Question about behavioral changes

[harmonia]

I have a very close friend who is a Type 1 Diabetic. He's been living/managing his diabetes for over two decades. He is very healthy and fit.

Anyway, we are very close friends and spend a lot of time together. But sometimes, his behavior will be erratic. He'll virtually not speak to me for weeks at a time, or when he does, he is snappish and intolerant.

He has blamed it on stress, poor eating/exercise habits and his BG's going from 40-600 in the course of an hour.

I pointed out that we all have mood swings. We all have BG swings, though not nearly as erratic. And as I female, I have PMS, and it can be bad.... really bad, but I don't behave that way.

So I guess my question is, is he using diabetes as a crutch for poor impulse control, behavioral management? How sympathetic and understanding should I be?

[Subby]

40 - 600? In ONE hour? It's amazing he's not been frequenting the hospital if that is indicative of what's going on for him at times. There is some serious bad stuff going on there. I don't mean it judgmentally, yes we can do the wrong things and it sounds like he is already beating himself up for bad habits and bad decisions. But other factors can create big issues, both within and to a degree outside of easy influence. For some, it's straightforward. For others, it's not that simple. These come down to personality and psychological as well as concrete biological factors.

It's surprising he's not needed more intervention, not just from the physical side effects, but I can say that for me (and others whom I have talked to and read about) wild swinging can completely do your head in.

For years with erratic fluctuation through the day (100, to 230, to 90, to 260, that kind of scenario) I was repeatedly diagnosed with severe depression, and suffered cognitive and emotional difficulty, some frighteningly close to the kind of thing described in bipolar disorder. Virtually all of which, cleared up with better control, for good (well, for years now). I also have some chronic fatigue and I do not know if there are other factors that contributed, but lets say the BG swinging link was extremely strong with head issues.

As a more general statement, swinging BGs are wildly known to cause moodiness, it's not a myth.

I can't comment how sympathetic and understanding you should be- I see that as a pretty subjective issue. Can BG be seriously screwing his head beyond what most people would experience? Yes. Is he laying it on as an excuse, or does this mean you should be responding some other way than understanding (such as saying "OK buster, I like you but get yourself sorted out and we can hang out again"?, Or, "I'm concerned, how can I help you help yourself?") I don't know.

[harmonia]

You are wise in that you picked up exactly what I was thinking about. I want to be a good friend, but at the same time, I don't want to be treated like ****. And I don't want to set the tone that it's OK to treat me like ****.

So you say that psychological issues can make the BGs swing? He said he had more stress than usual in his life. If he's given the opportunity to manage his fitness, he does so. He's very disciplined like that. But he has an enormous amount of pressure from others who want to manage his time. He isn't always able to take full control of his own time.

Diet, well he doesn't always eat the way he should. He tries but we're all human. Again, external factors have an influence.

Would you say the psychological issues are self-perpetuating? Sort of a chicken egg scenario?

[Subby]

I'll keep talking form my experience, I'm not speaking as some expert please understand. As long as that is clear.

What I'm referring to with the psych issues, is that having swinging and high BG affects the brain, and if I speak for my case, every indication was that the effect of swings was the cause of psych issues. Do moodiness, cognitive problems etc, perpetuate swinging BGs? Well, maybe not directly as such... but stress most definitely does. Which, of course, moodiness and all of those issues, may go hand in hand with.

Stress. A huge factor for me. I had to change my life significantly to help stabilise my condition (other factors like pumping and better understanding of how diabetes works - in general and in me - were also major factors to stabilisation).

Diet, exercise, very important, but stress and other issues can just throw spanners in the works than can make those efforts seem virtually ineffective, and throw all plans for control right out. The thing about stress such as at work, is it can be very hard if not in many situations, impossible to control its effect on your BG. The pump does help - you can change your background dose within an hour or two. On injections, you're stuck with a daily preset. These things are just blind, blunt tools for volatile BG situations.

It sounds like he might need to make some decisions. We like to think it's just a matter of discipline or effort to be able to control everything, to be able to do everything. Being affected by excessive stress might be one thing a diabetic needs to concede they can't win the fight with pure discipline and effort, but may need to find other answers. Like take the responsibility to avoid the stress in the first place if possible. Yes, may involve ridiculously hard decisions at times - like leaving a stressful relationship, or leaving a stressful career.

All that aside, no-one should be indulged to be moody and unpleasant without some consequences - not just for others, but for themselves as well. I think you have every right to draw a line, or make a decision it's not on, even if it IS caused by something not entirely his "fault". You might be able to influence him positively as a friend in some way with this. Or, decide it's time to give the relationship way, if he is going to continue with poor decisions and erratic behaviour. Ok, those decisions might be hard to make, to avoid stress. But sometimes life has these hard decisions, no fooling your way around them...

