Need advice for a friend whose husband has Type 2. My son has Type 1, so I know about diabetes from my end, but she is dealing with a lot on her end. Her husband has been diagnosed for several years but is in denial and refuses to take his meds because he doesn't like how he feels when he goes low. Obviously his meds need to be adjusted, but he won't go back to the doc. When she can get him to test he is always high - like 400 to 600 range! He is wasting away in front of her eyes - getting skinnier and skinnier, drinks liquids a lot and urinates a lot. I think he is clearly going into DKA, and so does she. When I have given her keytone test strips to have him test, he has come up with large keytones. He just says he's not going to worry about it and won't do a thing about it! I have sent over websites, links to Diabetes Powershow, etc. but he won't listen. She's at her wits end. Any advice on how to get through to him???
Sure! I've got some pop psychology that might help. :)
Hubby and she are in a classic pattern - she nags or otherwise exerts emotional pressure and he resists. It feeds on itself and it only raises his defenses. Tell her to act casual for a change. Don't pressure him. (Acting casual is not the same as biting your lip and being obviously worried. He'll know if she's repressing the urge to nag, and that's almost as bad.)
Right now his focus is inappropriately on managing the external pressures exerted by spouse and healthcare authorities. The goal is to re-target his focus from external pressures to building his own inner resolve and awareness. In other words, to get him to "own" his condition.
To help get him there, try to catch him when he's not in a particularly defensive mood. At those times, try to influence him in non-threatening ways. This takes some creativity. Expose him again and again to key facts in ways that break familiar patterns. For example, expose him to other diabetics who ARE controlling their diabetes - in a fun way, not a support-group way. (Lure him onto this forum and others like it, for example, not by way of the diabetic threads, but some of the humorous threads.)
For another example, at an optimal time - when he is not defensive, like at a fun social event - get somebody he respects and whom he will NOT automatically oppose - a friend, a colleague, an elder, a neighbor - to give him a copy of Richard K Bernstein's Diabetes Solution. He may actually read it if he gets it that way!
Try to approach his blindside. Use humor as much as possible. People are VERY vulnerable and amenable to influence when they are laughing. :) But don't then attack - because that will only raise defenses. Give him information with the trust that he will do something with it. He needs to feel as though he is voluntarily taking up the information given him.
Specifically, he needs to:
1) really understand what's at stake
2) feel empowered to do something about it (vs. feeling defeated or apathetic)
3) know WHAT to do
...and NOT necessarily in that order.
Really understand what's at stake - he's probably got too many defenses against this one already. People have been warning him from day one, probably. He doesn't need this reinforced at this point.
Number 2 is critical. He must feel both emotionally and logistically empowered (as in, not feeling helpless, and actually having all the supplies there and a way to easily learn how to use them). The Bernstein book is great in that sense - it reassures readers that they have the power and that ONLY they have the power to take responsibility for their health, and it tells 'em exactly what to do.
Knowing what to do goes hand-in-hand with being empowered. Realizing that normalizing blood sugars is possible and actually yields the only clear path to hope that many diabetics have these days is a biggie.
Once he gets that, THEN remind him of what's at stake.
By that time, he should have the ball and be running with it. :)
Yeah what Teld said. You can't force anyone to take better care of themselves. They have to want to do it. We have all heard the saying that you can lead a horse to water but you can't make him drink. I say there is nothing that says he won't. She should try gently leading him and remember that trying to force him will do no good. It would be like trying to force a child to eat something they don't want to eat.
I would try getting him to see that he can feel better and that the situation is not hopeless. You have to make him want to do better not force him to see the error of his ways
Teld and Sternwinder are very kind, and are probably right. Maybe this kind of strategy does work. I would not have the patience for it, however. I'd probably just ask if his life insurance was paid up and ask how he'd like to be buried and what he'd like me to have at his memorial. And then I would grant him total responsibility for his own life and stop letting him drag me down. I'll be interested to see what other TuD people have to say, maybe those who have dealt with this. It just feels wrong to me to put yourself in a position - whether you're being sneaky or overt - where you think you have to manipulate another adult's behavior.
Hi Cosumne Jan,
Not sure it's kindness, but I'll take credit anyway. ;D
I understand about not having the patience.
What I'm thinking is, if the goal is to get him to change and he doesn't want to, then exerting influence - manipulating, as you say - could work. Most of us manipulate other adults all the time, unconsciously if not consciously. We're constantly negotiating things in our work, personal relationships, professional associations, etc. Part of being human and all that. Doing something consciously to influence someone else is a legitimate strategy to me - it actually leads to LESS unconscious manipulation, or even replaces it - and it's not always a bad thing.
But if, on the other hand, the goal is to let him do whatever he wants and not be bothered, under the assumption that the issue isn't worth bothering about or that one CAN'T or SHOULDN'T consciously influence another person, then probably her focus should be on altering her own mood or divesting herself of attachment to him. That works, too. But just from that one description, though, it sounds like she's deeply vested in his survival - spouses can be funny that way! - and won't be content with the latter.
I've taken both positions - get involved, don't get involved - with various people close to me who were doing destructive things to themselves. It all depends on 1) the type of relationship, 2) how much potential there is to really affect the person, which depends on how firmly situated are the habits, the sorts of personalities involved, that kinda thing, and 3) the type or level of commitment defining the relationship.
