Читать книгу Sex and Diabetes - Janis Roszler - Страница 8
ОглавлениеIn this chapter:
Explore some of the feelings that you may have with diabetes.
Learn different ways to deal with them.
IF YOU HAVE DIABETES, it can affect the emotional and physical aspects of your intimate relationship. Let’s first discuss the emotional concerns.
Diabetes is never welcomed with open arms. It frequently stirs up difficult emotions, including fear and guilt. If permitted to thrive, these emotions can create a rift in your relationship and cause you to lose one of the most important supporters in your effort to lead a healthy and meaningful life.
YOU MAY FEEL GUILTY
Many emotions arise when you are diagnosed with diabetes, but guilt should not be one of them. You may feel that your diabetes magically appeared because of something that you did or ate, but that is not true. Each person who develops diabetes has inherited the potential to have it. We know that there is no way to prevent type 1, and type 2 has several environmental triggers—such as weight gain and inactivity—but both types require an inherited potential for the disease to develop.
Risk factors
There are certain risk factors that experts have identified that make a person more susceptible to developing type 2 diabetes:
If you are 45 years old or older
If you have a parent, brother, or sister with diabetes
If you have had gestational diabetes (diabetes during pregnancy) or have given birth to a baby that weighed more than 9 pounds
If you are of African-American, Latino, Native-American, Asian-American, or Pacific-Islander descent
If you were diagnosed with prediabetes
If you have polycystic ovarian syndrome (PCOS)
Think of all of the people you know who are overweight and inactive and don’t have diabetes; not everyone develops it. What you eat, how you behave, and health decisions that you have made over the years are not the sole cause of your disease, so don’t permit overwhelming feelings of guilt to place a wedge between you and the people you love.
Impact of Guilt on Marriage
“Because of my type 2 diabetes, Julie and I can’t be spontaneous anymore. Before we go out for the evening, we must plan everything around my eating schedule. If my blood sugar goes low, we can’t leave until I feel better. If my headache remains after treating my low, we’ll often cancel our plans altogether. How can she enjoy this? I sure don’t. If I had eaten less and exercised more, I wouldn’t have diabetes right now. My family says that I did this to myself and I believe them. If I didn’t have diabetes, Julie and I could enjoy more activities together. Instead, I’ve ruined our lives. She should be with someone else.” —Rick
Your partner may share your feelings of guilt, especially if he or she supported your desire to bring junk food into the house or watch television instead of heading out for a walk or exercise class. These feelings can bring a great deal of tension into the home. To help deal with any guilty feelings that either of you may have, learn as much as you can about diabetes and incorporate new health behaviors in your home. The changes that you make are healthy for the entire family.
The positive side of diabetes
Surprisingly, many people feel thankful that diabetes is now part of their lives. Before their diagnosis, they were sedentary, made poor food choices, their weight was significantly higher than it should have been, and they felt sluggish and unmotivated. Once diabetes came on the scene, they initially felt overwhelming feelings of guilt and so did their partner. But those feelings passed quickly as soon as they began to take control of their diabetes.
Open up about your feelings
The more that you and your partner know about this disease and what you can do to attain better control and reduce your risk of complications, the more comfortable you should both feel about the future that you can share together. Discuss your concerns with your partner. If you suspect that he or she feels negatively about your diabetes, talk about it. You may be right about your partner’s feelings or you may discover that this is not how he or she feels at all. An honest and open discussion will hopefully provide you with information that you can use to help strengthen your relationship.
Turning Your Life Around
“I used to be the fat guy that you would stare at in the grocery store. My cart would be filled with high-fat desserts, sausages, regular soda, chips, and more. When diabetes hit, I immediately felt that I had done it to myself. In the back of my mind, I knew that it would happen and then one day it did. Wham! When I got that blood test report back from the doctor, I felt my stomach sink. All I could think was, ‘why didn’t I say no to the choices I made?’ When my wife learned about my diabetes, she immediately blamed herself. For years, she supported all of the bad behaviors that I had developed. We both ordered in pizza and drank beer on Saturday nights. We both sat in front of the television for hours on end snacking on junk food and sugary sodas. And we both never made a move to … move! We didn’t do any physical activity of any type. Suddenly, the diabetes that I had caused was going to ruin both of our lives and our dream of us growing old together.