[harmonia]

I know there are long term psychological issues associated with erratic behavior because we are by nature, social creatures and how we interact with people effects our relationships.

What about physical health consequences?

[Subby]

Health consequences of erratic blood sugars? There's a reason diabetes is one of the biggest killers of our time. That's the effect of erratic and abnormal blood sugars on every organ of the body over the years.

There are probably some good resources out there for basic run down of complications, here's one page I found with a quick search. Complications of Type 1 - Understanding the Complications of Type 1 Diabetes (http://type1diabetes.about.com/od/schooldaycareandlaws/a/Complications.htm)

[harmonia]

Thank you for your help. I have some things to think about all of this, and now I have the information I need.

[Subby]

No problem. There is something I hope you might take into consideration. Diabetes can be really hard to deal with psychologically. It can involve layers of denial. The long term nature means we may not deal properly with this or that issue and it gets hidden or cacilfied through the years. There can be complex emotional elements being strapped to a condition that's very hard to like, but is a companion like it or not. It's not fun thinking about the myriad of complications. Good control does not guarentee being complication free, there is a big X factor whatever you do. Being affected physically and mentally, sometimes hour to hour certainly doesn't help the situation, even if it's partly your fault.

It can be an unremitting state to be in, even if from the outside it may look like it just involves some dreary considerations. Diabetics tend to be quite cagey when it comes to understanding from the outside. This is often born out of genuine experience of other people downplaying or dismissing or just, getting the whole thing plain wrong. Most people don't like a heap of sympathy or allowance for a condition, but on the other hand it can be infuriating, upsetting and isolating to feel you are up against something few people actually understand.

I guess, even if he's been unnaceptably rude or unpleasant to you, I guess I'm saying evidence based or fire and brimstone approaches may well come up against huge walls you're not even aware of. (I'm not saing you are thinking of that, but it strikes me as an option anyone would consider).

Sure, we can always take the line "I tried, not my fault the message was not recieved". But I tend to think we can't often change people by argument, only reach them through understanding and by lending strength and confidence and support. Those statements are specifically vague because I think that's what relationships are largely about: actually doing this by communicating with someone in some kind of effective or unique way. I think that's really what I'm getting at. If you did want to give it a shot at sorting this out, letting him know you're not happy but are concerned, and open to lending a hand, the best thing you can do is seek open communication.

[harmonia]

What do you mean cagey when it comes to understanding from the outside? Do you mean seeing how the mood swings effect others?

[Subby]

What do you mean cagey when it comes to understanding from the outside? Do you mean seeing how the mood swings effect others?

Imagine if someone who never got and really didn't understand what PMS even was, had an attitude they knew what it was all about and had the right to comment on how hard or easy it is to deal with, or whether you should be doing this or that. Often that actually comes about from "book learning" or intellectual grasp, giving someone the impression they really do know what they are talking about. It can come from a lack of empathy. It can come from a sense of bitterness or antagonism. It can come from pain old fashioned bigotry or lack of understanding. I bet there are a few guys around who think they really know what PMS is all about, like with any issue like this.

Now, I'm not a woman but I can grasp loosely the idea of hormones stuffing with your emotion, pains etc, I can generally understand a little even if I can't make any kind of real comment about it. If I did think I had a handle on PMS considering my limited experience and limited knowledge, I think I would qualify as arrogant and deluded.

With diabetes, it's a situation that many people might feel they grasp intellectually from the outside, but for the kind of reasons I have mentioned, can be full of difficulties and traps that come about by actually being there unremittingly for 24 / 7 / 365 / year after year, and from facing sometimes almost bizarre challenges that from the outside can look easy or logical, but can be terribly hard and frustrating at times. I'm not saying it's not possible to have some understanding of this - just like I can understand something about PMS because I have had mood swings myself, and because females have described how things can go to me. I am saying that many or most diabetics have come across people who just don't get it, but think they do, and that can be frustrating and disempowering. And so tend to get cagey when others insert their opinion on how to "do" diabetes or others think they really truly understand the situation, in order to comment firmly on it.

Again, having a chat and finding out things about how he lives with it, letting him tell you, is a potential good path with this. Open communication, give and take, and learning from him who is the expert on his body. I just see this kind of conversation as possibly bearing fruit. These are just basic ideas and suggestions to consider, I really don't know what approach is best for this particular person.

[shiftzor]

This really isn't helped by the medical fraternity who have read the book and fail to use it without preaching or dictating or simply interpreting it wrong. Helping a diabetic is difficult because the body is so complicated and unpredictable, there is no science that works for everyone, we simply have to work it out for ourselves. Maybe what this person needs is a break take them on holiday give them some down time and as Subby rightly said talk about it without dictating what the outcome should be and try to show him the light. All diabetics fall off the rails once in a while however it's not how far they fall that counts it's how quickly they get back onto the bandwagon.