You're not only kind, you're very smart. I think people who have you for a friend are fortunate.
he doesn't like how he feels when he goes low
I'm not surprised! If he's usually 400-600, even coming down to 300 would probably feel awful as his body isn't used to it. It's something that does pass with time as one's body gets adjusted to more normal BGs. I'd be inclined to at least give him that information, but I agree - you can't change someone else, just give them enough information to make an educated choice.
That's a tough one. I agree with both Teld and Jan. Nothing short of him owning his D will bring about the needed change. The problem is his. But his actions affect everyone around him. Thing is, arriving at that point is as individual as this disease.
I was in denial for years. I didn't have insurance or a big income and did not want a diagnoses that could be an albatross. Getting me to a doctor, and a diagnoses, was something of an intervention. Like your friend's husband I was wasting away (145lb at over 6 ft) and had already developed some bad complications. Staying alive and reversing my complications has been my motivation. He really needs to understand that all the complications are inevitable if he keeps the course he is on. Getting him there is the problem.
Teld has some great methods for accomplishing that. If those don't work, Jan has the only option. Get your house in order and make plans for a very unpleasant and short, future.
Tell them that, please - these days, they have this inexplicable idea that I never call, I never write...aherm.
This is horrible way to go rotting out.
After 26 years not really dealing with issue, got stroke from not really dealing with properly. That fixed me. It took 4 years to wrestle mess back to ground.
Got on 1200 calorie diet, 2 miles walking a day and metformin with proper metering and was able to get a1c dowm from 13.3 to 6.4. Weight finally came down from 330 to 240 pounds. Eyes cleaned up with hemorages gone, kidneys stabalized, off the actos/starlix/glyburide. Under proper diet, exercise, metering and insulin - lows and weight are controllable.
Under starlix/glyburide - that can be a fracas.
I am not Doctor and you need a good Doctor -Diabetes Team to advise and assist you.
See my book "At the Precipice" by Jim Snell. I can send one.
I would offer to the good man - please do not do your current approach any longer. Unless dead in box, it is NEVER to late to change and stop the rot.
I just went to Amazon and bought it for my Kindle.
thank you most kindly.
Jan and teld have good advice. I hope there are no children involved--what parent would want to kill themselves and leave behind that kind of example for their children?
However, now I'm curious. Is the fellow really T2 or has he developed T1?
whatever. My wishes are best of luck and please deal with asap.
There are no instant answers but current approach while in your hands do not seem best answer as one who has been there - done that. Good luck and may your Gods go with you.
How sad. Twice I dealt with similar circumstances with my ex. He was an alcoholic and after trying to fight the fight for over 20 years I divorced him. He wasn't interested in fighting it and I couldn't do it for him. 2 years later he was diagnosed with bladder cancer. Another 2 years went by and it kept coming back. The dr. said he should have his bladder removed but he wouldn't have any of that. I tried to tell him that living without his bladder would be better than not living. It took him another year to decide maybe he would do the surgery but it was too late. He died 6 months later.
Obviously the up front way hasn't changed his thinking. If the sneaky way (My daughter always says it's ok to manipulate for good and in this case I have to agree) doesn't work then I have to say the blunt way might. Andi if it doesn't then your friend should put her life in a position that she can deal with it when he passes. You can't make someone else take care of themselves.
it is unfortunate that his mind will not change. As everyone has said it is pretty much impossible to change someones mind if they do not want to do it. However, I think when his condition finally gets extremely severe, he will realize the reality of the situation. Hopefully, you can find a way to really express how serious the situation is right now: tell him about the future consequences and tell him how it will affect his wife. Maybe even give an ultimatum if necessary to save his life. It may seem a bit drastic, but it may be the only way to get him to respond. If that does not work well, all you can do is continue to wait.
This is most unfortuante. The high glucose levels are making his viens and ateries soft and rubbery all over and potential for bad stroke. Best case is he dies. Worst case is he ends up disabled all over and stuck in bed.
It really is critical to get the glucose levels down to 155 average or lower.
One does not have to starve - only practice good portion control and get good exercise and be on meds with correct dose and application.
best wishes and good luck.
1st of all tell her to join the site she doesnt have to have diabetes to join the site. 2nd that is something she is going to have to do an intervention including his doctor and other family members. 3 rd she just really need to explain to him that she loves him and he is only hurting himself. Also local support groups might help..
I wish you the best of luck, he is not only in denial but will soon be worse. With readings that high he will most likely lose a limb or his eyesight. I have seen it before in others, its a shame it takes that before someone wakes up.
I remember back when I was a kid, the weeks before diagnosis, things were obviously very very wrong (every sign of DKA for at least a month, getting far worse at the end) but I didn't get to the hospital until unconscious from DKA. And after that... acceptance wasn't that hard, being stuck in the hospital for two weeks in recovery.
Can you just get the guy to a hospital that will actually hospitalize him for DKA? I know "give them the pills and treat them as an outpatient" is popular these days, but if that didn't work, putting him in the hospital really is the right thing?
As to "not liking how he feels when he goes low" I can identify, but many docs I think are not that appreciative of hypos? I mean they either make them sound like the worst thing in the world (leading to the situation where your friend's husband is, preferring DKA to risking a hypo), or are scared to talk about them because then their patients might stop taking meds? Getting him to talk to other PWD's here might be much much better than any doc? Some of our attitudes are a little cavalier but most of us balance risk+fear of hypos with treating diabetes OK.