Friday Feature: The Effects of Diabetes on Relationships

This week we’re pleased to share a guest post by Elisabeth Almekinder RN, BA, CDE. It was originally posted on her site.

She asks will you leave your SO (significant other) because of diabetes?

Committed relationships are hard enough. When you add a chronic illness into the mix of everyday problems, it can place undue stress on a relationship. Do you leave your spouse or partner with diabetes when the going gets tough, or do you stick it out and work together to solve problems that come up, “in sickness and in health?” These are questions you may be asking yourself if you have been going through a tough time in your relationship or marriage due to diabetes. If your partner is in a state of denial and they are refusing to participate in self-care activities or listen to their doctor, this can be quite frustrating. You may be getting burnt out from always trying to fix the right amount of carbohydrates, only to catch your other half in the back room hiding with a box of candy. Feeling like you are the “diabetes police” and always nagging drains the joy out of your relationship. The spouse of a diabetic can feel a loss of control over the future, and be afraid that they will lose their life partner.

Conversely, if you are the diabetic in the match, you tend to get quite aggravated with all of the nagging and “sugar-shaming” that can be going on. Maybe your partner didn’t support you by attending diabetes education classes, and now she doesn’t seem to know that it’s ok for you to have an occasional treat. Maybe she doesn’t realize that you are having the extra carbohydrates, but you have a walk planned for after the meal. Sometimes you feel misunderstood. It’s true that diabetes can take a physical, mental and financial toll on a relationship. Remember that your overbearing and controlling partner is acting from a place of genuine caring and concern for you. Now let’s look at the different situations and problems that can cause a strain on a marriage or relationship due to diabetes.

Physical problems that may affect a relationship

Problems with intimacy due to nerve damage from diabetic neuropathy can cause strife in a relationship. Women can get vaginal dryness with diabetes around menopause. This can result in painful intercourse. Men can have erectile dysfunction. If a couple has difficulty in the bedroom with erectile dysfunction or dryness and painful intercourse, this may affect the level of desire a couple has for each other, and lead to many problems in the relationship. The main thing is to talk about it to each other, and to your health care provider. Use some of the different communication skills discussed in this article. There are many medications on the market that can help a man with diabetes and erectile dysfunction. There are even surgeries for penile implants if Viagra, Cialis or the other ED medicines don’t work as well as hoped. For women, there are a variety of vaginal crèmes available to aid in lubrication to make sexual intercourse more enjoyable. Hormone replacement therapy may help, and a woman should discuss these issues with her doctor or gynecologist.

The financial burden of diabetes

Other relationship issues can be finances, due to the high cost of medical care for a diabetic. If diabetes is out of control, and the partner with diabetes does little to keep it in control, then the financial burden can become great as health deteriorates and the complications of diabetes set in. The long term complications can indeed be devastating to patients and families and pose an undue financial burden. In speaking with one woman, who lost her husband at age 51 due to complications of diabetes, she expressed anger over the fact that he never took care of himself. “He died so young, and left me and my girls with little or no support. Thank goodness I still had my job, but at age 70, I still have to work. I can’t help but feel angry. If he had taken care of himself, he could have been here for us. I miss him.”

When your spouse is not supportive

During initial Diabetes Self-Management Education sessions, the certified diabetes educator asks questions about a client’s level of family and community support. These sessions can be quite telling, and many different relationship dynamics can be picked up on. One woman sat in the clinic room with her “common law husband.” He seemed to be interested in her care, and said that he does some of the cooking and would like to attend diabetes education classes with her. When asked about stress, the young woman glanced toward her partner, and stated that they have relationship issues. She quickly stated that she did not want to discuss it at that time. The interview proceeded. She was asked about emergency room visits. She turned to her partner and stated, “Did I go to the Emergency Room when you dropped that TV on my arm?” At that point, there was suspicion of abuse, so the woman was asked to come back to a clinic room alone to discuss with the social worker issues that she may be having at home. She was able to confide in the social worker about abuse by her partner, and get help in a battered women’s shelter. This woman did end up getting a divorce, as she had no true support and was in an abusive relationship. Her blood sugars were high in part due to the stress the abuse was causing.

