NINE. When a Family Member or Loved One Has Diabetes

What should a parent, spouse, partner, or caregiver know about diabetes in order to provide support to a loved one?

My child has diabetes. What can I do when he or she is sick to help prevent the diabetes from going out of control?

My spouse/partner has diabetes and we are planning a family. What is the risk that our children will develop diabetes?


My partner/child/parent does not follow his or her doctor's advice on management of his or her diabetes. How can I help to improve things?

This is a very difficult question and is one that can be extended beyond diabetes to many aspects of a loved ones life where their behavior is apparently either endangering themselves or likely to lead to short- or long-term negative consequences. Sometimes it can be immensely frustrating for a caring parent/partner/friend or relative to experience lack of commitment to good healthcare practices on the part of someone they care about. Moreover, the knowledge that much of the burden of the consequences may fall on others can lead to anger and resentment.

There is no easy answer that can be applied universally, as everyone is different and their circumstances are unique. It is important to remember that, except in the case of a minor child, you must yield the control of the problem to the person who has it. For example, your spouse/partner owns his or her diabetes and must be empowered (except in very special circumstances) to make his or her own decisions on how to manage it. He or she is more likely to take advice if it is sought out than if it is given uninvited. They are likely to believe that they are giving as much attention to their diabetes as possible, whether or not it seems obvious to others that this is not the case. Frequent pressure to do more may engender a sense of failure and actually lead to doing less. Motivation through fear is generally not successful unless the object to be feared is immediately present. People with diabetes generally do not see or feel the consequences of the neglect of their diabetes on a day-to-day basis. When they finally do, it is too late to reverse them. For example, if you get too near the log fire in your living room, soon you realize that you do not want to get closer but should move away There is no such warning before touching a hot iron or a burner on the stove. Thus, household cooktop and iron burns are much more common than burns from touching the blazing logs in the fireplace!

Perhaps the best that one can do is to help to ensure that our loved ones have access to high quality education about diabetes and its consequences, ensure that they are given the tools to do what is needed to take care of it, and to support them in that effort to the extent that they are willing to participate. After that, their autonomy must be respected, even though it may have some negative consequences for others. It is important to remember that you are not obliged to join your loved one in dangerous or destructive behaviors nor must you unquestioningly accept the consequences. Whether you choose to do so will depend on several factors, including your personal belief system.

What should a parent, spouse, partner, or caregiver know about diabetes in order to provide support to a loved one?

The more informed a spouse, partner, or caregiver is about diabetes, the better source of support he or she can be to the affected person in their lives. Thus, the answer can be very open-ended. To be practical, let us focus on a few key issues that are especially important. If you are the main food preparer for the loved one in question, knowledge of diabetic diets and nutrition is very helpful (see Question 40 for more information). The appropriate type of diet for a person with diabetes is generally not complex, time-consuming, or expensive. Attending diabetes education with your loved one's dietitian is probably the most useful and important thing you can do. Getting to know as much as you can about diabetic meal preparation is very important, especially when there may be special requirements relating to kidney complications (nephropathy — see Question 34) or high blood pressure.

It is important to remember that yon are not obliged to join your loved one in dangerous or destructive behaviors nor must you unquestioningly accept the consequences.

Knowing how to treat a low blood sugar reaction, whether moderate or severe, is very valuable. The mental alertness and coordination of the person with diabetes can be impaired with moderately severe low blood sugar reactions and he or she may not have insight into what is going on or how to treat it. In the case of severe low blood sugar, reactions, the affected loved one may be drowsy or unconscious and prompt action on your part is very important. Knowing how to check the blood sugar with their machine and how to treat a moderate low blood sugar, or how to use a glucagon kit to treat a severe low blood sugar, is very helpful indeed. This is addressed in detail in Question 92.

Finally, knowledge of how to manage sick days is very helpful. The body's response to illness can be somewhat unpredictable. In the case of an infection such as gastroenteritis or influenza, blood sugars may be high or low, depending on whether the body's stress reaction pushes the blood sugar higher or the failure to eat pushes it lower. Either way, during anything other than a minor illness, it is important to monitor the blood sugar frequently, and treat low or high sugars (the latter with insulin if necessary) and to ensure that your loved one is well hydrated, as dehydration will rapidly make the situation worse. Most important is to know when you are unable to keep pace, meaning that the blood sugar is rising in spite of your best efforts and your loved one is unable to take in fluids or is becoming drowsy In this case, ensuring that he or she gets prompt medical attention is the most valuable thing you can do.

There are, of course, many other ways in which you can help by your knowledge of diabetes, but these are three of the most important.

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