Fortunately, my doctor insisted that we attend the diabetes classes at the local hospital. I learned how to make better food choices, checked my blood sugar regularly, began walking each day, and started to lose some weight. Lucy joined me for the walks, which made them far more enjoyable. I began to feel younger than I had felt in a very long time. I was becoming healthier and more energetic. If I hadn’t been diagnosed with diabetes, I never would have made any of these changes. Now I’m in far better shape than many of my friends. It sounds strange to thank diabetes for anything, but I really do. And so does my wife. With my previous lifestyle, she always believed that she would end up as a young widow. Now that I’ve changed so dramatically, we both look forward to a bright future together.”—Chuck
YOU MAY FEEL DEPRESSED
About 30% of all individuals with diabetes experience some form of depression. Why these two conditions tend to go hand in hand is not clearly understood, but we do know that having diabetes doubles the risk of becoming depressed. When you are depressed, you may experience:
a loss of interest in things that you used to enjoy
guilt
a sense of worthlessness
a drop in your energy level
too much or too little sleep
withdrawal from friends and family
physical pain
loss of desire or physical ability to connect intimately with the one you love
Feelings of depression can be overwhelming and affect every area of your life, including your intimate relationship. Individuals with depression describe how they feel in a variety of different ways. Some say that they feel blue or numb, while others experience actual physical aches and pain.
Depression’s Toll on Marriage
Mark has had type 2 diabetes for several years. He never paid much attention to it, because he always felt fine. Recently, however, Mark and his family have noticed a very definite change in his behavior and attitude toward the things that he used to enjoy. He no longer asks his wife and children about their day when he arrives home from the office. He doesn’t plan family activities for the weekends like he used to do. All he does is lie down on the couch and watch television. He doesn’t even care what’s on. He’ll watch old movies, reality shows, and even the poorly written sitcoms that he always considered to be a waste of time. Nowadays, he feels so tired that he can’t muster up enough energy to do much else. At first, his wife worried that he was ill, but that concern quickly turned into frustration. He never listens to her, doesn’t compliment her on anything she does, and no longer wants to join her for a night out to see a movie or be with friends. Mark is depressed and it is affecting their relationship.
Physical Effects of Depression
“I have had type 1 diabetes for about eight years. I used to have so much joy in my day. Tom and I loved holding hands as we watched television. The little things made us happy. Now I can barely get out of bed. Don’t even mention romance to me. I don’t want any part of it. I feel like I have a flu that won’t leave.”—Diane
Coping with depression
Depression can be challenging to deal with, but there are several things you can do to help improve your situation.
Keep your blood sugar level in a healthy range
High and low glucose levels can cause emotional swings and exhaust you. Your partner may find your mood swings challenging as well. It is more difficult to connect romantically with someone whose demeanor can’t be predicted. Ways to accomplish this goal will be discussed in greater detail in chapter 3.
Participate in some form of physical activity every day
Exercise releases endorphins (“happy hormones”) that lift your spirit and help fight mild depression. Sexual activity is a healthy form of exercise also. Don’t underestimate the mental and physical value of connecting with a person in an intimate way.
Share your problems with a qualified counselor
It can be helpful to talk over your relationship problems with a neutral third party. Ask a member of your health care team for a referral.
Discuss your feelings with your physician
There are many different depression medications available today that are quite effective. One may work for you.
Pray or connect with your church, synagogue, or spiritual group
Research shows that people who have a spiritual connection handle the challenges of diabetes better than those who don’t.
The emotional connection that you create with your partner is important for your relationship. If that area of your life has been altered because of your diabetes, do what you can to heal it. It will help you enjoy the intimate life that you want and deserve.
