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!

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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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Comments

Posted by Anonymous on 3 February 2010

Hi, My son has Type 1 and amongst the other people that I know with T1, some are married couples. T1 doesn't stop a person getting married and having a normal life but of course, with T1, it is important to learn what brings on lows and what to do to deal with them. Your fiancee may be scared about her diagnosis as it is early days for her too and if she thinks that you are being freaked by it, it may make her feel that not only does this diagnosis mean that she has to take extra care of herself now but that it could take away the man she loves. Why don't you both learn together what to do and if she is going low at particular times, don't say anything, just give her a high carb snack in advance...

Posted by Anonymous on 3 February 2010

David,

My advice is take your time. At 26 you are very young. You have a very big decision in front of you about marriage and it's better to decide before you marry whether it will work or not.

As wonderful and lovely as your fiancee is, she is looking at a lifetime of managing this disease. Without proper management, it can become a health trap with continual side effects that affect you both.

You as a potential life partner needs to decide if you can live with her managing or not managing her health.

As someone about 2 times your age, I will tell you that your young, robust health is a gift (I assume here you are healthy), but most people have something going on...you just don't know about it. Saying that, the trials and rewards that working with the one you love to manage her condition will not be unique to her or any other woman you may meet. Meaning: deciding you can't bear to see a loved one with disease does not mean that another will not have problems. In fact, statistically, it will be the opposite...they will have some condition to manage in time.

With this said, think deeply about your perspectives on health and committing to a person with a life-long condition, yet recognize the fact that almost everyone will have hurdles to cross. Is it better to grow and accept a known issue in someone you love or to seek a healthier person who may end up with something far more complex and severe (cancer, autoimmune disease, etc.)

Posted by Anonymous on 5 February 2010

Please don't give up the one you love==if you really do--just because of a disease that in time can be very well managed and can even be something that, working together, might bring you closer. I have a boyfriend who got scared the 1st time I had real low blood sugar (I take insulin) but in time it came to be another way for him to show his love for me. I would call him if I got too low in the morning and ask him to call me back in 15 minutes. We worked together to see that it happened almost never but during this process we came to love each other even more. And guess what?? now he is ill and it makes taking care of him easier and even a real blessing. Remember you may not always have perfect healther either. Don't look back and realize that you gave up the perfect woman for you just because of a disease she never wanted to get.

Posted by Anonymous on 5 February 2010

I appreciate the concerns expressed by the "nervous Finace'. It s correct that all this takes a life time of adjustment. If love is strong it can v]be weathered--otherwise you will only transfer your worries to her and thus double the chances of her developing even more anxiety and later depression at 'letting you down' Believe me, I am 63 years old, have had diabetes for past 15 years ( T2) but have a labile tendency and hit lows if not careful. Have also hit the ambulance route.After learning to manage the problem I have done hours ad hours of daily productive work years with extensive touring for Govt of India, and for UN for at least 13 of these years of diabetes. I am retired now and still cope generally alone at home sometimes have hubby at home or one of the kids.
The first thing for you both to remember is IT IS NOT UNMANGEBALE. Apart from long term complications if care in lie style is not taken you certainly will have lows after sex, any excessive exercise. So eat your required calories and balanced diet BUT break it all into many meals as against one big one. I dont know the medical advice for T1 but for me the advice is 3 main meals and 3 snacks or small meals. Its difficult getting used to it but of you measure the quantity ad components of what you eat it becomes second nature. One starts out from home with emergency food in handbag, and if snack time will come while you are out ,make sure you have your healthy snack with you.
The important thing to remember, not to add to your weight but in a period f a day with 3 hour gaps you give the requiste kick to the pancreas.
I think it is important to check with yor doctor whether such a method will work for her as it works for me.Yes you will have to accept the challenge of not meeting prescribed 6.00 HB A 1C but over time this can be achieved with care.
IT IS ALWAYS A PITY TO SURRENDER A LOVING RELATIONSHIP. WE ALL GO THROUGH UPS AND DOWNS. HELPING SUPPORTIVELY IS A GREAT WAY OF LIVING
All my very best fro a wise decision.
Ms. Adarsh Misra

Posted by angivan on 5 February 2010

My husband is my 2nd marriage, and I love how he handles this. When we're doing foreplay, he gently whispers "did you check yourself?" and if I nod yes, he helps me disconnect my pump in a very sensual way. Fabulous! He treats my pump gently and respectfully as if it were just another limb...perhaps use some creativity and romance to come up with gentle, sensual ways to make sure she's ready to go.

