Caring For Your Spouse

Your Role

It's "In sickness and in health," not "In comfort and in wealth." Whether your spouse has been living with diabetes since childhood or has recently been diagnosed with the disease, diabetes is now part of your marriage.

How diabetes impacts your union is, in part, up to you. You know your spouse is phenomenal! Having diabetes has contributed to how great your spouse is. Common characteristics among people who live with chronic illness include:

• A sense of priorities. Insignificant events don't get blown out of proportion.
• A heightened understanding. They know what it means to struggle.
• A tendency to live a healthier lifestyle. They're likely to exercise more and eat a more wholesome diet.

On the other hand, diabetes care is time-consuming, can be expensive and may lead to serious complications if not controlled. But if you share in the lifestyle management of the disease, you'll both emerge winners. The meal plan recommended for people with diabetes is a healthy diet for everyone. While your friends are battling to lose the same 10 pounds over and over again, if you follow your spouse's meal plan, you're likely svelte. Join in on the exercise component of diabetes care, too. Your spouse doesn't always want to head out alone on a daily walk. Your spouse would much rather be walking hand-in-hand with you.

If your spouse has been neglecting the exercise component of diabetes self-care, you can help by joining your spouse in making a lifelong commitment to fitness. The key is to make physical activity an essential health habit. Make exercise as routine as brushing your teeth. Here's how.

Start today. Once you both feel the joy of sweat, you'll get hooked and begin planning ways to incorporate more physical activity into your daily lives.

• Be realistic. Vowing to exercise for two hours a day, 365 days a year is setting yourselves up for failure. But it could be realistic to say that you'll go to the gym three times a week.
• Be specific. Don't say, "We really should exercise more." Say, "We're going to jog for half an hour on Monday, Wednesday and Friday." Then write these fitness dates in your daytimers.
• Stay motivated. If you try skiing and find you don't like it, try something else. Tennis anyone?
• Don't beat yourself up if you miss a few exercise sessions. Your kids are going to get sick. You're toilet is going to flood. Just start up where you left off.

Diabetes Emergencies

If your spouse has diabetes, everyone in your family must learn how to recognize and respond to a diabetes emergency. A quick response could save your wife or husband's life.

Blood glucose levels that rise too high or drop too low can result in a medical emergency. If you're not sure whether your spouse's blood glucose levels are too high or too low, give him or her something sweet and get immediate medical attention. The sugar may help; if it doesn't, it won't make your spouse any worse. If you have young children, teach them how to dial 911 when Daddy or Mommy is sick.

There are two types of diabetes' emergencies.

1. Hypoglycemia

Hypoglycemia results from very low blood glucose levels (usually less than 4 mmol/L). If your spouse has type 1 diabetes, he or she may have missed a meal or snack, or exercised more than usual without adequately increasing food intake. Hypoglycemia can also result from vomiting, administering too much insulin, diabetes pills or drinking alcohol. Hypoglycemia is much less common with type 2 diabetes but your husband or wife may be prone if he or she takes diabetes pills.

Hypoglycemia can develop in minutes. Early warning signs include shaky hands and sweaty palms. But if your spouse has had diabetes for 15 or more years, hypoglycemia may occur without warning.

The signs of hypoglycemia include:

• cold, clammy or sweaty skin
• pallor
• hunger
• trembling, feeling nervous
• lack of coordination
• irritability, impatience, confusion
• fatigue
• headache
• blurred vision and dizziness
• abdominal pain or nausea
• eventually fainting and unconsciousness

If your spouse is conscious, give him or her a readily absorbable form of sugar such as five glucose tablets, six LifeSavers™, _ cup of juice or regular pop (not diet), or two teaspoons or two packets of sugar. If your spouse has type 1 diabetes and a doctor has shown you how, inject glucagon, a hormone that causes the liver to release glucose.

If you are not totally confident about the state of your spouse's health, don't hesitate to get medical help from your diabetes healthcare team.

2. Hyperglycemia

Hyperglycemia occurs when blood glucose levels are too high. It develops over hours or even days. It can result from too much food, less than the usual amount of activity, not enough insulin, diabetes pills or an illness.

The signs of hyperglycemia include:

• increased thirst
• increased urination
• fatigue
• agitation or confusion
• a sweet smell to the breath

If your spouse has type 1 diabetes, ask him or her test for ketones in the urine. Seek medical advice if ketones are present.

If your spouse has type 2 diabetes and you know by testing that his or her blood glucose level is high, call or visit your healthcare team. You can also refer to sections on Sick Day Management and Treatment of Hyperglycemia.

Physical & Emotional Stress

In times of stress, life and diabetes collide. The stress of work deadlines, family worries and financial difficulties can affect your spouse's blood glucose levels. Usually, stress leads to high blood glucose because stress hormones, such as adrenaline, cause the liver to dump stored sugar into the bloodstream. But some people with type 1 diabetes find that certain stresses cause their levels to fall.
When your spouse is stressed, his or her blood glucose levels will take more effort to manage. Add to this the fact that your spouse will have less patience for his or her treatment plan. Roll up your sleeves and cook healthy meals, help your spouse test his or her blood glucose and make sure insulin is taken on time.