Depression Risk Assessment
Take the following assessment exercise to see if your feelings of depression require more urgent medical attention. Circle the number for each statement that best describes how often you felt or behaved this way during the past week.
Scoring the Depression Risk Assessment
To determine your score, add up your responses to all of the questions: _________
If your total score is 16 or higher, you should consider taking action immediately—contact your health professional for a referral to a qualified mental health professional.
If you feel depressed, but your score is below 16, don’t ignore your feelings. You can still speak with your health care team about how you feel.
YOU MAY FEEL STRESSED
The stress of living with any disease can affect your energy level, how you feel about yourself, and how you relate to your partner. Life with a chronic disease like diabetes can be exhausting. When you live with diabetes, you must focus on a number of factors at once. A few of these factors are:
food choices
medication
physical activity
blood glucose testing
foot care
In order to have good diabetes control, you must monitor your life closely. If you are emotionally and physically exhausted from the tasks that you need to do each day to maintain your health, you will have less to offer your loved one. Bedtime will become a time to collapse and fall asleep. When you add other responsibilities to the mix, such as children, homework, carpool, elderly parents, shopping, cleaning, and working, it’s no surprise that you have little energy left to participate fully in the bedroom.
Exhaustion From Daily Diabetes Maintenance
“I hate sticking my fingers. I think about it most of the day. I test before meals to provide my doctor with the information that he wants and then test two hours after my meals so I can check if I balanced my insulin and food intake well. I check my feet each night and brush and floss my teeth so I don’t develop any oral infections. When I shop, I read labels to check out the carbohydrate content of the foods that I purchase. I watch the clock to make certain that I don’t miss a feeding or dose of medicine. Frankly, I’m pooped! After all of this, I can’t gather up any additional energy to go home from work and be a fabulous partner in the bedroom. When my head hits the pillow, I’m out for the night.”—Kim
Reducing your stress level
Here are some steps that you can take to help reduce your stress level:
Adjust your job duties
If your workload is overwhelming, try to share some of the load with a coworker. If your current position is too stressful, consider switching to a different one or see if the duties of the job can be altered in some way. You may feel additional stress if you don’t work in a diabetes-friendly environment. (see box)
Does your supervisory staff permit you to test your blood sugar and have snacks during the day? Are they threatening to fire you because you have diabetes? If you feel your rights are not being respected, contact the advocacy department of the American Diabetes Association for helpful advice. Their website is www.diabetes.org or you can call 1-800-DIABETES.
Eliminate some of the activities that you do
If you volunteer for your church or another worthwhile organization, in addition to all that you do, step back for a while and invite others to do these tasks. If you wish to remain active, take positions that allow you to contribute something unique and important but perhaps take up less of your time. If you run yourself down and cannot care for your health, all who depend on you lose out.
Try yoga or gentle stretching
The style of movement that is taught in several types of yoga can help you recharge your battery, reduce your stress level, and help you deal with the challenges of life with diabetes. There are numerous types of yoga. Some, such as Iyengar and Hatha, are gentle and relaxing. Others, such as Ashtanga, are more athletic and aggressive. Before you sign up for a class, make sure that the style of yoga that is being taught is appropriate for your needs. Let the instructor know if you have any physical issues that may prevent you from participating fully. If you have neuropathy in your feet or hands or any other physical concerns, some of the poses used may not be appropriate for you. There are many websites that can introduce you to the practice of yoga. Two that are very helpful are www.yogafinder.com and www.yogajournal.com.
Participate in regular physical activity
Exercise releases endorphins and can help relax your muscles and make you feel less stressed. If you are especially stressed in a specific environment, such as your home office, leave the house to do your activity at a health club, community center, or at a park. Invite your loved one to join you and use this time to strengthen your body as well as your relationship. There are various things for a person with diabetes to keep in mind when building an exercise program. A list of risks and recommendations is contained in Table 1, opposite.
