This is a very difficult question and is one that can be extended beyond diabetes to many aspects of a loved one’s life where their behavior is apparently either endangering themselves or likely to lead to short- or long-term negative consequences.
Sometimes it can be immensely frustrating for a caring parent/partner/friend or relative to experience lack of commitment to good healthcare practices on the part of someone they care about. Moreover, the knowledge that much of the burden of the consequences may fall on others can lead to anger and resentment.
There is no easy answer that can be applied universally, as everyone is different and their circumstances are unique. It is important to remember that, except in the case of a minor child, you must yield the control of the problem to the person who has it. For example, your spouse/partner owns his or her diabetes and must be empowered (except in very special circumstances) to make his or her own decisions on how to manage it. He or she is more likely to take advice if it is sought out than if it is given uninvited. They are likely to believe that they are giving as much attention to their diabetes as possible, whether or not it seems obvious to others that this is not the case.
Frequent pressure to do more may engender a sense of failure and actually lead to doing less. Motivation through fear is generally not successful unless the object to be feared is immediately present.
People with diabetes generally do not see or feel the consequences of the neglect of their diabetes on a day-to-day basis. When they finally do, it is too late to reverse them. For example, if you get too near the log fire in your living room, soon you realize that you do not want to get closer but should move away. There is no such warning before touching a hot iron or a burner on the stove. Thus, household cooktop and iron burns are much more common than burns from touching the blazing logs in the fireplace!
Perhaps the best that one can do is to help to ensure that our loved ones have access to high-quality education about diabetes and its consequences, ensure that they are given the tools to do what is needed to take care of it, and to support them in that effort to the extent that they are willing to participate.
After that, their autonomy must be respected, even though it may have some negative consequences for others. It is important to remember that you are not obliged to join your loved one in dangerous or destructive behaviors nor must you unquestioningly accept the consequences.
Whether you choose to do so will depend on several factors, including your personal belief system.
What should a wife know in order to provide support for her Diabetic husband who won’t take care of himself?
The more informed a spouse or caregiver is about diabetes, the better source of support he or she can be to the affected person in their lives. Thus, the answer can be very open-ended. To be practical, let us focus on a few key issues that are especially important.
If you are the main food preparer for the loved one in question, knowledge of diabetic diets and nutrition is very helpful. The appropriate type of diet for a person with diabetes is generally not complex, time-consuming, or expensive.
Attending diabetes education with your loved one’s dietitian is probably the most useful and important thing you can do. Getting to know as much as you can about diabetic meal preparation is very important, especially when there may be special requirements relating to kidney complications or high blood pressure.
Knowing how to treat a low blood sugar reaction, whether moderate or severe, is very valuable. The mental alertness and coordination of the person with diabetes can be impaired with moderately severe low blood sugar reactions and he or she may not have insight into what is going on or how to treat it. In the case of severe low blood sugar, reactions, the affected loved one may be drowsy or unconscious and prompt action on your part is very important.
Knowing how to check the blood sugar with their machine and how to treat a moderate low blood sugar, or how to use a glucagon kit to treat a severe low blood sugar, is very helpful indeed. Finally, knowledge of how to manage sick days is very helpful. The body’s response to illness can be somewhat unpredictable.
In the case of an infection such as gastroenteritis or influenza, blood sugars may be high or low, depending on whether the body’s stress reaction pushes the blood sugar higher or the failure to eat pushes it lower. Either way, during anything other than a minor illness, it is important to monitor the blood sugar frequently, and treat low or high sugars (the latter with insulin if necessary) and to ensure that your loved one is well hydrated, as dehydration will rapidly make the situation worse.
Most important is to know when you are unable to keep pace, meaning that the blood sugar is rising in spite of your best efforts and your loved one is unable to take in fluids or is becoming drowsy. In this case, ensuring that he or she gets prompt medical attention is the most valuable thing you can do.
There are, of course, many other ways in which you can help with your knowledge of diabetes, but these are three of the most important.
How do I know when my loved one with diabetes is having a low blood sugar reaction? What should I do to help?
The signs of a low blood sugar reaction can range from fairly obvious to quite subtle and hard to detect.
