Thursday, August 13, 2009

"Fact of Life" #3: You've Got to be a Team Player

Diabetes is not something that any of us signs up for. Not our spouse/loved one, not us. This can be particularly true for those of us whose partner developed the disease during our relationship, and it comes as a complete surprise. However, even if we went into the relationship knowing that our partner had diabetes, I think at some point the intricacies and daily grind of it get to be too much... and we think "how can I continue doing this?"...

Now, a disclaimer: I write this knowing how much harder it is for my husband with type 1 than it is for me. I need to say that! He has the hourly balancing act on his plate 24/7, whereas I get to forget about the diabetes for long periods of time throughout the day. I wish he had that luxury.

The funny thing about living with someone with type 1, is that over time I've realized how critical it is to approach the diabetes as a "team sport". If I think that we're both on the same side with wanting to do things right, then it becomes easier to understand and support my husband. I am less at odds with any of his choices / ways of coping. It is absolutely true that diabetes affects everyone around it ... it is a "family disease" ... and so with that in mind, I've figured out ways for me to not only show my support for my husband, but also take my place as his team-mate, and to hopefully remove a tiny bit of the daily burden off of his shoulders.

Here are some of the ways that I have found useful to act in that team capacity:
  • Make healthy choices when shopping - Since I am the one mostly responsible for the food shopping and cooking in my house, I try very hard not to bring those things into the house that will be tempting for my husband (and for me!). Those wonderful croissants, chips, white breads, dessert items... the vast majority of the time I leave them in exchange for healthier, complex carb items, fruits, fresh vegetables, proteins... things that I know are better for all of us. We don't need that other stuff! Because I know that if it is in the house, it will get eaten... so I try hard not to bring it in.

  • Be a "co-pilot" in the car - Since my husband prefers to drive (and I like him to as well, takes the stress off of me!) whenever we take road-trips I make sure that we are well-stocked in the front seat of the car with anything we might need for lows while driving. I stay alert, stay engaged with my husband to ensure that if he doesn't pick up on those subtle hints of a low while we're driving, I do. It is probably the only time that I ask him to check his numbers before we leave the driveway (then I can check it off my co-pilot check-list ... "numbers normal, check! we're good to go..."). Stay supportive, but don't freak out. Offer to drive if he needs time to keep his sugars in a safe zone.

  • Allow them to make their own choices, but try not to tempt - This kind of follows along with point #1, but if there is an opportunity for something out of the ordinary... a special dessert, etc... I always try to let my husband choose how much he'll indulge in any given thing. He's an adult, he can make his own choices... he knows his body and his insulin better than I ever will. I do however try not to create too many opportunities where he'll have to make that choice over and over! If it's occasional, I stay out of it... and let him enjoy.

  • Understand the important numbers - Over the last 12 years I've become more educated and well-versed in things like A1cs, creatinine levels, cholesterol numbers, etc., than I ever thought I would at my age. But I've stayed interested and involved in my husband's journey with these things. I attend appointments with his Endocrinologist when I can, just to stay visible and to be involved in the "behind the scenes" talks that my husband has about any issues or concerns he's having. When he gets a good A1c back from his labs, we cheer! I know the hard work it takes to accomplish something like that, and I make sure to recognize that.

  • Collaborate, don't dictate - if there is one thing that I have learned doesn't work in my relationship with my husband, it is my becoming the "Diabetes Police". How many years did it take me to figure that one out?? Only about 12... I recognize now that it is my collaboration with my husband that is meaningful, my ability to partner, to be a team-player in his diabetes management that keeps us aligned and moving forward in the same direction. As soon as I feel myself slipping into "dictator" mode, I can see the reaction and the subtle (and not so subtle!) ways it pulls us apart into different, opposing directions. Not a good place to be in a relationship. It takes time, and some good communication, to figure out how to become that collaborator... but it is possible. And definitely worth it.