Meditate
Meditation is another wonderful stress-reduction tool. It is normally taught by an instructor, but you can try to do it on your own. It can help reduce your stress level, think more clearly, and even lower your blood pressure. All of us would love to come home to a loving partner who is calm and welcoming. Meditate a few minutes before your spouse arrives. As few as 10–20 minutes of quiet breathing can help you shake off a lot of the stress that you have accumulated by the end of the day.
Positive Effects of Meditation
on Stress Relief
Here is a simple type of meditation that you can try right now. It is called focused awareness meditation.
1. Sit in a quiet and comfortable location.
2. Locate an object, such as a candle or a statue that is in your room.
3. With your eyes half-open, gently stare at the object.
4. As you watch the object, focus on your breathing. You can also do this lying down, in a chair, inside, outside, anywhere. It is a very soothing exercise and only requires a few minutes of your time.
Other forms of meditation include mindfulness meditation, which focuses exclusively on breathing, and transcendental meditation, which uses a mantra, or a personal word or phrase that is repeated over and over. You should be able to find a type of meditation that feels right for you.
Listen to relaxing music
Soothing music, especially at bedtime, can help you calm yourself after a challenging day. Invite your partner to listen with you also. Intimacy doesn’t happen in the bedroom alone. The time that you spend together, even if it is only in the same room doing different projects, can strengthen your loving bond.
Visit a friend
The support of a friend can also be helpful. Even if you do nothing but laugh or chat about the weather, a meaningful friendship can help change your mood. It can also give you an opportunity to share your daily gripes and groans with someone other than your spouse, especially if you believe that he or she has become tired of listening to them. Don’t disclose personal issues without your partner’s permission, but you can certainly talk a bit about how challenging life with diabetes can be if your friend welcomes that discussion. This will give you an opportunity to discuss something other than diabetes with your loved one.
Sit outside
We often undervalue the benefit of quiet time. Our world moves so rapidly. Now that we carry cell phones, we are never alone. Take some time to get off of life’s treadmill. The fresh air is energizing and the quiet is calming. Some people relax by sitting in front of the television. This can be a helpful break, but many of the disturbing images that come across the screen and upsetting news highlights that are broadcast can change a soothing moment into one of great anxiety.
Enjoy a great book
When is the last time that you sat and enjoyed an engrossing book? The library and bookstore shelves are overflowing with stories that can engage you and take you to a different time and place.
Pamper yourself
Treat yourself to a massage, facial, or manicure. When you feel relaxed and good about your body, you will be more enthusiastic about enjoying intimacy with one you love. The time that you spend engaging in sexual activity should be mutually satisfying for both you and your partner. If you don’t feel positively about yourself, it is difficult to relax and fully enjoy the sexual experience.
Schedule intimacy into your life
The connection that you have with your partner can be a great source of support, especially when life becomes hectic. Schedule regular intimate moments with your partner. A weekly evening of bedroom activity or a midday tryst can help boost your spirits and alleviate some of your stress for the remainder of the week. Don’t expect your love life to always be spontaneous. Plan ahead and keep it healthy.
Take on new health care behaviors in small, easy-to-do steps
To do this, use the “Jump Start Pledge,” which was developed by one of our authors, Janis Roszler. See the Jump Start Pledge for more.
Jump Start Pledge
The Jump Start Pledge is a way to slowly incorporate new health behaviors into your life without becoming overwhelmed. Here is how to do it:
1. Choose a small health behavior.
2. Pledge to do it for a single week.
3. Keep that pledge.
4. At the end of the week, review your progress.
5. Renew the pledge for an additional week, change it, or add another.
Make sure that your pledge is small and easy to accomplish. This will help you build your self-confidence as you improve your overall health and diabetes control.
For example, if you drink five cups of coffee each day and want to cut back on the amount of caffeine that you consume, don’t stop suddenly. Your Jump Start Pledge would be to drink four cups rather than five for the next week. You can substitute that cup for a decaffeinated beverage. At the end of your week, if all is well, cut back by an additional cup.
