Mr. Jones has a different attitude about his diabetes. He also hates having it, but he’s determined to “lick it” by “being the best darn diabetic I can be.” He regularly meets with his health-care team. He is careful about what he eats, and he has asked Mrs. Jones to join him in following his diabetes meal plan. At first, she cooked special foods for him, but now the whole family follows the same meal plan as Mr. Jones. The Joneses try to take a walk together after dinner. Mrs. Jones is also worried about her husband, but she trusts that he is doing the best he can, and if he slips once in a while, she doesn’t say anything. They talk about his diabetes when one of them wants to, but they try not to focus on it too much.
You can readily see that for the Smiths, diabetes is a big problem, and how they cope with it causes stress and conflict in their marriage. Mrs. Smith is trying to be supportive, but she is offering “directive support.” This means that she takes responsibility for tasks that are really her husband’s, and she often tells him what to do, feel, or choose.
In one study of adults with Type 1 diabetes, psychologist Edwin Fisher, Ph.D., and colleagues found that directive support causes more negative moods and is probably counterproductive. Partners who provide this type of support run the risk of joining the “diabetes police,” a term coined by psychologist William Polonsky, Ph.D., C.D.E. 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, it can be annoying and, by making you feel like a diabetes criminal, breeds anger, resentment, and shame. The way they are coping with diabetes leads to greater distance and will probably affect other aspects of their relationships.
In contrast, for the Joneses, diabetes is also a problem, but one they have both accepted as a challenge. They collaborate on how to deal with it. Mrs. Jones is providing “nondirective support.” She assists her husband and cooperates with his requests, but the responsibility for his behavior lies with him; she has not taken it on. She tries to be actively involved in his self-care regimen, and she also recognizes that it’s good for her and the whole family. Their nightly walks and talks contribute to more closeness and intimacy, so that they are ready to deal with the next problem that develops and work it out together.
In these examples, the husbands’ attitudes play a big role in how the diabetes affects the relationship. But it’s also true that the partner’s attitude is very important. Even though Mr. Jones takes responsibility for caring for his diabetes, the Jones’s relationship could still be marked by strife and tension if Mrs. Jones resisted making the changes that he requested or chose to simply ignore her husband’s diabetes.
What is support?
To better understand what people with diabetes and their partners need as they cope with diabetes, my colleagues (Drs. Ruth Weinstock, Jonathan Sandberg, and Roger Greenberg) and I interviewed 42 people with diabetes and partners and asked them what is helpful and not helpful in their interactions with each other.
We found that help with diet is most important. Some partners help with grocery shopping and meal preparation.
One woman with diabetes said: “My husband likes to cook a lot of meat. I ask him not to fry my portion, and he is fine with that. He sautés it or broils it instead. He is very accommodating of my dietary needs.”
Others focused on being sensitive to the need to time meals, especially if the partner injects insulin.
One partner said: “I’ve learned that he needs to eat within 30 minutes after the insulin, now that he is on that. So I am sure to let him know when I’ll be serving supper so he can time his injection correctly.”