For people with diabetes, things are pretty straightforward. There are certain things you must do such as take insulin and medication, and other things you should do like staying physically active. But if someone close to you has diabetes, things can be a bit murky. What are your responsibilities? When should you get involved? And when is it best to just back off?
The answers to these questions are not straightforward. Some people require extensive help tending to their diabetes on a daily basis — young children and people with disabilities, for example. Others are highly independent and may become defensive when people throw in their two cents. Regardless of your specific situation, here are five ways to help your loved one with diabetes.
Build your knowledge base
The more you know, the better you will be able to support your loved one. In particular, learn about the causes of diabetes, the short-term and long-term health implications, and the basic principles of blood glucose management. It can also be helpful to learn about the medications your loved one is taking or the devices he or she is using to monitor blood glucose or deliver insulin.
A great place to turn to for this kind of information is a Certified Diabetes Educator (CDE). CDEs are health-care professionals skilled at teaching people with diabetes and their loved ones all there is to know about living with diabetes. You may be able to find a CDE at your local hospital, or ask your physician for a recommendation. CDEs can also be found through a free online service: ncbde.org/find-a-cde.
Book and web resources are also available through the American Diabetes Association website: diabetes.org.
Communicate with the “patient”
As long as your loved one is open to the conversation, ask him or her how you can best help. Find out when he or she would appreciate your involvement, and perhaps more importantly, when he or she doesn’t want your involvement. It always helps to get specifics. For example, your loved one may not want you to tell him or her what to eat, but he or she may want you to have certain types of foods readily available or not readily available.
It can also be helpful to ask what the goals are. Living with diabetes entails many responsibilities; it is unrealistic to expect your loved one to do everything right all the time. Knowing what he or she hopes to achieve can help you set appropriate expectations.
Support, but don’t insist, on healthy and appropriate behaviors
Put yourself in your loved one’s place. If someone was constantly badgering you to do something, would you be motivated to do it? Rather than lecturing, find ways to make it easier and more fun for your loved one to make positive choices.
For example, have wholesome food options readily available at home, and choose restaurants that offer healthful items (such as a salad bar). Do your best to keep meals and snacks on schedule if your loved one needs to eat at certain times. And make healthy choices yourself — your actions can easily rub off on those around you.
From a physical activity standpoint, be willing to accommodate your loved one’s need to work out on a regular basis. Compliment him or her when he or she exercises, and be active yourself. Even if you can’t exercise together, your example can have a positive influence.
Stress reduction is another area in which you can support your loved one. Emotional stress can make it more difficult to control blood glucose levels in both the short term and long term. Finding ways to lessen common stressors in your loved one’s life can make a real difference in his or her ability to manage his or her diabetes.
Be prepared to step in…when necessary
Even if your loved one can take care of his or her diabetes independently, some situations will require your intervention.
Hypoglycemia
In many instances, people with diabetes are unable to properly treat themselves when hypoglycemia takes place. Hypoglycemia is usually defined as a blood glucose level of less than 70 mg/dl (3.9 mmol). Hypoglycemia can occur in anyone who takes insulin or medications that cause the body to produce extra insulin (sulfonylureas and meglitinides). Common causes of hypoglycemia include increased physical activity, multi-tasking, missed or delayed meals/snacks, eating less carbohydrate than usual, taking the wrong type or amount of insulin, vomiting, and alcohol consumption.
Symptoms of hypoglycemia typically include trembling, sweating, pale skin, loss of focus, erratic behaviors and slurred speech. In some instances, a person experiencing hypoglycemia may have difficulty thinking clearly or coordinating his or her movements, so a friend or family member may need to intervene.
If you suspect that a loved one is having a low blood sugar episode and a glucose meter (or continuous glucose monitor) is available, take a few seconds to check his or her blood sugar. It is best to learn how to do this before hypoglycemia takes place. Once you have verified that the blood sugar is low (or if no meter is available), find a food or drink that will raise the blood sugar as quickly as possible. Examples include:
• 3–4 glucose tablets;
• a handful of sugary candies (such as SweeTarts, Smarties, Skittles or jelly beans);
• 1–2 cups of a sports drink;
• 1/2 to 1 cup of orange or grape juice; and
• 2–3 graham crackers.
Keeping these types of foods with you whenever you are with your loved one is a good idea.
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Severe hypoglycemia
An extreme or prolonged low blood sugar may cause loss of consciousness, seizure or an inability for your loved one to consciously eat or drink. When a person is unwilling or unable to consciously swallow food, putting any kind of food into his or her mouth can be dangerous. Instead, call for emergency help and administer an injection of glucagon. Glucagon is not sugar. It is a hormone that raises blood sugar by stimulating the liver to release its stored-up sugar into the bloodstream. Glucagon is a prescription item that takes several steps to administer properly. You should be trained in its use by your physician or diabetes educator. Unused/expired kits can be used for practice on a pillow or doll.
Administering glucagon is 100% the responsibility of the support person. Make sure you have a prescription for it and have at least one kit on hand at all times (stored at room temperature). Plan to replace it yearly or right away if you must use it. Take it with you when you are away from home with your loved one who has diabetes.
“Sick” days
One’s ability to carry out diabetes management tasks can be compromised during an illness, so the support of a loved one or caregiver may become essential.
Illnesses usually cause the body to produce stress hormones that drive the blood sugar higher than usual and make insulin less effective. Ketones may also be elevated during an illness, particularly in those who are insulin-dependent. The buildup of ketones is called ketosis. When ketosis becomes excessive and is combined with dehydration, a life-threatening condition known as diabetic ketoacidosis (DKA) may develop.
Managing blood sugar levels during an illness is very important. Communicate regularly with your health-care team. Even if your loved one is not eating as much as usual, he or she needs to continue taking diabetes medications and basal (long-acting) insulin. It is important to check blood sugar regularly; ketones may also need to be checked (particularly for those who take insulin).
People with diabetes must consume extra fluids when they are ill — preferably clear, caffeine-free liquids. Calories in the form of easily digestible carbohydrates and a modest amount of protein are also needed. Be sure to contact your health-care team and/or go to a local emergency department if any of the following take place:
• repeated bouts of vomiting;
• prolonged diarrhea;
• large/high ketone levels;
• a very high blood sugar level that does not respond to the usual treatments;
• high fever that does not respond to fever-reducing medication; or
• erratic mental disturbance (delirium).
Setting up and getting to important appointments
If your loved one has difficulty traveling independently, do your best to offer assistance with transportation to and from important medical appointments. This may include routine doctor’s appointments as well as visits to a diabetes educator, podiatrist, ophthalmologist (eye doctor), dentist or other medical specialist.
Emotional distress
People with diabetes are at an increased risk for depression, anxiety/panic attacks, disordered eating and burnout. At some point, you may notice that your loved one, who previously was on top of things, suddenly starts neglecting his or her self-care. It does not matter whether your loved one is a seasoned pro who has been managing diabetes for many years or if he or she is new to diabetes. Depression, anxiety and burnout can strike anyone at anytime.
If you suspect your loved one may be experiencing issues with his or her emotional health, you need to discuss it with him or her and address it with his or her health-care team so that diagnoses can be made and appropriate treatment can be provided.
Take care of yourself
It’s important to make yourself a priority. You can’t help others unless you are well enough to do so, and eating well, exercising and getting enough sleep are key to physical and emotional health. If you are feeling burned out as a support person, look to community and peer support for caregivers for help. Check with the social worker at your local hospital to find help in your area.
Want to learn more about supporting a family member or friend with diabetes? Read “How to Support a Loved One With Diabetes” and “Hypoglycemia: What Your Inner Circle Needs to Know.”