Posted by Anonymous on 5 February 2010

I'm sure this is rather scary for both of you. I've been married for 30 years and was diagnosed with Type 1 34 years ago. My wife has gotten pretty good about providing "non-directive" support rather than "directive" support as discussed above. It can work, however (and we are far from perfect people).
I want to point out, too that it is very unlikely that the sexual activity "caused" the low blood sugar condition. More likely your fiance was paying more attention to you than to her BG levels - and, oops.
Finally, she will get the hang of managing this. It takes some time. I haven't had a serious low episode for over 6 years - basically since I started using the pump.
Good luck!

Posted by cde on 6 February 2010

It may sound harsh...but until and unless she learns to control/know/manage her BG levels, the prospects for learning to manage the wedded life are not terribly high.

Try (her) reading Dr. Richard Bernstein's book, THE DIABETES SOLUTION. It will point her in the right direction. Some people's BG goes up with sexual activity (higher counterregulatory hormones probably) and others' BG goes down...so each person has to learn to learn/control/manage his or her tendencies.

Dr. Stan De Loach
Mexico, DF

Posted by Anonymous on 6 February 2010

Sometimes doctors know less than patients, and this is one scenario where you shouldn't listen to your doctor as much as your own gut feelngs. Some of you are privileged to have a doctor who has the same type of diabetes as you do, but for most this is not the case.

I've had type 1 for 15+ years and have been married for 2. Whereas my Dad can detect a low blood sugar just by seeing a minor change in my personality (even before I can), my wife has not been able to master it and struggles with this. This is similar to the nagging you spoke of -- because my wife often isn't quite sure, she will nag me as a sort of cover-all to try and prevent lows.

Well, nagging will eventually desensitize the naggee, so don't do that. And not doing anything will have the diabetic go into lows which is bad.

WHAT IS NEEDED IS BALANCE!!
Encourage your spouse to pay close attention to your personality when you have a normal sugar. They should notice a certain consistency in both how much you talk and also how you talk. Your body movements will be slightly different, maybe slightly slower, with a low sugar. Also, you might miss certain obvious facts like the price of a grocery item, or the need to do a task at hand. It's usually a very subtle change in a person's attitude, but there's nobody more equipped than a spouse to notice subtle changes in their loved one.

If you haven't felt like your good at this, don't worry you're not alone. I mentioned my Dad -- well, he was with me and beside me all my life until I got married, and that's decades. So he knew me as good as I knew myself, and he knew what my "norm" was, and could therefore detect very quickly when I started straying from my norm -- a sign my sugar was too low (or even too high).

Give your spouse time. It might take years, but explain these concepts to them and help them understand that it takes time to train oneself to fully learn a person's norm, and then to interpret the little nuances, the small changes, the "100% yes that's my spouse!" vs. "hrrmmm, this seems like 99.7% my spouse, maybe something is wrong..."

It's a very fine line. Or as my Dad would say, the line is thinner than the hair on a frog. :-) But the skill will come over time.

Enjoy marriage, it is a wonderful blessing regardless of diabetes. If you feel alone, just remind yourself to keep communicating with each other. Listen (don't criticize!) and feel your spouse's anxiety -- don't try and fix it -- just listen. This is less a diabetes problem, and more a "learning to have a good marriage".

This too shall pass. Blessings in Him who made marriage!

Posted by Anonymous on 9 February 2010

Say 'please test your blood sugar' four times a day and once for good luck before having sex. I've had diabetes for 43 years and the more often you test the better in control you stay.

Posted by Anonymous on 21 February 2010

Since this is still new to your sweetheart, see about getting her a glucowatch or a implant like a puc. Lifes so busy these days and this small manmade device can her keep her glucose at the proper level. She needs you to listen to her and your just going to have to let her make up her own mind what she will do. Try to support her and as hard as it is to keep trying to fix her, just post ideas and reading material around your place and see what she comes to you about. Your research can lead you both to a better understanding of this change of your life style. I really think the anonymous posted on Feb 9 2010 says it best. Test often and you will find better control.

Posted by Anonymous on 14 May 2010

I have had type 2 diabetes for about 5 years. I am currently age 62. Before I lost my wife of 41 years to cancer in 08, she was constantly working on my diet, special diabetes meals, and monitoring my blood sugar. She would even give my my insulin shots. I realized that she took extra care of me and I NEVER resented it. It was what she did. Unfortunately, after I lost her, I was on my own to monitor and care for my BG levels. I have done pretty well, but have had several low BG level episodes..scary..

Now I have met someone else, and she is very interested in helping me manage my BG. I have trouble understanding (from a diabetic view) why anyone would consider it nagging to ask how your BG levels are, or remind you that you may be eating wrong. To me, this only shows that someone cares.

My suggestion to any diabetic is to accept the reminders that come from a loved one or even a friend as helpful, and not done to be nagging, but out of genuine concern. Diabetes is nothing to be ashamed of, it is a manageable disease. I appreciate knowing that so many people are supporting me.


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