Were pregnant! your brother announces.

you chuckle under your breath, imagining your brother and his wife strolling hand in hand, both with very large baby bumps. Umm . . . dont you mean

?

While credit does need to be given where credit is due, groundbreaking research shows that we language in couples can actually benefit relationships and health (Rentscher et al., 2017). In the world of chronic illness, its called shared illness appraisal, and in simple terms, means couples see one partners condition as ours; its not just his/hers or mine. This

mentality naturally leads couples to pool resources and engage in joint input, mutual effort, and a team approach to coping with or solving the problem (Berg et al., 2008a, 2011).

The good news is that this also proves true for couples living with type 1 diabetes (T1D) (Helgeson et al., 2016; Helgeson et al., 2018).

In a recent study, Helgeson and colleagues took a closer look at how considering T1D as our disease, not just his/her or my disease impacts couples and health (2019).

In their extensive study of nearly 200 couples wherein one partner had T1D and one did not, researchers observed that when individuals with T1D viewed their illness as shared, they felt more supported in T1D management than those in relationships where T1D was just mine. And interestingly, this was the case whether or not their partners appraised the illness as shared. Why? It could be that when individuals with T1D see it as shared, partners behaviors feel supportive even if they arent. Its kind of like looking through rose-colored glasses.

While individuals with T1D may feel supported regardless of partners illness appraisals, the research shows that it was not until

partners appraised T1D as shared that those with T1D showed significant health improvements, both physical and psychological. This included better A1c (average glucose across three months), less diabetes-related stress, higher relationship satisfaction, and increased feelings of support and collaboration.

Appraisals of the partner without the illness

matter.

Viewing T1D as shared leads partner behaviors to go from just

supportive to

supportive, making real differences in the health of the individuals with T1D.

In all, the research provides promising results for individuals with T1D when they can share some ownership of the disease with their partner, especially if their partners accept.

Among many couples, individuals with T1D maintain complete ownership of their disease and partners tend to see it the same. (The mine mentality among those with T1D makes sense; most are diagnosed in childhood, long before romantic relationships start (Helgeson et al., 2019)). Some research has suggested that each couple has their own unique style of illness management, that ranges on a continuum of illness sharing (Yorgason et al., 2010). Although each couple may develop their own patterns around T1D, those with low concordance miss out on potential resources from partners that support illness management.

In another common scenario, partners without T1D appraise it as shared while the individuals with T1D do not. Partners without T1D may try to provide support, but it comes off as criticism, overprotection, or micromanagement, leaving the relationship and physical health in a poor place.

Awareness, authenticity, and empathy are lifelong relationship

, meaning they develop with consistent and intentional

Each is essential to developing shared illness appraisal, as well as unity in the rest of the relationship (Kayser et al., 2007).

Would scheduling a time to sit down and talk about your day help you practice awareness, and empathy? Maybe engaging in family traditions or going on a date once a week would allow you time to intentionally practice these traits. Perhaps its just talking openly while you prepare and eat dinner together that would make all the difference! Whatever it is, as you and your partner intentionally work to develop these relationship skills, especially in the context of T1D, you will notice T1D beginning to feel more like a couple-level adventure, feelings of support will increase, and T1D management will improve.

So just like both partners are important during pregnancy, both partners are important for type 1 diabetes.

Insulin, CGMs, Humalog, Novalog, Lantus, infusion sites, transmitters, A1c, and ketones... Initially, type 1 diabetes (T1D) may sound like a foreign language! Although it is a lot to learn, your efforts to become familiar with T1D terms and concepts will not only allow you to better support your spouse/partner, but also give you a sense of empathy for the learning curve he or she went through at diagnosis. Research suggests that your sincere efforts to understand your spouse/partners experience with type 1 diabetes can both strengthen your relationship and equip you with skills to lend positive support in their diabetes management. In this blog post, we hope to provide you with a basic explanation of T1D and a reference guide for common T1D terms to support you in these endeavors.

What is Type 1 Diabetes?

As stated by the Center for Disease Control, type 1 diabetes is a chronic condition that occurs when the bodys immune system disables the insulin-producing cells of the pancreas. When the pancreas no longer releases insulin, the body cannot bring sugar from the blood stream into muscles and organs, and thus it cant use the glucose in food for energy. Insulin can be thought of like the key that allows glucose into cells where it is then packaged as energy units for the body. Without insulin, glucose builds up in the blood stream, causing damage to blood vessels and nerves, and eventually to vital organs. Additionally, the life sustaining energy that insulin would have made available from food is now obtained through processes that dont require insulin but that release toxic chemicals and eventually poison the body.

To understand this further, lets take a closer look at the process our amazing bodies go through when we consume food. Then, lets compare that to what happens in the body of someone with type 1 diabetes. The following example involves a female with T1D and their male partner.