Stress and Complications

Having diabetes in itself is a huge stress. People with diabetes carry with them the knowledge that the risk of complications increases as they get older and the longer they have the disease.
Many people with type 2 diabetes are threatened with insulin. "You better take care of yourself or you'll end up on insulin," warns the doctor. But diabetes is a progressive condition. The beta cells in the pancreas simply continue to deteriorate. Having to take pills or insulin does not mean that you and your spouse have failed in your efforts to manage diabetes. It means your spouse's body is getting older and needs help keeping blood glucose levels as close to normal as possible. About 40% of people with type 2 diabetes wind up injecting insulin no matter how well they take care of themselves

Avoiding Stress

Before stress starts to mount, help your spouse identify what helps him or her relax. Is it meeting with a friend? Taking a yoga class? A back massage from you
There's no question that people who exercise are in better control of their stress. Trouble is, most of us tend to slack off on exercise when our stress levels soar. And what we should be doing is exercising more! Work up a sweat and stress oozes out of your system. \
When tension's high, it could also be time to rent a funny movie. As we get older, many of us have had the humour drained out of us. A preschooler laughs about 400 times a day. On average, adults laugh only 15 times a day. Crack just a little smile and it'll lift your spirits. Go for a good belly laugh, and you'll both become downright invigorated.

Depression

The rate of depression among individuals with diabetes is about three times greater than in the general population. Depression often hits in the year after the diabetes diagnosis and is common when a new complication appears.
Fortunately, your spouse has been blessed with you. It's a quick slide from sadness to depression if there's no one to catch you on your downward descent. Depression rates are lower among married people and higher among divorced people and those who live alone.

Symptoms

People say they're depressed when they miss the bus. But depression is not just feeling down when things don't go your way. Depression is incapacitating. Your spouse may have depression if several of the following symptoms apply to him or her, and the symptoms have persisted for at least two weeks.

• feeling sad or irritable
• disturbed sleep patterns, especially waking unusually early at 3 or 4 a.m.
• a change in appetite
• a loss of interest in previously pleasurable activities and friendships
• a loss of interest in sex or a preoccupation with it
• feelings of guilt and worthlessness
• trouble concentrating
• crying easily or feeling like crying
• thoughts of suicide or a preoccupation with death

If you feel your spouse may be suffering from depression, encourage him or her to see the doctor. You can't talk a depressed person out of his or her troubles; having a negative perspective is part of the illness. Instead, let your spouse know that you recognize how badly he or she feels, and that you are available to listen.

Getting Help

Your spouse may feel it's hopeless to reach out for help. Your spouse is wrong. Just about everybody with depression can be helped. It's crucial that individuals with diabetes get help for depression. When you're depressed, you don't care about yourself so you don't take care of yourself. Your spouse's blood glucose levels may go all over the map and he or she may try to treat this despair with alcohol or by overeating.
People with diabetes are usually prescribed medications such as Prozac®, Zoloft® or Paxil® for depression. These selective serotonin reuptake inhibitors (SSRIs) are not "happy pills." SSRIs correct imbalances in the neurotransmitter serotonin in the brain. They're non-addictive and non-tranquilizing. In individuals with diabetes, they have to be carefully monitored and adjusted because side effects can include hypoglycemia. The combination of counselling and antidepressants is the best therapy around. 

Sexuality

In the movies, couples get impassioned after only a couple of kisses. A sexual relationship is decidedly more complex.

Your Wife and Diabetes

If your wife has diabetes, recognize that diabetes is associated with reduced libido, lubrication and sexual activity in women. Persistent high glucose levels may also lead to frequent bouts of vaginitis (inflammation of the vagina) and yeast infections.

You might want to consider a water-soluble lubricant in your lovemaking. Even moderate vaginal dryness can lead to painful intercourse. KY Jelly and Astroglide are effective in making intercourse more comfortable. Vaginal moisturizers (such as Replens® and Vagisil®) can help, too. And don't forget that most women require at least 20 minutes of foreplay before being ready for intercourse.

If vaginal dryness is minor, sex itself offers an all-natural solution. Intercourse on a regular basis actually promotes lubrication. The more sex you enjoy, the less likely that vaginal dryness will be a problem.

Your Husband and Diabetes

If your husband has diabetes, recognize that diabetes can be particularly hard on the penis. Libido, penile sensation and the ability to reach orgasm may be affected. At least half of all men with diabetes have erectile dysfunction, the persistent inability to attain and/or maintain an erection sufficient to permit intercourse.

Once a man has experienced trouble achieving an erection, he may worry about his next sexual encounter. And the more he worries, the more likely he is to a have problem! To interrupt this performance anxiety cycle, acknowledge the problem. Broach the subject in a supportive way, while reassuring him of your continued love and interest in sex. You could try suggesting other ways of making love which focus less on penetration. In fact, intercourse is usually not the most pleasurable part of lovemaking for a woman. Surveys reveal that about 70% of women can't achieve orgasm through intercourse at all, but only through manual or oral stimulation. What women want is to feel loved, and you don't need an erection for that.

Treatments

There are many treatment options for erectile dysfunction. The medication Viagra® helps some men with diabetes. Vacuum constriction devices are extremely safe and effective. Your husband is a pro with a syringe, so may want to consider penile self-injection therapy. The medicine in this injection causes blood to flow rapidly to the penis, causing an erection. Penile implants require surgery, but have a long history of success in men with diabetes. You can also read more on this topic in our brochure Man Talk