Navigating Marriage When You Both Have Diabetes
Couples who manage together, stay together
So many resources for couples and diabetes seem to focus on one spouse with diabetes. But what if both of you have diabetes? Real married couples give their secrets for success in navigating the highs and lows that life throws their way.
Experts will tell you that communication is key in making any relationship succeed. When two people have diabetes, the push and pull between openness and privacy can feel even more fraught, says Jenna Eisenberg, LMFT, owner and operator of Denver Diabetes Counseling and Denver Marriage and Family Therapy.
In counseling couples with diabetes—and in her own life with type 1 diabetes—Eisenberg urges patients to be honest with each other but to err toward privacy when it comes to sharing all aspects of their diabetes.
Eisenberg suggests that couples set boundaries and guidelines about diabetes early on in their relationship. Those boundaries can be modified as partners assess their needs. Asking what each person needs of the other, really listening to that response, and respecting each other’s wishes are the keys to keeping communication lines open.
The way you treat your diabetes may be different than how your spouse treats his or hers, Eisenberg says. That may mean that you have a daily check-in about your diabetes but only ask about your partner’s when you spot signs of a low. Eisenberg says concern, or even fear, can cause you to want to push a bit, but it’s important to respect each other’s wishes, even if that means leaving each other alone for an hour.
You may, for example, set a rule that you and your spouse can ask each other about blood glucose levels three times daily—but your partner only has to answer twice, as is the case with one couple Eisenberg works with. Or you may choose to not allow specifics—only to say, “I’m high but treating, thank you,” or “I’m low. Would you please get me a juice box?” Or you may choose to only intervene in the case of an emergency—such as a serious low—with a plan in place, just in case.
For Steve and Lisa Lindsey of Elizabethtown, Kentucky, setting boundaries helps them cheer each other on and gives them the space they need. Lisa, 48, was diagnosed with type 1 diabetes in 2007, and Steve, 58, developed medically induced diabetes in 2015, a result of the anti-rejection medications he takes for a double-lung transplant. “We often share our numbers, [such as] A1C, blood glucose,” Lisa says. “The only time we don’t share or help is when one is grumpy or frustrated and doesn’t want to listen to the other.”
You may choose to share everything. And with today’s diabetes management tools, such as apps that work with continuous glucose monitors (CGMs) to transmit glucose readings to friends and family, you can. Cassie and Jason Thompson, both 46, of Royse City, Texas, transmit their glucose levels to each other’s phones. Sharing it all makes sense for the couple, who have been together for 25 years. They both have latent autoimmune diabetes in adults, or LADA. They offer gentle nudges about self-care but ultimately give each person ownership over his or her diabetes. “If we’re together, I’ll just say, ‘Hey, do you need a juice box, or do you need something to eat?’ ” Cassie says. “Just a little gentle reminder: ‘I see your numbers are going down, what do you want?’ ”
Even with clear boundaries, frustrations may rise. Differences in management can lead to one person asking, “Why can’t you do things the way I do?” Eisenberg says. And that can backfire. It makes the other partner feel attacked, she says. “Even if one [person] has [a lower] A1C, or type 2 versus type 1, it’s different for every single person.” What might work for one person may not do the trick for a spouse.
Those differences can cause relationship dissatisfaction. In a 30-year review of couples with diabetes, published in December 2013 in Contemporary Family Therapy, researchers found that hiding concern for the other person, pretending that things are fine to avoid conflict, nagging, poor communication, and attitude discrepancies between spouses were indicators that couples with diabetes were suffering.
Cherise Shockley, 34, of Noblesville, Indiana, was diagnosed with LADA a decade before her husband, Scott, was diagnosed with type 2. Post-diagnosis, Scott has a better understanding of her diabetes, Cherise says, but differences still remain: She and Scott could eat the same meal, and it would affect their blood glucose differently.
Those differences could be a source of competition or jealousy in a relationship with diabetes, Eisenberg says, but couples can communicate their struggles and successes to help each other keep a positive mental outlook.
