What to Do?and Not Do?When A Loved One Has Diabetes

?You know you?re not supposed to eat that.???If only you hadn’t gained so much weight.???Why can’t you listen to your doctor?? These are familiar and painful comments heard by people with diabetes. As harsh as these words sound, they are usually uttered out of concern?and frustration?felt by loved ones. But such advice is rarely perceived as helpful and serves only to drive those with the disease away from the path to better health.

Why Support Is Important. Diabetes afflicts more than 18 million Americans, a number that increases every year. In susceptible people, weight gain and inactivity can trigger type 2 diabetes.
   Managing diabetes means keeping blood sugar levels ?in control??within a normal range that minimizes peaks and valleys throughout the day. How? By eating a healthful diet on a regular schedule, staying active and taking medication, if needed. Poorly controlled diabetes can lead to heart attack, stroke, kidney failure, blindness and amputation. Knowing this is scary and intimidating, both to those with the disease and to the people who love them. And yet research shows that family support?from a spouse or significant other?is one of the strongest predictors of how well people manage their disease. EN takes a look at how to successfully support a loved one with diabetes.

Step One: Get Educated. Managing diabetes is a family affair. Beyond sharing genes that may leave other family members at risk for diabetes, families share meals as well as lifestyle habits and attitudes that can either help or hinder efforts to tackle the disease. When families work together to learn the basics of diabetes care, good blood sugar control is much easier to attain.
   How to familiarize yourself with diabetes care? Attend medical appointments with your loved one, read books and magazines on diabetes (check out the American Diabetes Association’s monthly Diabetes Forecast magazine, a terrific resource) and attend diabetes education classes. The latter may include counseling sessions with a certified diabetes educator (C.D.E.), who can develop a personalized plan that involves the entire family.

Step Two: Be Supportive, Not Critical. For someone with diabetes, changing diet and lifestyle is challenging enough without the added pressure of well-intentioned family and friends critiquing every bite. Family members often end up focusing only on what the person with diabetes is doing wrong. Those who are responsible for grocery shopping and preparing meals need to guard against falling into the role of ?food police.?
   So, as hard as it is, resist the urge to lecture. According to nutritionist and diabetes expert Janis Roszler, R.D., C.D.E., co-author of The Secrets of Living and Loving with Diabetes (Surrey Books, 2004), all families make the same mistake. They try to act as ?coach,? but instead become ?inquisitor,?? treating the person with diabetes like a child. This breeds resentment and encourages hiding problems instead of sharing.
   Scaring someone into compliance with frequent reminders of ?what could happen if they don’t control their diabetes? is another ill-advised approach. ?It rarely works,? says Roszler, ?and only reinforces the role of loved one as ?parent? instead of supportive spouse or friend.?

Walk a Mile? A better approach? Start by putting yourself in their shoes. Diabetes is a 24-hour condition that requires constant attention. And sometimes, no matter what a person does, blood sugar will be high. Diet and exercise aren’t the only factors that influence blood glucose levels; illness, hormones and stress do too.
   Most important, avoid being judgmental. Instead of blaming your partner’s high blood sugar readings on dietary indiscretions or skipped exercise, help troubleshoot problem areas and figure out solutions. Whenever possible, focus on the positive. Point out when things are going well, so your partner will be more open to suggestions when diet or lifestyle needs fine-tuning. If blood sugar is well controlled most of the time, occasional high readings are not a crisis.

Ask and You Shall Receive. Ask your loved one how they would like to be supported; don’t assume you know. Your role may be as simple as lending an ear to vented frustrations. And even though it’s best for the person with diabetes to be in charge of his or her own health, helping with some tasks is a powerful statement that you want to be supportive and understand the challenges. Here are some specific tasks to lighten the load:

? Accompany your loved one to medical appointments. Take notes.
? Help shop and prepare food. 
? Be an exercise buddy. This will benefit your health as well.
? Offer to help log blood sugars, but don’t take over the task. If you?re
computer-savvy, there are excellent resources that help track and display
blood sugar readings. Some allow you to display them in chart or graph form
over time, helping you get a handle on problem times of the day or week.
? Learn how to test blood glucose, in case you need to do it during illness.
? Help keep diabetes medications and supplies in stock and up-to-date. 
? Prefill syringes if there are insulin injections, particularly if your loved
one is vision-impaired.
?Learn what to do in an emergency: Become familiar with the warning signs of hypoglycemia (low blood sugar) and how to treat it with easy-to-absorb sugar (e.g., sugar cube or juice, not a candy bar) or glucagon, an injectable substance that raises blood sugar if someone is unconscious.

Derailing Diet Debates. Not surprisingly, diet is a frequent source of stress for people with diabetes. What you may not know is that diabetes educators no longer talk about forbidden foods; the new diabetic diet is all about portion control, particularly of carbohydrates?any kind of carbs, not just sugar. Although all foods eventually convert to glucose after digestion, carbs break down more easily, so have more of an effect on blood sugar if not kept within certain limits. Accompanying your loved one to sessions with a registered dietitian is a great way to learn about diet?how, what and when to eat?and also provides a neutral forum for both of you to hash out diet concerns.

The Bottom Line. People with diabetes want to be like everyone else?in control of what and when they eat and how they manage their disease. But family members and friends can assist them in meeting their diabetes care goals. Whether it’s offering to grocery shop, helping to devise an exercise plan or providing positive reinforcement when the going gets tough, being a partner in managing your partner’s disease can make all the difference in your loved one’s health.
   Above all, don’t be judgmental and, as hard as it may be, don’t hover. People with diabetes are ultimately responsible for managing their own health. 


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