being investigated, but the leading theories point to either functional abnormalities in the prefrontal cortex or the pituitary-adrenal system, and the folks reporting DPD have high levels of cortisol. It’s also more common in people with Alzheimer’s — which some scientists think is a form of diabetes. But what about links to garden-variety diabetes?

One German study found a “robust” association between DPD and diabetes. While PWDs made up 5.9% of the people interviewed in the study, they made up a good 16% of those reporting DPD. That’s quite a bit higher than the 1-2% of the general population. But the study also found DPD more common in people with hypertension, chronic pulmonary disease, and chronic pain.

Hmmmm…. All tough things to live with. Who wouldn’t want to step outside their body for a break?Save Me Mirror

Oddly, however, folks in the study who had cancer didn’t seem to suffer DPD.

But other than this one study, I could find precious little beyond anecdotal reports, and many of those seem to be about transient cases of depersonalization associated with low blood sugar events, not a full blown all-the-time disorder like you are reporting.

Of course, DPD is linked to depression and depression is strongly linked to diabetes. But it would be stretching too far to connect the dots by saying flatly that because depression and DPD ore linked, and because depression and diabetes are linked, so too must diabetes and DPD be linked.

Meanwhile, what about your medical team’s feeling that you’re just under stress? Well, it could be. High levels of stress often lead to a medicine-head get me the hell out of my body desire. But yours sounds more severe. The dream-like state, the slow motion feel of the world around, the stranger in the mirror, the feeling that your hands are not yours to control. So why would your medical team blow this off so easily?

Most likely, your medical team didn’t even recognize DPD as a possibility. Most primary care physicians and even diabetes specialists aren’t trained in brain stuff. They probably never even heard of DPD before. After all, it is pretty rare, and it’s not possible to know all there is to know in medicine. All of us in the trenches can only recognize what we’ve been trained in, and what we’ve seen before.

I think that in this case, you need to step out of medicine and go visit our colleagues in the field of psychiatry. Yep. Ya really gotta to see a shrink for help on this one. The treatment isn’t simple, and there doesn’t appear to be a slam-dunk cure for DPD. Cognitive behavioral therapy is said to be helpful, as may SSRI class antidepressant drugs for some people. And alcohol seems to make DPD worse, so you might want to avoid that.

Beyond proper treatment, there are some things that seem to make DPD better, according to DPD expert Daphne Simeon, such as “comforting interpersonal interactions” and “intense physical or emotional stimulation.” So it’s a good thing you are in a long-term relationship. Get some comfort time from your boyfriend and then reward him with some intense physical stimulation. You know. As medicine for your DPD. “Doctor’s” orders!

And hey, for what it’s worth Shelly, your words sing. I can feel your pain, your confusion, your fear, your anguish.

I know you don’t feel real to yourself — but you feel very real to me.


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.


Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.