Embrace the Upside
Kylee Walsh of Manchester, Connecticut, says she and husband Josh don’t get competitive. They’ve found a different way to check in on each other. “The only time we ever really compare to each other is if we have the same blood sugar at the same time,” she says. “One of us will jokingly say, ‘Meant to be together.’ ”
The Walshes say the fact that both have type 1 diabetes does more to help their relationship than hinder it. The couple met while working at the same diabetes camp and were married soon after. For the Walshes, both 30, that shared history meant the other instantly understood aspects of diabetes that required explanation with other dates. “It makes that conversation of getting to know each other that much easier when they can completely understand, not having to worry about ‘Oh, they’re going to judge me,’ ” Kylee says. “They just get it.”
Address Money Worries
Diabetes brings with it any number of stressors—and few things are as stressful as financial concerns. Diabetes is expensive to treat, so it comes as no surprise that double the costs for two people’s diabetes supplies means double the squeeze. “I don’t know what we would do without our insurance,” Kylee Walsh says, “because it’s not just Josh and I. It’s our son [who has type 1], too.”
When it comes to insurance plans, most cover insulin, diabetes medications, and durable goods such as insulin pumps. But paying for your care and supplies can still be expensive. Shana Alex Charles, PhD, MPP, a health care and insurance expert and assistant professor in the Department of Health Science at California State University–Fullerton, cautions against plans with low premiums—they may sound good, but they usually come with a high deductible. That means that while you pay less per month, you’ll pay more out of pocket before your insurance coverage kicks in. “Don’t be afraid to pay a higher monthly premium [for family coverage],” she says. “It will probably save you money in the long run.”
If you know your family will have to change insurance plans in the future, talk to your health care providers to make sure they’ll accept your new coverage. “Do as much investigation as possible, and be really open with your doctors,” she says.
Flexible spending accounts offered by some employers can help you save money on medications, doctor visits, and more. Such accounts draw money from your paycheck before taxes. To help you determine how much money to put into your flex account, add up the previous year’s medical expenses for both you and your spouse.
Health care providers who embrace technology may also end up saving you money, Charles says. Sending a text—or using a CGM that allows your provider to see your blood glucose levels in real time, for example—could save an office visit.
Setting aside money in an emergency fund can help you to feel more prepared in the event of an unexpected medical expense, a short-term disability, or something else. Financial experts generally recommend saving an amount equal to three to six months’ worth of household expenses.
Sex And Intimacy
Diabetes can cause issues at the least opportune moments, and that includes in the bedroom. Complications of diabetes can create sexual problems, but a little patience and openness can help couples keep their partnership healthy.
Understand the Issues
For men, erectile dysfunction can be a side effect of diabetes, particularly with poorly managed blood glucose, according to research published in the March 2016 issue of the journal Current Sexual Health Reports. For women, vaginal dryness led to difficulty becoming aroused and reaching orgasm—resulting in sexual dissatisfaction for almost 35 percent of women with diabetes who used insulin, and 26 percent of those who didn’t, an August 2012 study in Obstetrics & Gynecology found.
Diabetes can also mean more risk for vaginal yeast infections, making sex uncomfortable. And when sex is uncomfortable, desire disappears, says Joseph Nelson, MA, LP, CST, a practicing psychologist and sex therapist and former director of behavioral medicine services at the International Diabetes Center in Minneapolis. A healthy sex life is a vital part of a marriage, so communicating issues and desires—or a lack of them—is important.
Preconception planning is essential, so if you’re not ready to have a baby, be sure you avoid unintended pregnancy. Couples, especially women, who are trying to have children are encouraged to get to health targets first. A woman’s elevated blood glucose at the time of conception can raise a baby’s risk for birth defects. In women who have very poor blood glucose management, that risk is as high as 25 percent, and the risk for complications during pregnancy is raised, too, says Aaron Caughey, MD, PhD, professor and chair of the Department of Obstetrics and Gynecology and associate dean for women’s health research and policy at Oregon Health & Science University.
Diabetes is hereditary, and a child’s risk for diabetes is greater if both parents have diabetes. There’s no definitive answer as to how much greater, but studies have found the risk to be 1 in 50 with a type 1 mother and 1 in 15 for those whose fathers have type 1.
Type 2 is more likely to be hereditary (having two type 2 parents led to a 30 percent higher risk—that’s six times the risk of someone without any type 2 parents—one study found), but Caughey urges families not to discount environmental effects. “Households tend to eat together, so the dietary and exercise habits of the parents are often passed down to the children,” he says. “So, yes, the offspring have a higher risk of diabetes, but the genetics are only a small part of the story.” Learn more about diabetes and pregnancy.
