Independence vs. Dependence

In my practice, I’ve seen some married couples lately that remind me of my own family of origin: the man has diabetes that he controls with insulin and has great pride in his ability to deal with it without depending on anyone else, for anything. These men do not tell anyone they have diabetes unless they are forced to do so (by severe hypoglycemia, or low blood glucose levels, for example), and they believe they need little advice on managing the condition.


They usually do not inform their doctor of much and certainly do not tell their families about the wrestling matches they are having with their blood glucose control. This wouldn’t be so bad if their blood glucose were actually in control, but more often than not, their control is erratic. This erratic control leaves them vulnerable to severe lows, which require assistance from others in the family.

Don’t get me wrong—I am not blaming these men for their lows. I understand that using insulin puts a person at risk for lows, and that they are not fun and no one wants to experience them. What I want to discuss is the struggle between the perception of independence and the shame of dependence. I believe that this struggle leads these men and their partners to be more vulnerable to the lows and the emotional pain that comes with the fear of this traumatic event.

I recall the many times I would witness my father, who had Type 1 diabetes, during such severe hypoglycemic events. At times he would be silly and joking, at times he would be angry and hostile, and then there were the times he would convulse. In all of these situations, my mom and I knew he wasn’t himself, but that didn’t change the fact that we were experiencing a traumatic event, fearing that if we didn’t act appropriately, he might die, and if we did act correctly, he wouldn’t remember any of it. This left us scared and quite diligent about preventing any further such events. I do think that we, in some senses, were traumatized from these events, and I suspect he was also. Although we never talked about it, as I sit with couples today I see the same level of trauma and how difficult it is to regain balance.

The couples I am working with report the same types of events, though less frequent. The same dynamics tend to exist with the man not sharing much, wanting to do it on his own, and the woman in the position of guarding against the hypoglycemic events. The woman is also often hypervigilant, like someone who is experiencing posttraumatic stress disorder (PTSD). This leads to anger and fights within couples trying to figure out how to deal with something that is both physical and psychological.

As I continue to work with these couples, I wonder how many others are out there with the same types of issues. And I wonder how much of this is related to the need for independence vs. the shame associated with feeling dependent. Finally, I wonder what impact this dynamic has on the couple and on the other family members.

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  • diddy

    i understand the need for indpendance,but i know that i can depend on my wife for help and support. i appreciate that you ackowledged that it is a struggle dealing with diabetes.

  • Bernard Farrell


    Thanks for highlighting an important issue.

    As the man with diabetes, I know my wife did a good job of working with me to change my ways.

    For example we worked out a protocol (over several years) where if she asks me to check my blood sugar I will automatically do that. This means that even if I’m low and she asks me I’m less likely to refuse.

    I also better understand the fear she has when I’m driving, which means that I generally test before I drive – probably about 90% of the time, even if I feel my levels are good.


  • Suzanne

    Having also observed this professionally, I experienced it on a personal level last month. My husband who has type 2 daibetes and takes 1/2 the smallest dose of Prandin had a low driving on a vacation. He is a physician and has done very well overall but resisted coming to our education center. He only tests fasting and resists doing frequent SMBG. I have not pushed as he clearly wants to do it by himself. Part of the problem is that the person having a low is not processing during that time and does not remember fully the event later. My approach now is to request that he help me help him; so we are having discussions about this. It is a process and pushing usually slows rather than speeds.

  • Ephrenia

    This issue is so VERY important. Men don’t realize the stress they put the rest of the family through when they block us out. My Dad was that way. No matter the problem he was having he wanted to handle it himself. He even would tell the Drs he was doing okay when he really weasn’t. He “didn’t want to worry? us, particularly Mom, like he thought we couldn’t SEE it and that made us worry all the more.

    We lost him in November. The same day he went to the doctor who treated his diabetes and didn’t tell him he was having breathing problems because his appointment with the pulmonary Dr was the following week. He wanted to wait until then, he didn’t make it.

    Guys, don’t put your family through this. TALKING about it and knowing you really ARE looking after yourself is infinitely preferable to the WORRY of not knowing for sure and the GRIEF of finding out you didn’t.

  • The Spouse

    Your article made me feel as though I just read an excerpt from ‘My Life’. My husband is ashamed of his disease, as though he did something ‘wrong’ and brought it on himself. He was diagnosed at the age of 4. He is currently 48.

    He plays the ‘Blame Game’ because I made him visit an endocrinologist who changed his shot schedule from 1/day to 2/day. Now he is taking 4-5/day. Everything was better at 1/day, according to Doug. Less reactions, better control…

    Every day is a battle. It makes you want to walk out, but you can’t because you care, even though it isn’t realized.

    If and when a reaction occurs, the hostility grows. Communication ceases and it gets worse instead of better. The shell around him grows and grows. This makes it harder and harder for anyone to get in. Thus his life is in danger more and more each day.

    Living w/ this diabetic profile is scary for everyone involved.