You, Me, and Diabetes – How the Condition Impacts Relationships
By Alexandra Frost
Explore the challenges and effects of diabetes on relationships, and how to position yourself and your loved ones for success in relationships of all types, at all stages.
It can seem like there are three people in any relationship for someone with diabetes – you, the other person, and the condition itself.
The constant burden of monitoring blood sugar, administering insulin, planning your next meal, and anticipating medical issues can make diabetes feel like an unwanted third wheel. From marriages to friendships, dating to working life, diabetes seems to insinuate its way into every aspect of relationships.
Erick Lurhs, a library computer systems manager in Easton, Pennsylvania, has lived with diabetes for 36 years and knows this well.
“I’ve been living with it so long that I don’t know life without it,” he said. “But the other people in my life have had to adapt to me. Like loud glucose alarms in the middle of the night, confusion when I’m low, food requirements around sugar, carbs in general, gluten. It’s the parents, siblings, and spouses that make it possible.”
Researchers have studied the impact of diabetes on relationships extensively. They’ve found that many married people with diabetes tend to cope better, which led to lower A1C values. Loneliness also has been connected to an increased risk of type 2 diabetes.
But marriages involving people with diabetes can be fraught with challenges. According to another study on type 1 diabetes, misconceptions and stereotypes, occupational and fertility limitations, and quality of life can all create barriers in marriage.
Relationship issues are often intertwined with mental health concerns, which people with diabetes are at elevated risk for, said Dr. Henry Anhalt, endocrinologist and chief medical officer at Embecta. He said mental health conditions are poorly recognized, diagnosed, and addressed, and if left untreated, can take a toll on relationships.
In a study on chronic conditions, over half of respondents said that their self-care negatively affected their relationships, which are well-charted in the Taxonomy of the Burden of Treatment, an intricate web showing just how far those impacts reach.
Here are the trends that experts see in relationships, and how to position yourself and your loved ones for success in relationships of all types, at all stages.
Self-esteem, sex, and relationships
Anhalt starts at the beginning of a romantic relationship’s lifecycle, noting many of his patients who begin in their first serious relationships as teens or young adults encounter some problems early on that others without diabetes might not have to face.
One of the most predominant, he explained, is self-esteem issues as people with diabetes navigate treatments that may cause weight gain, and explore intimate encounters with pumps, alarms, and other interruptions related to their treatment.
Even though some progress has been made to normalize challenges around diabetes equipment, he said his patients still struggle with maintaining a positive body image. In some cases, this can lead to eating disorders like diabulimia. For men, erectile dysfunction can also be a concern after years of living with diabetes.
“Sexual function and fertility are huge obstacles in a diabetes diagnosis that may require interventions and careful family planning,” said dietician Jess DeGore, who works with clients with diabetes. “Sexual dysfunction can feel very shameful and is very difficult for many patients to talk about.”
She recommends reaching out to a therapist who specializes in relationships (or a sex therapist, if needed) alongside your current healthcare team.
Feeling like a burden for a caretaking partner
Whether friends and family have helped with diabetes care for years or are just starting out, the person with diabetes might worry about being a burden to others, said Anhalt. Conversely, some partners feel overwhelmed, potentially feeling like they “didn’t sign up for this.”
Though many with diabetes are fiercely independent and used to taking care of their own condition, partners might be on the lookout for signs of a medical issue or they feel they need to be involved in care as much as possible.
“Overall, I think the best thing you can do for a loved one living with diabetes is to ask how they can be supported. Some people thrive on accountability and encouragement; some prefer to keep their diagnosis more private,” DeGore said. “By making your person feel cared for and reminding them you are available for help, you are giving them reassurance in the relationship.”
“Thinking forward 20 years, I can imagine [more significant] relationship problems once I need more help caring for myself,” Lurhs said. “It’s a really complex disease, which I’ve managed to keep under excellent control. But that requires a lot of attention to numerous details around food, exercise, insulin, etc. I don't think it will be possible to manage it that well once I have to rely on other people more, and that will be really stressful.”
When relationships come second to intense medical journeys
Survival takes precedence over all types of relationships, which means that partners, friends, and relatives might take a backseat to more pressing concerns at times.
Shavonne Reed is the CEO of OPUA Agency and used to work at the Centers for Disease Control and Prevention on education around chronic health conditions. She knows the impact of diabetes on a personal level as well, having lost her mother from diabetes complications.
“Her ability to maintain her health continued to slip after her second heart attack and stent placement,” Reed said. “There was an increase in her irritability, and her outlook on life was significantly compromised.” Diabetes-related health concerns also weighed heavily on her mom, causing severe depression.
“She would complain of her aches, pains, and aging, and was not very fun to be around all the time. Given the distance we lived from one another, it was already a challenge to visit as frequently as I would have liked,” Reed said. “On top of this, once we were together, she often required more tending to, and this was laborious and placed a strain on not only myself but also the family members supporting her.”
And a wealth of unwanted advice…
People with diabetes might have experienced situations where others often try to help by voicing what their “friend’s sister’s husband’s neighbor” did to alleviate their symptoms.
“Regarding extended family members and friendships, I very often see them trying to intervene with advice from their hairdresser, best friend, dog walker,” DeGore said. “Advising someone on how to manage diabetes without the education or lived experience can be detrimental to any relationship. Few people enjoy being told what to do or how to live their lives, so this advice is generally unsolicited and creates tension or anger.”
Both Reed’s grandmother and her mother had diabetes, so she said that her grandmother was able to provide “excellent counsel” to her mother – though the advice sometimes didn’t take.
“My mother was stubborn and uncompromising when it came to what she was willing to give up and not give up,” Reed said. “She was a smoker and drinker, addicted to sugar, and neglected her self-care.”
Though those closest to people with diabetes often mean well, the constant advice can come at a cost. Anhalt pointed to a young adult he worked with who became violent with his parents, and another college-aged student who struggled due to persistent and nagging parents, relentless with their reminders and micromanaging.
The result, Anhalt explained, is turning away from advice due to feeling judged. Instead, he hopes families and loved ones will take a step back to consider what it might be like to “walk a day in their shoes,” working to create a relationship with solid communication, honesty, and a judgment-free zone.
Everyone’s relationships, and at least one person’s life, depends on it.