This is an extreme example and most often, a lack of support shows up in other ways. A woman came to diabetes class, distraught that her husband backed out of coming to her diabetes education visit at the last minute. “He gives me no support,” she said. “Last night he brought home a dozen doughnuts. I try to get him to take a walk with me after supper, but he won’t. I feel like I have to do everything on my own, and he is always fighting me on it. If I am trying to stick to my plan, he tempts me by eating all the wrong things in front of me. I am so frustrated. How can I get my husband to support me in my efforts to stay healthy with diabetes?

When the support your spouse gives you is getting on your nerves

“She just nags me all the time,” stated one man with diabetes. “When I am trying to do what I am supposed to do, my wife stays on me constantly. She criticizes every bite of food that I put in my mouth. Being supportive of me is one thing, but I feel like she is always trying to be my boss. I’m an adult, and I can take care of myself.”

From what this man said, he might appreciate an extra nudge now and then to resist a tempting dessert, or a reminder to take his medication, but men tend to want to take charge of things. Having his wife constantly telling him what to do served to increase his anxiety. Provoking anxiety, frustration and even depression in your partner with diabetes is counter-productive for their diabetes, and will actually cause blood sugars to go higher.

Another woman with diabetes complained that her spouse was supportive in the beginning, but now that she is self-managing and doing so well with it, he tends to not take her so seriously anymore. “Oh, go ahead and have 2 brownies,” he said. “It won’t hurt you.” This bothered her, making her feel that he is minimizing the steps that she needs to take to stay healthy for him and for the whole family.

How can you be supportive without being overbearing?

Any chronic illness can be a stress on a relationship. Diabetes is no different. So what are some of the ways that we can be supportive for our partner with diabetes without making them feel like we are constantly nagging, taking notes and taking prisoners? One thing that we can do is that we can let go. We can accept the things that we can change, and we can accept the things that we cannot change. We can be there for support of our partner with diabetes, but we cannot make them do anything that they do not want to do. In this way, we accept that we cannot control the other person, and respect that they are a human being capable of making decisions. Even if those decisions do not necessarily go along with the decision that we would have made for them, we allow them to make their own decisions with respect to their diabetes.

This does not mean that we do not support them. As a partner, we can be particularly helpful when it comes to grocery shopping and preparing diabetes friendly meals. If it comes to slapping their hand when they go for seconds, we have crossed the line from supportive to overbearing. When we draw up their insulin and give it to them when they are perfectly capable of doing it for themselves, we are not allowing them to self-manage. We are trying to control their behavior, and that is annoying.

For the diabetic, letting your significant other know how you feel, and being clear about the level of support you require will make it easier for your partner to figure out what they can do for you, or also what may make you feel helpless and brow-beaten. Have a long, deep conversation, where you explore what kinds of tasks your partner could do that would be helpful for you. Also, make it clear to your partner those tasks that you feel up to taking on yourself. Those tasks should then be off limits for your partner to nag you about. Make it clear that you will handle certain things for yourself, and ask clearly for what you want or need. Always include your partner when it comes to decisions concerning your health. As a couple, you are a team. However, your partner should realize that any decision about personal health is ultimately yours to make.

Use “I” messages instead of “You” messages

Everyone can agree that communication is the key in any relationship. This is especially true of a marriage or long term relationship where there is a commitment involved. When you communicate with your spouse or significant other, it’s a good idea to use “I” messages instead of “you” messages. An “I” message is an appropriate way to express our feelings, without putting the other person on the defensive. Thomas Gordon coined the term “I” messages in the 60’s, when he learned to use them when doing play therapy with children. Let’s look at some examples of “I” messages versus “You” messages, and see how they differ in the way they can make us feel.

“You” message example

Partner 1: You forgot to take your medicine.
Partner 2: That’s because you were running me late!
Partner 1: You’re always forgetting your medicine. Why can’t you be more responsible?
Partner 2: If you would quit nagging me so much, I might be (crossing arms).

Do you see how in the “You” message example, the diabetic partner is immediately put on the defensive? He or she crosses their arms, shutting off any further communication between the two. Now let’s look at a more effective way of communicating with “I” messages.