If you had difficulty achieving your initial goal, renew your pledge for another week. As long as you set a Jump Start Pledge each week, you are moving forward toward your ultimate goal of good health.
Seek professional help
If your stress comes from difficulties in your relationship that are more than you can handle on your own, don’t hesitate to contact a trained therapist who can help you work them out. To find a qualified therapist in your area, visit www.aasect.org, the official site of the American Association of Sex Educators, Counselors, and Therapists.
YOU MAY FEEL ANGRY
In his book, Diabetes Burnout, Bill Polonsky, PhD, CDE, coined the term “diabetes police.” These are the folks who decide that it is their task to hover over you and correct every diabetes-related move that you make. Although these comments are usually motivated by a combination of love for you and fear for your health, their good intentions rarely come across and can cause you to become quite upset.
Tension From Attempted Weight Loss
“My wife and I used to have a nice relationship. We disagreed now and then, but that happens in all marriages. When I developed type 2 diabetes, Saundra’s attitude toward me changed dramatically. She started to nag me constantly about my weight. I tried to lose weight, but really struggled with it. In her opinion, I had caused my diabetes to get even worse. Her friend had type 2 also, but was able to lose weight and control it with diet and exercise. I couldn’t do it because I wasn’t trying hard enough. I hate her constant nagging. She has turned into some sort of S.W.A.T. team that swoops in whenever I even think about taking a piece of chocolate. Maybe she’s correct—I’m not trying hard enough. Maybe I don’t care enough about my health and my family. When my diabetes educator asked if we were having any problems in the bedroom, I had to laugh. We are so angry at each other that we now sleep in separate rooms.”—Christopher
If your spouse has become a diabetes drill sergeant, try the following:
Share how you feel and find out why he or she feels compelled to nag you all of the time. If talking about this issue is difficult, use the “Magic Pencil” exercise described in chapter 7 as a structure for your discussion.
Attend a diabetes class together so you both have up-to-date information about how to care for diabetes. Often, a spouse will nag if he or she believes that you aren’t caring for your diabetes properly or aren’t taking it seriously enough.
Visit your health care provider together so that you can both hear how he or she wants you to handle certain diabetes-related situations.
YOU MAY WORRY ABOUT BEING REJECTED
Diabetes goes with you wherever you go, including the bedroom. You may feel self-conscious about wearing a pump or worry about the mood swings that you experience when your blood sugar level enters an abnormal range. If you worry about how your mate feels about you and your diabetes, that can carry over into the bedroom where acceptance and communication should be guaranteed. This concern can affect your ability to enjoy and physically react to intimacy.
Keeping Your Diabetes a Secret From Partner
Carl wears an insulin pump. He loves the improved control that he gets with it, but doesn’t know what to do in an intimate situation. He read on an Internet message board that some people leave their pump attached to their bodies during sexual activity, but he can’t see doing that. Where would it go? He can’t picture the logistics of that. He knows that he could disconnect it and leave the small plastic infusion set attached to his abdomen or remove everything and hide the pump somewhere, but can’t figure out what to do about the adhesive marks that the infusion set leaves on his skin. He isn’t in a committed relationship with anyone who would understand. Sometimes his sexual experiences are with individuals whom he has only known for a short time. Many of them don’t even know that he has diabetes. “I don’t want to start giving a diabetes lecture when I am alone with someone. That is not how I want to spend my evening!” He is so worried about this.
Dating can be traumatic as well. You may worry that your date will reject you if he or she learns that you have diabetes. Fortunately, some have discovered a way to handle this situation. See Jennifer’s story, opposite.