Tuesday, August 4, 2009

“Fact of Life” #2: Anxiety

What’s the one thing that all of us who are partnered with someone with diabetes have in common? We are all anxious. It varies by degree, but it is a common strain that runs beneath many a calm, functional exterior. It can be related to fear of lows, anxiety around complications or co-existing medical problems, fear of the future, or the biggie, death of our loved one. Since my husband was diagnosed with type 1 in 1997, I have felt the omnipresent sense of worry that stays with me day-in and day-out. Sometimes the worry is very specific (“he’s driving home – is he low?”), sometimes more generalized (“I can’t reach him … what's happened?!”), but it is always there. After 12 years it doesn’t bother me as much anymore – and I have learned some important ways of dealing with this unique form of “diabetes-anxiety”... they include the following:

  • Try not to “anticipate” – just because something has happened in the past does not necessarily mean it will happen this time … I try hard to live in the present moment and judge situations for what they are.

  • Actively gather information from people who know what they are talking about – for me, knowledge is power, and it helps quell my anxiety (about my husband’s lows, or his risks for complications for example) if I know what I can expect to happen… asking people I trust (my husband’s physician or other people I know with diabetes) helps me to feel prepared “in the event of” - of course I recognize that things may always change, but at least I know what is likely to happen in most instances

  • Come up with tools or things to make sure you are prepared – I try to be active in my coping ...making sure we always have juice in the house for lows, or that I know exactly where the glucagon is (even though we’ve never had to use it!). In this way I know that if these things are needed, we’re covered, and I can relax just a bit.

  • Remember that you’re not alone in this – when things get too much sometimes, it helps me to remember that there are others out there who understand my situation, and who are facing the same things every day. All I have to do is seek these people out (by connecting with friends or finding groups online), and I’ll find people who really “get it”. Hearing other peoples’ stories about their loved ones with diabetes always put my own into perspective.

  • Try to be kind to yourself and have some understanding of any “knee-jerk” anxiety around your loved one’s diabetes – it is not easy to constantly feel “on guard” around my loved one’s health, especially when it is related to a past negative event (e.g., a near-miss while driving, a midnight call to 911). However, I take responsibility for my own anxiety and try to separate out the “rational” from the “irrational” worry about his diabetes that I may feel on any given day. It’s my responsibility not to bring baggage into our daily relationship. He doesn’t need one more thing to have to manage!

  • Try to work out better ways of responding – someone once told me if something wasn’t working, to try doing the opposite to see what would happen. For me it’s been the same with my reactions to my husband’s diabetes – sometimes when I feel the most anxious about a situation or his response to it (or lack thereof!), I try to be the most calm, the most objective… and it often works to stop my anxiety in its tracks! I feel more empowered, and it also seems to make the situation better… go figure!

“Fact of Life” #1: Blood Sugar Lows

One of the hardest things for people who love someone with type 1 diabetes is dealing with the blood sugar lows that happen on a fairly regular basis. Over time we may get used to them, and get more competent at helping our loved one come back to normal levels more quickly. We also become experts at recognizing the signs that a low is imminent, if not already happening (for me it’s all in the eyes!). Since my husband was diagnosed with type 1 in 1997 and keeps his diabetes in very tight control, we’ve been through many, many low episodes – some worse than others.

Over the last 12 years I’ve learned some very important lessons – what I call “How to Keep Your Head When Your Type 1 Spouse is Losing Theirs in a Low”… here they are:

  • Don’t panic – you freaking out can cause the person extra stress which can actually make them go lower … so hang in there, and project a calm face if you can … even if you’re absolutely faking it

  • Be supportive – offer to get them some juice and/or make them a quick snack … just because you “felt like one too”

  • Don’t force them to treat their low the way you think they should and/or “hover” – use your judgment, but remember that they are adults, not children, and treat them accordingly

  • Let them guide you – if they just need space to come back up, give it to them without overdoing the “just checking in”

  • Have empathy for what they are going through – remember that they didn’t do this on purpose, or to get attention, to delay doing something around the house, or because they “felt like it” … lows feel bad, no matter what.