Talk It Out
“When people are experiencing sexual problems, more often than not they keep it to themselves,” Nelson says. “That means that their partner might be making some assumptions. If a man isn’t able to get an erection, maybe the partner starts to think, ‘Maybe he’s not attracted to me anymore.’ If neither one is talking about it, the distance just becomes broader and broader.” But if couples are able to talk about their issues, they can find solutions, Nelson says.
Aman Shah and Elizabeth Reyna of Bolingbrook, Illinois, have found that to be the case. Both have type 2 diabetes, and they tackle it together using metformin and healthy eating. But Elizabeth, 41, says that diabetes has had an effect on her desire, which in turn has had an effect on Aman, 60. “I want my wife to come back to me again,” he says. “That is a key factor in a relationship. If I have to find a medicine for that, I have to find a medicine. The distance can become a wall, eventually.”
Elizabeth says that confiding in her health care providers has not been helpful because they offered her brochures without discussing diabetes or its side effects, particularly regarding sex. Though the medical community has come a long way, Nelson says, some providers are uncomfortable or unwilling to discuss sexual issues. This is unfortunate because medical interventions—including medications, lubricants, techniques, and forms of stimulation—for men and women can make sex more pleasurable. If you want more help, make an appointment with a sex therapist. Start your search with the American Association of Sexuality Educators, Counselors, and Therapists (aasect.org).
Nelson suggests that couples dealing with sexual dysfunction focus on pleasure, not orgasm. Broadening your definition of sex to include other types of play can make everyone feel good and maybe even add some spice to the relationship. The Walshes, on occasion, have taken each other’s insulin pump off (though not for longer than an hour) to get things going.
For some couples, the person who has had diabetes longer—the one with “more experience”—may feel as if he or she is responsible for helping the other manage. Jane K. Dickinson, RN, PhD, CDE, is the program director for the Master of Science in Diabetes Education and Management at Teachers College at Columbia University. She’s lived with type 1 diabetes since she was 7 years old. Her husband, Randall Hannaway, was diagnosed with type 2 diabetes when they were dating. Even when one of you is a professional diabetes “expert,” that doesn’t put that person in charge, Dickinson says.
Rather than coaching, Dickinson suggests becoming a teammate. “The way I try to do it—and I would recommend this to other couples—I say, ‘Do you want to go for a walk with me?’ ” she says. It’s a better approach than the more combative, “Are you ever going to exercise?” But it takes effort from both. “If he wants to come, it’s awesome,” she says. “If he doesn’t … that’s his choice.”
Get a Game Plan
When a couple has diabetes, they may experience simultaneous lows, with mood changes and irritability, or they both may need assistance getting fast-acting glucose at the same time. So having a plan in place is wise. For some couples, that may mean a policy of treating your own low before helping your partner. It might also mean teaching children to spot their parents’ lows. For the Thompsons, that makes sense, as their youngest son, Seth, was diagnosed with type 1 when he was 16 years old. “From the very beginning, we developed a family approach,” Cassie Thompson says. “When he and Jason got [continuous glucose monitors], he wanted me to listen for the alarm. We all just kind of listen for each other and help each other out.”
Managing together can improve relationships, some couples say. Making healthy food choices can mean more home cooking and family meals. Getting active together can lead to better health for both. Talking candidly about how you feel, and why, builds a foundation for strong bonds. And all of that improves mental health, according to a 2012 study published in the Journal of Health and Social Behavior—an important benefit because people with diabetes are at a higher risk for depression. Couples who work together can face whatever diabetes throws at them. “I think it’s brought us together,” Reyna says. “We’re more aware because we don’t want this to take us down.”
“Everyone thinks I’m married to Superwoman,” Scott Shockley says of his wife, Cherise. “But every once in a while she could use a little tender loving care when it comes to her diabetes.” He advises partners to be kind to each other, but the Shockleys, and many other couples, look beyond each other to find added support in managing their diabetes. Cherise is a familiar face to the diabetes online community. She runs weekly diabetes social media advocacy Twitter chats with the hashtag #DSMA. Not sure where to start? Ask your health care providers about local diabetes support groups, or visit the American Diabetes Association’s online community at community.diabetes.org.