Positive Attitude About Diabetes Boosts Confidence
“I was always afraid to tell my dates about my diabetes. I used to hide it. I didn’t want them to think that I was damaged or that any future with me would be filled with doctors and hospitals. Then, it hit me. I was acting damaged, wasn’t I? I believed that having diabetes was something to be embarrassed about. It is part of me. Just like my red hair. It is who I am—a great lady who just happens to have diabetes. Now, when I date, I don’t flaunt my diabetes, but I don’t hide it either. If I have to take a shot, I pull out my pen and inject right through my clothes. No one even notices. If I need to test my blood sugar level, I whip out my meter quickly and do it. I’ve found that my attitude sets the tone for my date. If I’m relaxed about my diabetes, he will be, too. If I expect any romance to happen, even simple hugging and kissing, I definitely say something. I don’t want to suddenly have my blood sugar drop while we are together. And if it does, I want him to understand what the symptoms look like and how he can help me. I just say, if I look a bit drunk or start to act a little strange, my sugar may be going low, so please get me a glass of juice. It doesn’t happen often, so don’t worry.”—Jennifer
Poor diabetes control can interfere with many pleasurable activities. If you aren’t confident in your diabetes care, speak with your health care team. If they aren’t receptive to your needs, seek additional help from a different provider. Don’t stop until you are comfortable that you have all of the tools to handle every situation and that you are achieving the best control possible for your diabetes. And also remember to wear medical identification at all times; a card in your wallet isn’t enough. It is too easy for you and your wallet or purse to become separated. Low blood sugar symptoms may cause people to believe that you are drunk and need to “sleep it off.” If you have a real medical emergency, you want all around you to know that you require medical assistance.
YOU MAY LOSE INTEREST IN SEXUAL ACTIVITIES
Exhaustion Can Ruin a Romantic Evening
Kevin and Tina recently went on a weekend getaway where they expected to relax, use the spa, walk on the beach, and enjoy a generous amount of romance. Their plans changed a bit when the evening rolled around and Kevin chose to hop into bed without Tina. When she peeked into the room, he was sound asleep. “I had hoped that this time away would kindle his interest in sex, but it hasn’t made a difference. He has lost interest and I don’t know what to do about it.” Kevin has had type 2 diabetes for about five years.
Emotional issues
Many emotionally related issues can cause a drop in libido; however, a variety of factors can also affect your sexual interest, including:
communication problems within your relationship
a lack of romance
a hectic schedule that limits time with your partner
children and the time required to care for their needs
a history of negative or traumatic sexual experiences
stress or depression
poor self-image from weight gain or other changes
In addition to those listed above, you can also lose interest because of issues that may develop when you have diabetes. How do you feel when your blood sugar is too high or too low? While battling hypoglycemic jitters or high glucose headaches, is it extremely difficult to be in the mood for love.
Financial pressures
Diabetes is expensive, especially if you don’t have adequate insurance to cover the test strips, medications, doctor’s visits, and other items that you need. Many couples find that diabetes brings significant financial pressures into their lives and into their bedrooms.
Loss of Job Leads to Relationship Problems
“I have type 1 and can’t stop the blood sugar roller-coaster ride that I am on. Either I take too little insulin and my blood sugar level soars or I take too much and it plummets. Because of this, I missed a lot of work, so my boss fired me from my position. The loss of my job was rough, but not as rough as the loss of my relationship with my wife. She used to have so much patience with me; I could always count on her. But when my work problems began and money got tight, she started to resent the fact that I had diabetes. Now when I try to hold her, she pulls away. I know that she is angry, but I don’t know how to fix things. We now sleep in separate rooms. I feel like I’ve been fired from my job and my marriage.”—John
If you feel overwhelmed by the cost of diabetes, speak with your health care team. They should be able to put you in contact with various assistance groups in your local area. A list of pharmaceutical companies with prescription assistance programs are located in the Appendix. Don’t let your emotional response to diabetes interfere with your relationships. Take steps to reduce the negative feelings that diabetes has brought into your life.
FOR YOU AND YOUR PARTNER
1 How has diabetes negatively affected how you feel about your sex life, work situation, and day-to-day living?
2 What steps would you like to try to help improve the situation?
