Diabetes

“Diabetes” is actually a class of several chronic illnesses, including immune-mediated diabetes mellitus (Type 1), insulin resistant diabetes mellitus (Type 2), and gestational diabetes mellitus. The common thread across all diabetes types is that patients’ bodies are not able to produce or use insulin properly. Insulin is a hormone that allows us to convert sugar from the food we eat into energy for our body’s cells.

Over the last several years, diabetes rates in the United States have risen dramatically. Experts believe the main reason for this is because Americans are increasingly sedentary (i.e., not exercising or engaging in physical activities), eating high-fat and carbohydrate-rich diets, and gaining weight. This is cause for alarm because diabetes can lead to serious health problems, like cardiovascular disease (which is the most common cause of death and disability in our country), nerve disease, eye disease and blindness, kidney failure, and sexual dysfunctions. People with diabetes are also more likely to struggle with mental health problems like depression and anxiety.

What are the Symptoms of Diabetes?

There are a lot of symptoms associated with diabetes. The most common ones include:

• Frequent urination
• Excessive thirst
• Extreme hunger 
• Increased feelings of tiredness and fatigue 
• Unusual changes in weight 
• Irritability
• Numbness or tingling in the fingertips or toes 
• Blurry vision 
• Breath that smells strong and “fruity”

Any person who experiences these symptoms (or combination of symptoms) should follow-up with his or her healthcare provider immediately, because early detection and treatment may limit the severity of the disease and its complications.

How Does Diabetes Affect Relationships?

Diabetes is often called a “family disease” because it affects more people than just the person who is diagnosed. As the patient is required to change old routines (and adopt new ones) across a wide variety of areas in his or her life, significant adjustments by all of those close to the patient are also necessary in order to ensure good disease management and physical health.

For example, managing diabetes requires careful attention to diet, including what foods to eat (and in what portions) and what foods to avoid. This usually means that the whole family must change their diet along with the patient, because not very many people are willing (or can afford) to cook two different menus everyday. As families attend to patients’ ongoing medical care, their income may be strained as they pay for more co-pays and doctor visits, blood testing supplies, healthy foods, and other expenses. As it relates to exercise and physical activity, patients are better able to stick with their doctors’ recommendations when they have someone to exercise with. Therefore, family members are frequently encouraged to exercise together.

Adjusting to and managing diabetes in these ways can be very hard for couples and families. For example, some family members may feel resentful about having to change their own everyday diets (or lose their ability to spontaneously eat tasty foods), when they are not the one with the disease. Others may struggle with a sense of encroachment on their free time, because the person with diabetes wants them to go for walks or engage in other types of exercise. Children without diabetes can sometimes feel jealous of how their diabetic sibling gets more parental attention. Patients with diabetes (both children and adults) may feel that others’ attempts to be supportive are actually “nagging” them.

However, when families come together and fight diabetes as a team, everybody wins. Research has shown that patients have better health when their families are supportive and share in disease management. And many describe diabetes as actually having helped them to become even closer. Talking about foods, cooking together, exercising together, going to doctor visits together, and so forth, all help families grow stronger. Furthermore, research has shown that non-diabetic family members who do this improve their own health—like losing weight and reducing blood pressure.

What Kinds of Diabetes Interventions Are Out There?

Because diabetes is a physical disease that affects patients and their families, interventions for the disease span from individually-oriented medical treatment all the way to family- and community-based treatment.

• Medical treatment for diabetes is highly individualized, depending on the patient’s overall health and presence (or absence) of diabetes-related conditions and other diseases. The main areas of focus include: controlling blood sugar through the administration of insulin, oral medications, and/or lifestyle changes in diet and physical activity. Drugs to lower blood pressure and bad cholesterol are also common.
• Individual therapy and psychoeducation generally involve patients meeting with a physician, diabetes educator, nutritionist, and/or therapist to talk about specific health behaviors (like meal planning, exercise, and regular blood sugar testing and record-keeping) and common feelings of depression, anxiety or stress. 
• Couples therapy and psychoeducation generally involve patients and their spouses or partners meeting with a therapist and treatment team to learn about diabetes together, and to build a sense of teamwork in everyday relationship functioning and disease management. It also provides a place to identify and work through some of the challenges and difficulties that couples and families commonly face. 
• Family therapy and psychoeducation follow a similar path as couples therapy and psychoeducation, but purposefully include children, siblings, parents, and anybody else who is living together or closely associated with (and affected by) the patient and his or her disease. Common challenges worked through in these forums also include negotiating normal struggles between teenagers’ developmentally-appropriate desire for more independence in the context of parents wanting be very involved in their child’s care. 
• Social and community interventions provide opportunities for patients and their family members to connect with other patients and families. By doing this, the personal, lived experience of people who have “been there” is accessed. Veteran spouses and partners can share with spouses and partners of new patients how they have achieved a balance between being supportive versus being a “nag.” Veteran patients can share with new patients how they were able to adjust their diets in a way that was not entirely unsatisfying or impossible to stick with.

Resources

• American Diabetes Association: This site offers a wide variety of information about diabetes, conventional treatment strategies, and community programs and advocacy. It also offers search capabilities and links to professional and scientific research and literature.
  
• Centers for Disease Control: Information is provided for both laypersons and professionals about diabetes, including current and up-to-date research, statistics, and educational resources and publications.
  
• National Diabetes Information Clearinghouse: This site offers an A-to-Z list of topics, terms and information about diabetes. It also provides an overview of diabetes symptoms and diagnostic criteria, descriptions of different treatment strategies, and up-to-date statistics.
• WebMD Diabetes Health Center Find up-to-date information regarding diabetes facts, symptoms and types. It also talks about diagnoses and tests, treatments, and patient support and resources.