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Despite the focus that clinicians and researchers place on the ‘self’ part of self-management, people don’t manage their diabetes alone.
If you’re living with type 1 diabetes (T1D), you’re probably aware of the helpful (and sometimes unhelpful) ways people are involved in your diabetes management.
If you have a loved one with T1D, you’re probably aware that managing diabetes is difficult and that helping your loved one sometimes comes naturally and sometimes ends in an argument or perhaps the opposite of what you hoped to accomplish.
The Involvement of Others in Diabetes Self-Management
Living with T1D means living – which means managing around other people. Even for people who prefer to have a great amount of independence in their self-management, diabetes occurs in a social context.
The involvement of others can look different for different people. It may be informal – a one-off remark from a coworker over lunch asking more about blood glucose checking. Or it may be more direct – a parent helping to change an infusion site or a spouse bringing juice to help treat a low.
Close relationships allow for the opportunity for other people – like a romantic partner, a best friend, a roommate, or a parent – to be more intimately familiar with and involved in T1D self-management.
The ideal standard, from scientific research, is for these close relationships to provide social support: a sense of belongingness or caring, giving advice or information, or listening to worries or concerns. Social support provides benefits for a lot of areas of life, including general well-being, general physical health, and diabetes self-management (e.g., Song et al., 2017; Skinner et al., 2000).
Many times, however, actions or statements that are meant to be supportive are not interpreted that way by the other person. Sometimes loved ones try to regulate or force someone to change their behavior, like in health-related social control (e.g., Thorpe et al., 2013). Other times, loved ones simply miss the mark (like what happens in ‘miscarried helping’).
But it’s an oversimplification to say social support is ‘always good’ and control or miscarried helping are ‘always bad’. The distinction between the two might be in not what is said or how it is said, but to whom it is said.
Asking your son if they checked their blood glucose might be interpreted as controlling, whereas asking your spouse the same question might be interpreted as loving.
So how might one navigate the different expectations of different relationships to provide more supportive interactions around T1D management?
Remembering the ‘Person’ in the Person You Love
Let’s pause for a mini social psychology lesson. The Basic Psychological Needs Theory – a ‘mini theory’ of Self-Determination Theory – suggests people have an innate need for autonomy – a feeling that what they do is a matter of their own choices – along with needs for competence and connectedness (e.g., Ng et al., 2012). Essentially, autonomy support communicates to another person that we believe they are capable and that we care for their well-being.
If we use Basic Psychological Needs, especially autonomy support, to understand the scientific research on close relationships and diabetes self-management (e.g., Kelly & Berg, 2019), we can start to see why involvement from other people is often, but not always, beneficial.
It boils down to something we all know, but that is sometimes difficult to appreciate: people are individuals who want to feel valued, competent, and able to make their own choices. People will vary in terms of how much autonomy versus connectedness versus competence they desire, but all three are important.
How might I support my loved one with T1D?
Your loved one is an individual with different preferences and needs. But, if we think about basic psychological needs, the following might be good places to start.
- Avoid shoulds and should nots. Especially for people who have lived with T1D for a long time, it’s unlikely that they don’t know what they ‘should be’ doing to manage their diabetes. Remember, your loved one is generally a competent individual who wants to feel that way. Instead of simplifying your words into ‘shoulds’ or ‘shouldn’ts’ – which imply that you do not think they know what to do – focus on how you feel and express that you respect and care for them.
- Remember the limits of good intentions. If what you say or do seems to have the opposite effect or outcome you were hoping for, take a step back. Did what you say communicate what you intended? If not, consider owning up to it and trying again: “I think what I said came across negatively. I’m sorry. What I meant was…. Can we talk more about that?”
- It’s never too early to give autonomy support. In the case of supporting a child with T1D, it can be difficult to balance allowing choice and managing their physical health. But it is possible to support autonomy at any age. For young children, give concrete and clear expectations along with reasons for why the management task is necessary. Listen to their concerns, validate their feelings, and provide choices wherever possible. For example, a young child needs to eat after taking insulin – but they can be allowed to pick what they would like to eat.
- When in doubt: ask! Imagine your best friend with diabetes comes to you and says they were so stressed at work that their blood glucose has been running high all day. What would you say?
There’s no need to stress about picking the ‘right’ response if you’re unsure what would be helpful. You can simply ask. “It sounds like you had a frustrating day. Would you like to talk more about it, or is there something else I can do to support you?”
Remember, there are no one-size-fits-all approaches to supporting someone with T1D. You don’t always have to ‘get it right’, but understanding how to balance psychological needs with physical health needs might help make interactions with your loved ones a little easier.
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