Every so often, we get questions here at our weekly advice column, Ask D'Mine!, that flat out break our hearts. Today, your host Wil Dubois, veteran type 1 and diabetes educator and author, respAsk-DMine_buttononds to one of those: a new wife who is scared about how her now-husband is managing his type 1 diabetes. She's worried about his already-surfacing complications and what it could mean for their relationship, and Wil offers some straight up advice on what might be necessary.

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Peggy, type 3 from Wisconsin, writes: I recently married an amazing middle-aged man who has type 1 diabetes. He works hard, but does not take proper care of himself. He goes without eating for 6+ hours, eats high glycemic food every single day, does not check his blood sugar, and basically is just "winging it" with his insulin—going by the way that he feels. In the short time since we have been married, he has developed erectile dysfunction (which I thought would have motivated a change of lifestyle), and this week he had such a terrifying hypoglycemic episode in the middle of the night that I thought he was having a stroke -- he was not making any sense and could not communicate his words to me. Apparently he took too much insulin and his blood sugar dropped to 55. This is the first time he has checked his blood sugar since we have been married! He expects me to just act like nothing's wrong concerning these matters, and ignores me when I try to address it with him. I love him, I am very worried about what is going to happen to him if he keeps up this way, and I do not know how to help him. He doesn't have to die from this, but he will if he doesn't straighten up soon. Please, if you have any advice in this matter, I would greatly appreciate it. I am out of solutions.

Wil@Ask D'Mine answers: I can feel your pain, confusion, and fear. It drifts off the page like the smoke from a distant fire. I want to help you. I want to help him, too. But I'm not sure where to start, and even for me, it's too early in the day to start drinking.

Damn it. Hell. Wow. This is a tough one.

Innovation 2015

OK, first off, you are keenly correct when you say that he does not need to die from diabetes. And you are also correct when you say that he may, anyway. The crazy thing is that no one needs to die from diabetes, and yet the big D remains the seventh leading cause of death in the United States. It puts more people in the ground each year than we lost during the entire Vietnam War. We'd need a lot more real estate for a memorial wall of our own. How messed up is that?

It's not like diabetes is impossible to control. Hey, I'll be the first to admit that diabetes done right is a lot of work—just like a new wife, diabetes requires an investment in time and attention. But just like a new wife, diabetes done right has a host of benefits.

So what's the problem?

I submit to you that the greatest enemy of diabetes care is denial, and your guy has denial in spades. D is for DenialThere's no denying that. So why is it that diabetes and denial go hand in hand? And where does denial come from in the first place?

Brain mechanics theorize that denial is a defense mechanism to protect our fragile little minds from shocks too big to take on all at once—like a marriage falling apart, witnessing a shooting, or experiencing abuse. Or perhaps, the diagnosis of a chronic, progressive illness that can kill you.

Denial, quite properly, functions to let bad news or bad experiences soak in slowly so we can adapt and overcome. It's actually an important mental safety switch, like a fuse that protects an electrical system from overload.

Denial is actually universal. We all suffer from denial of some sort. Some of us deal with minor cases; some of us suffer from major cases. For instance, I'm personally very good at denying the reality of my checkbook balance when I'm cruising eBay or Etsy. But at least the only people that get hurt by that are my creditors. I know other people who suffer more destructive denial cases to rationalize away the abuse of powerful substances, compulsive gambling or cheating, or... diabetes. (Why, yes, I do know a lot of very interesting people, thank you for asking.)

Denial itself isn't so much the problem as the fact that many people seem to get stuck in a state of denial. And why not? Why would you want to leave your happy place and face the cruel reality that you're hiding from?

But in this case, as in many cases, while the denial makes the mind happy, it's killing the body. Your new husband will have to get past the denial to move on and deal with his diabetes. So how can you facilitate that? The warm fuzzy crowd will suggest that you start by using various methods to try to get the person in denial to realize that they are in denial with supportive communication and redirection. (I'm rolling my eyes here.) Failing that, the kinder-set suggest that it's time to turn up the heat in stages by throwing down gauntlet, and even going so far as setting ultimatums.

Now, I'm no head-shrink, but I think that a very direct approach is indicated for you, especially at this point. The way I see it, denial has a thick skin. It's a tough nut to crack, with a strong armor.

OK, I've clearly run out of witty idioms.

My point is that I think it takes a big shock to break through the barriers of heavily entrenched denial. What does that look like? Well, most men would wake up at the point of erectile dysfunction. In fact, I remember reading once that ED is actually one of the most common medical complaints that leads to diabetes diagnosis. Men won't go in to see the doc if they are tired, peeing every 30 minutes, suffering from blurry vision, or if their feet and hands start burning 24-7-365. But if the ol' pecker fails to work? Oh yes. That gets a man to the doctor.

But your guy has a brand new wife, with all the potential fun that entails, and he's unwilling to address the issues that are causing his ED?

Clearly, we are dealing with some very serious denial here.

Of course, cutting your guy some slack here; neither you nor I have any idea how his diagnosis was handled. We don't know the level of care or education he got. As he's managed to (barely) survive for this long, he may not know he's doing it "wrong" or that by doing it differently he could be healthier and feel better.

Still, that work can't even begin until the ice on the denial begins to thaw and crack.

You said you were out of solutions. Now, I don't know what all you've tried. I know you've attempted to engage him in conversation and that has failed. You might have tried verbalizing, empathizing, and BlamingDforRelationshipStressesstrategizing. What's left?

Of course, in this case, withholding sex is off the table.

I think that breaking through denial this big is going to take a really big shock. Think of it as Tactical Nuclear Therapy. Baby, you need to drop the bomb on this guy.

It's time to pack your bags and walk out the door.

I've been told this has worked for others, including my veteran type 1 friend Mike who tells me he wasn't taking very good care of himself when he was newly-married and his new bride issued that ultimatum. As she put it: "I'm not going to stick around here to watch you kill yourself, if you don't love us enough to do something about it." That kicked Mike in the rear to do better, he says, and they're now coming up on their 9th year of marriage.

Maybe it's time to follow suit.

It will be the hardest thing you will ever do. To keep what you hold most dear, you need to risk losing it. Yes, it's messed up. But there it is. It might work, I hope it does, and worst case—if even losing you doesn't crack his denial—then maybe you are better off with a clean break. Living with someone who is slowly committing suicide is hard on your soul. In point of fact, it's a form of abuse, as dangerous to your well-being has having a new husband who slaps, kicks, and punches you.

After all, if your newly minted husband slapped, kicked, and punched you—would you stay? I hope not.

All that's left to say at this point is Good Luck, to you both. And I mean that!

 

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.