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Scared of Lows


Feb 3, 2010

Dear Diabetes Health, I'm 26 years old and engaged to a woman I've known since college.  We live together, love each other, and have good sex, but now I'm having doubts. A year ago, she was diagnosed with type 1 diabetes. She started taking insulin, and it has been rough. Four times now she has started sweating and shaking and saying strange things. Twice this happened during sex. 

It turned out that her blood sugar was low, and she got better after sucking on hard candy and resting. Another time, when I wasn't there, she wound up needing an ambulance. Now I'm nervous about going to bed with her.

I tell her to check her sugars more often and make sure she eats enough.  She says I am nagging her, but I'm just worried about her. What can I do? This is putting a real strain on us. We're reconsidering the whole marriage idea.

Nervous Fiancé

Dear Nervous,

Thanks for writing. You are in a tough situation, but it is a common one for newly diagnosed people.

Learning to manage type 1 diabetes takes time. You both need to be patient. This is going to require teamwork and communication. Episodes of low blood sugar ("hypoglycemia") are among the most upsetting things families with type 1 have to deal with.

People with type 1 get low when they haven't eaten enough to cover the insulin they have taken or when they do vigorous exercise without eating extra food.  If you're close to running low, sex can put you over the edge. So how do you help your partner avoid these lows?

According to psychologist Paula Trief, PhD, the key is to provide "nondirective support." This means, "[You] assist [your partner] and cooperate with her requests, but you don't take responsibility for her actions."

If you try to take responsibility for her ("directive support"), you may threaten her independence. This kind of behavior is the trademark of what William Polonsky, PhD, CDE head of the Behavioral Diabetes Institute in La Jolla, CA, calls the "diabetes police." 

Writing in Diabetes Self-Management, Trief says "The diabetes police are always watching to see if you eat the right things, check your blood glucose at the right times, and have the right blood glucose numbers. While they are usually doing this to protect you, making you feel like a ‘diabetes criminal' breeds anger, resentment, and shame. [This] leads to greater distance and will probably affect other aspects of their relationship."

We don't want you to ignore the danger of hypoglycemia. That would not be reasonable or safe. Your partner would probably appreciate your support if you agreed on how to do it. Try talking about what is bothering you, using "I" messages like "I really get scared when you start shaking and sweating. I think something terrible might happen to you. Then I get angry because I think this didn't have to happen. What can I do to help you prevent these attacks?"  Use your own words, obviously.

It may be that your partner doesn't know what is causing the lows. She might need to talk with a diabetes educator, nurse, or doctor to help figure out what to do differently.  But she shouldn't object to your asking her to check her sugar if you see signs that she is going low, if you do it nicely. Say something like "You seem to have some sweat on your forehead. Are you hot, or do you think you should check your sugar?"

It is also quite sensible to check before sex.  Sex goes better if your sugar is in the normal range. Maybe you could even integrate it into your foreplay.

The first couple of years after diagnosis are often the hardest.  You two should check in with each other once a week or so about how things are going.  Tell each other how you are doing and what's happening emotionally. Tell your partner what she is doing that helps you and what doesn't help, and ask her what you can do to support her. 

Hypoglycemia is not the only diabetes issue you two will face together. If you get in the habit of learning about problems and talking about them as they come up, we're sure you will be able to work them out.

If you are both willing, you might want to go to diabetes education or doctor's appointments with your partner. You will learn more about what she is going through, and she may appreciate the support. You might also consider attending a support group. This site can help you find one in your area.

Let us know how it goes. Our readers probably have some good advice to share, as well. 

http://coupleswellness.sitesvp.com

* * *

Note: David will be speaking in Lafayette, Louisiana, and Fairbanks, Alaska, this month.  If you live near there, e-mail us for details at david@davidsperorn.com .  We'd like to meet you!


Categories: Blood Glucose, Blood Sugar, Columns, Diabetes, Diabetes, Food, Hypoglycemia Unawareness, Insulin, Love and Diabetes, Low Blood Sugar, Sexual Issues, Type 1 Issues



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