Person without T1D: You feel a little hungry and excitedly remember the chocolate chip granola bars you just bought! Opening the cupboard, you grab a granola bar, tear open the wrapper, and take your first bite, and then your second. Mmm... a perfect mixture of sweet and salty. Satisfied after your last bite, you toss the wrapper into the trash, grab another granola bar for the road, and run out the door to go play some soccer with your buddies. Unbeknownst to you, even before you swallowed your last bite, enzymes in your stomach began digesting the food, breaking down the carbohydrates in the oats and chocolate into smaller molecules called glucose. Not much later, your stomach and small intestines absorb the glucose and release it into your blood stream. Your pancreas, a long gland that lies behind the stomach,

senses how much glucose is in your blood stream and immediately releases the appropriate amount of a hormone called insulin. Insulin, like a key to the cell door, lets the glucose from your blood stream into your bodys cells where it is turned into energy, empowering you on the soccer field or stored for later. As the insulin allows the glucose into the cells from the bloodstream, your blood glucose levels drop. The pancreas senses the drop in blood glucose and stops the insulin secretion. It knows that certain organs, like the brain, must have some sugar in the blood to stay alive, and too much insulin could drop blood glucose to dangerous levels. Well, your soccer game goes great! With one assist and one goal, plus some time with the guys, you feel rejuvenated and thankful for your body. Pulling off your cleats and reaching into your bag, your hand brushes across the granola bar you grabbed on your way out. Happily, you tear off the wrapper and take a bite, relieving the little pang of hunger that has now got your attention. Now, the digestion enzymes begin working, the glucose is absorbed into the blood stream... you know the rest.

Now, lets look at the food metabolizing process for your spouse or partner with T1D when no insulin is produced by the pancreas.

Person with T1D: Spotting you enjoying your snack, your wife wants one too! She does those sweet puppy dog eyes and how can you resist? You toss her a granola bar. But rather than tear open the wrapper, she goes through the process that by now, you may have observed hundreds of times. Perhaps she reaches into her pocket and wakes the screen of her continuous glucose monitor, a device that displays her real-time glucose values from a sensor inserted into her abdomen or arm. Or maybe she goes looking for her glucometer, a device she regularly uses to check her blood sugar. With a little prick, a small drop of blood is produced at the end of her finger. She applies the blood droplet to a small plastic strip inserted in the meter, and her blood sugar level is then displayed on the small screen. After checking her blood sugar, she looks briefly at the back of the wrapper to check the carbohydrates, does a little multiplication in her head (who needs a calculator?), and may administer a very specific dose of insulin (either by injection or through her insulin pump), depending on her blood sugar level. As she eats, the enzymes in her stomach digest the food, turning the carbohydrates from the granola bar into glucose. The glucose is then absorbed by the stomach and small intestine and released into her blood stream. Unlike your body, your wifes pancreas does not sense the glucose in her blood stream, nor does it release insulin to help the glucose get into the cells. Luckily, the insulin she injected before eating is now starting to enter the bloodstream, letting glucose into cells to be used as energy. Its a good thing your wife has an excellent endocrinologist and diabetes educator who have helped her learn to count carbohydrates and calculate the correct amount of insulin she needs. If she accidentally gave too much insulin, her blood sugar levels could drop to dangerous levels and she would experience hypoglycemia. On the other hand, without this insulin she injected, glucose would build up in your wifes blood stream, she would experience hyperglycemia and begin feeling extremely fatigued, hungry, and perhaps experience flu-like symptoms. As you have probably seen, your wife may do all she can to minimize hypo- and hyperglycemic events and still experience blood sugar swings, sometimes multiple times a day. Medical professionals understand that some blood sugar swings are normal and therefore use average blood glucose, (or A1c) as a primary indicator of diabetes management. If your wifes average blood glucose remains in the hyperglycemic range, the overabundance of glucose molecules can begin causing damage to her blood vessels and nerves, eventually leading to organ failure. In order to obtain some sort of energy necessary for survival, your wifes body would resort to a dangerous process in which fat is broken down with the release of acidic chemicals called ketones that would eventually result in ketoacidosis or poisoning of the body by ketones. As you can see, lack of insulin or too much insulin are both extremely dangerous.

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As illustrated in the scenario above, in type 1 diabetes, balancing food intake with the appropriate amount of insulin is critical to your spouse/partners physical and emotional well-being. Its no wonder he/she sometimes feels overwhelmed with the responsibility of it all. Not only does your spouse/partner have to act like a pancreas, he/she has to think like one too which can prove very tricky when dozens of other factors besides food and insulin influence blood sugar levels (e.g., stress, exercise, menstrual cycle, etc.). As you take the time to learn about T1D and the challenges your spouse/partner faces, research suggests you will better be able to provide empathy and positive support, which can both strengthen your spouse/partner and your relationship.

(If youd like to see a visual representation of carbohydrate metabolism, check out this short clip!)

Word Glossary

Whether you are only anticipating dealing with chronic illness in a committed relationship or years into the venture, youre not alone if youre overwhelmed with living type 1 diabetes. You and your spouse/partner brave more than the average couple: Incessant blood sugar swings, serious threats of diabetes complications, gnawing fear of financial scarcity, anxiety about children developing the disease, judgmental friends or family, and the shame, anger, and despair that come when best efforts fail to provide the elusive control propagandized by a mercenary pop health culture. And we could go on.

All considered, it is no wonder that the reality of living with type 1 diabetes often imbues fear into relationship formation and processes. Chronic illness can indeed break couples apart.

But for many couples living with T1D, this hasnt been the case (see Graham, 2000; Walsh, 2000; Yorgason et al., 2007). And it doesnt have to be for you either. Although youll undoubtedly still experience normal stresses and fatigue associated with T1D, intentional effort on your part will not just save your relationship, but help it thrive.

How?

We polled a few couples living with T1D and experiencing thriving relationships to get their insight.

From those living with T1D:

From their partners:

Here are some additional ways diabetes may be strengthening your relationship:

As you read over some of the ways diabetes can strengthen your relationship, we hope that you feel some hope! Perhaps you have thought about some of your own experiences. We invite you to talk with your partner about these and practice identifying more of your strengths together. If you dont identify with what has been described above, we urge you to consider with your partner ways that you can claim the benefits of diabetes for your relationship.