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    Living With Type 2 Diabetes Is Family Affair

    Family involvement is crucial to diabetes control.

    Spouse Affected Most

    Whether the children and parents of a person with diabetes live at home or have grown up and moved away, a diabetes diagnosis most affects a patient's spouse or significant other. It seems obvious. Yet this fact often goes unappreciated -- and unspoken.

    "Many, many couples in which one partner has diabetes have never sat down and talked about what this is like for them," Fisher says. "They don't know what their spouses are thinking and their spouses don't know what they are thinking."

    Very often spouses represent an unrecognized health problem.

    "The data is very clear that rates of depression, depressive affect, and bad mood is high among spouses of people with diabetes," Fisher notes. "This isn't often attended to. Often the spouse feels no role in the disease. They are very concerned. This often gets them into the role of being the diabetes police. The patient takes a piece of cake and the spousal eyebrows rise."

    Once these issues are out in the air, many people find that they can come to terms with what they've been avoiding.

    "These are normal couples struggling with abnormal situations," Fisher says. "It is not that they are crazy or sick: It is a new situation. It is a husband, a wife, and diabetes -- a threesome -- and diabetes is often the elephant in the living room that never gets mentioned."

    Resolving Family Roles

    In every family, different family members tend to take on different family roles.

    "One person wants to focus the family on moving on, and another wants to make sure the illness gets taken care of. A family needs both types," McDaniel says. "Some family members get so scared they don't want to go near any mention of the illness. Some get too involved, to the point where the patient gets angry and says, 'Quit telling me what to do.' That happens even in the most well-adjusted of families."

    This is where a family therapist can help.

    "I think with a little bit of tweaking, people move from polarized positions over time," McDaniel says. "The overbearing person may say, 'Well, probably I was overdoing it a bit,' and the avoiding kind of person may say, 'Well, maybe we do need to pay a little more attention.' Sometimes meeting with someone like me helps them see that every family has a continuum of response."

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