“I” message example

Partner 1: I’m starting to feel like I’m going to be unhealthy if I don’t get my blood sugars under control.
Partner 2: I know it worries you. How can I help? Can I do anything for support?
Partner 1: I think if I could be reminded to take my medicine at night that would help. I tend to forget it at night.
Partner 2: That’s a good idea. I can give a reminder.
Partner 1: That’s great help. Then maybe my blood sugar will come down if I remember my nighttime dose. Thanks for supporting me.

In addition to using “I” messages instead of “You” messages, another good phrase to use when trying to get across your feelings is “When this happens…I feel… “Some people find this helpful to get their point across without placing the other person on the defensive. Other communication techniques that are important to communication in general may also help. Try waiting a few seconds after the other person has finished expressing an idea before giving a response. This will help us to practice good listening, which is also essential for excellent communication between committed people, or anyone. You can also practice repeating what you think that you heard the other person say. In this way, you are able to clarify your partner’s thought, and make sure you really understood the intent of the communication. For example, when your spouse states, “I don’t like to give myself a shot,“ you may say, “Something about having to give yourself a shot is bothering you. Can you tell me what bothers you about it?”

Is it time for marriage or couples counseling?

Let’s say you’ve tried the communication skills listed above. If things still do not seem to get any better between you and your partner, there is marriage and couples counseling available. It can sometimes help to talk out your problems with an impartial party. Your minister, priest, rabbi, or other religious leader may be able to provide marriage or couples counseling for you, often at no cost. However, they do know you so they would not be considered impartial. If you prefer to go the professional route for a therapist, look for a therapist with at least a master’s degree and experience in working with committed couples. You may also ask if they have special expertise in working with couples who are having difficulty relating to each other due to a chronic illness that one has. Ask around to find a therapist who you will both be comfortable to talk with. If your spouse or significant other refuses to go to counseling, go on your own anyway. It can help you personally to talk with someone about it, even when your partner won’t.

In the end, marriage and relationships are important. It is almost always beneficial to work on a commitment that you have made to another person. True, a chronic illness with all that goes along with it, can strain any marriage or relationship. Many situations in life will try to pull a couple apart. The main thing is to keep the lines of communication wide open, and have a mutual respect for one another. Hopefully with these communication tips and advice, you will be feeling less stress on your marriage or relationship due to diabetes, and move closer to your happily ever after.

Questions and Answers

If my spouse is not supporting me with my diabetes, what can I do to let him/her know that I need help?

Use specific “I” messages to let your spouse know how you feel. These are less intimidating than “you” messages, and don’t put the other person on the defensive.

Should I leave my spouse due to a diagnosis of diabetes?

Marriage is a commitment, and there are many things in life that may cause you to feel like you want to run from your marriage. Only you can fully decide if you want to stay married to your spouse or not. However, when something is important to you, trying some communication techniques or marriage counseling may help you to repair your union. Diabetes can be managed, and people go through phases of the disease where they move from denial to acceptance. How your spouse feels about self-managing their diabetes today may be different than how they feel about it tomorrow. Things may get better.

If I am having erectile dysfunction, and it is affecting our sex life, what can I do about it?

Talk to your doctor. There are a variety of medications that can be useful for ED and work quite well. Poor blood sugar control contributes to erectile dysfunction, so this is usually a good motivator for men to get their blood sugar under better control.

I am having vaginal dryness and painful sex. What can I use to help with this?

There are several over-the-counter crèmes that you can purchase to help with vaginal lubrication and painful sexual intercourse. Ask your pharmacist to help you pick out a product that will work for you.

Our marriage is stressed out due to the financial burden of my diabetes. I don’t have any insurance, and I can’t afford my insulin. Then I get sicker, and it strains our marriage even worse. What should I do?

Apply for Medicaid or the Affordable Care Act insurance if you have not already done so. If you do not qualify, or the subsidies offered with the Affordable Care Act are still not affordable to you, find a free or reduced clinic where you can get medical care. Check about the website for the drug company who makes your insulin. Each company has a program where indigent patients can get free insulin. You will fill out an application that you will submit to the drug company. Talk with a local Medical Social worker about available programs in your area, and about the process for applying to Medicaid or the ACA.

Last but not least make sure to read Riva’s story here https://diabetesstories.com/2016/04/16/sharing-something-most-intimate-my-blood-sugar/