The very young and the elderly are less likely to spontaneously complain of symptoms, but more often just slip into hypoglycemia.
Those who have had diabetes for a long time, generally more than 10 years, may lose their ability to perceive hypoglycemia and fail to make complaints or take action to prevent seriously low blood sugar from occurring. This is much more common in longstanding type 1 diabetes than it is in type 2 diabetes.
Those who are aware that something is wrong and who are able to voice their concerns will complain of a combination of hunger, headache, shakiness, sweating, palpitations (a sensation of fluttering in the chest), blurred vision, and inability to think straight or coordinate their actions, especially fine motor actions such as writing, typing, or dialing phone numbers.
The very young, the elderly, or those with unawareness of low blood sugar will often exhibit confusion or bizarre behavior, shakiness, sweating, drowsiness, or restlessness in the earlier stages. Bizarre behavior can take many forms, from inappropriate laughing or crying, aggression, staring blankly, to making repetitive movements or inappropriate verbal responses to questions.
Most people with diabetes will have their own individual pattern of behavior that tends to repeat itself each time their blood sugar is low. Therefore, familiarity is very helpful for recognition of low blood sugar in loved ones or colleagues.
Warning Signs of Hypoglycemia
The signs of hypoglycemia can vary from person to person, so you should become familiar with your usual symptoms. You might have one or more of the following signs or symptoms of hypoglycemia, which can occur suddenly:
• Feeling drunk
• Rapid heartbeat
• Dizziness or light-headedness
• Feeling sleepy
• Difficulty speaking
If the low blood sugar is severe, loss of consciousness and seizures will occur. This is of course very worrisome to the observer and necessitates prompt action.
Preventing hypoglycemia in your loved ones
You can reduce your chances of having hypoglycemia by carefully planning when they eat and coordinating mealtimes and snacks with their glucose-lowering medication and exercise. The following steps can help you avoid hypoglycemia:
• Follow the meal plan provided by the doctor, diabetes educator, or dietitian.
• Space their meals evenly throughout the day and eat between-meal snacks.
• Make sure that they eat their meals no more than 5 hours apart.
• Wait for half an hour to an hour after eating before exercising.
• Double-check the dose of their glucose-lowering medication before they take it to make sure that they aren’t taking too much.
• Tell them to carry a quick-fix food such as hard candy with you at all times. Keep a sugar-carbohydrate-protein food (such as an energy bar) in the car in case their blood sugar gets too low while you are driving.
• Check their blood sugar level regularly throughout the day.
• Make sure you are familiar with taking glucagon injection if they become unconscious.
A Quick Fix for Hypoglycemia
If you have a feeling that your loved ones’ blood sugar level is too low, quickly check it with the blood glucose meter. If the blood sugar is 70 mg/dL or lower, let them consume one of the following foods right away to raise it:
• 1 cup of fruit juice
• 1/2 cup of a sugary soft drink (not diet or sugar-free)
• 1 cup of milk
• 5 or 6 pieces of hard candy
• 1 or 2 teaspoons of sugar or honey
• 2 or 3 glucose tablets
After 15 minutes, check the blood sugar level again to make sure it is still not too low. If it’s still low, have another serving of something sweet. Repeat these steps until the blood glucose rises above 70 mg/dL.
Loss of consciousness can result from both very high and very low blood sugar. It comes on much more rapidly with low blood sugar than with high blood sugar and is usually more rapidly reversible if treated promptly and effectively. However, unless the circumstances unmistakably indicate high blood sugar or a fingerstick glucose reading is available, the safest treatment is to administer sugar or glucose or use a glucagon injection kit.
Additional glucose is unlikely to worsen in the short term the already serious situation of a coma due to high blood sugar but could be lifesaving to a person with coma due to very low blood sugar. Therefore, when in doubt, glucose or household sugar administration is the best route to take.
Fortunately, the body has powerful mechanisms to prevent the blood sugar from becoming fatally low and these are generally intact in those with diabetes. For this reason, severely low blood sugar, while it is an emergency, is seldom fatal, considering how often it occurs.