Helping a family member take care of his or her diabetes can be extremely frustrating, especially when that person is not following their physician-recommended regimen of checking their blood sugars, eating healthy, and being physically active. It is helpful to remember, however, that changing and then maintaining a new behavior is difficult. More importantly, when living with diabetes, family members likely need to change several behaviors all at once.
Family members might have the best intentions to help someone change, but may not be working with the right set of tools to be successful. This fact sheet provides tools and resources for all family members to use to provide supportive and effective assistance to those with diabetes.
Behavior change experts suggest that people go through six “stages of change” (Prochaska & Di Clemente, 1982). Our personal motivations “pull” us through the stages towards adopting a health behavior such as healthy eating or physical activity. Being aware of the six stages can help family members find ways to support or encourage the person with diabetes, motivating them to change towards healthier behaviors. The six stages are:
- Precontemplation: Family member with diabetes has no inclination how to change a behavior related to diabetes management. He or she does not view that there is problem or is unaware of their problem.
- Contemplation: Family member is aware of a problem with their diabetes management and the consequences of not changing or not adopting self-management behaviors, but still is not committed or motivated to change. They weigh the pros and cons of changing their behavior(s).
- Preparation: Family member is motivated to change, but has not yet started. He or she is making plans, looking into strategies, or setting concrete goals.
- Action: Family member has started to change and has maintained the behavior for fewer than six months.
- Maintenance: Family member has maintained the behavior for six months and beyond, and the adopted behavior has become a habit.
- Relapse: Family member returns to previous behavior(s) of poor diabetes management.
It’s important to recognize what stage a family member living with diabetes is in when it comes to behaviors such as healthy eating, physical activity, taking medications, checking blood sugars, and even accepting a diabetes diagnosis. As a family member without diabetes, it is possible to feel stressed, fearful, or frustrated especially if a loved one is stuck in the early stages and is not progressing to the next level. As is often the case, family members without diabetes might feel as if they are the ones “pulling” for the behavior change and consequently feel overwhelmed and underappreciated. It is also common for those recently diagnosed with diabetes to experience grief and loss; the loss of an “old self/old lifestyle/freedom of choice” (Kubler-Ross & Kessler, 2005). Other family members may experience these feelings as well (Kubler-Ross & Kessler, 2005). The following strategies support and encourage a person with diabetes to move towards the physician-recommended behavior changes of diabetes management.
In the precontemplation stage, help the family member with diabetes realize that unmanaged diabetes could negatively impact their aspirations for the future, relationships with family members and friends, and their overall quality of life. Effective dialogue can help them discover personal motivations to change and also the consequences of inaction (Steinberg & Miller, 2015).
- Ask the person with diabetes open-ended questions about what is important in life. Start with “who, what, where, why, when…” An example:
- “What are you looking forward to within the next six months?”
- “How will diabetes affect your plans?”
- “What is most important to you?”
- “How could a diabetes complication like kidney disease affect what is important to you?”
- When it comes to discussing the potential consequences of inaction, use "I” statements and observations versus “you” statements, which can come across as shaming or nagging (Gordon, 1977). For example:
- “I care about you and am worried about the complications that diabetes can cause if we don’t make some changes.”
- “I’m worried what will happen to your blood sugar if you eat two bowls of ice cream.”
In the contemplation stage, help the family member with diabetes tip the decisional balance in favor of the “pros” versus “cons” towards behavior change. Continue to dialogue about motivations to change and provide evidence-based resources.
- Non-judgmental conversations or open-ended questions
- “How are you feeling about what the doctor told you? What are you thinking?”
- Active listening (Gordon, 1977)
- “I hear you say you are sad that you have to limit ice cream. How can I help?”
- Make the behavior change sound easier and more appealing
- “I know how much you love your two bowls of ice cream but remember how bad it made you feel last time. I took this Dining with Diabetes class and found these tasty healthy dessert recipes.”
- Encouragement and support
- “I’m glad that you trust me to talk about your concerns, fears, limitation, and goals.”
In preparation, help them make the changes.
- Help them set goals that are SMART—specific, measurable, achievable, realistic, and time-bound. For example:
- “When snacking, I will measure the recommended serving size (i.e., ½ cup ice cream, 1/3 cup of spaghetti) a minimum of five meals per week for the next three weeks.”
- “I will walk 30 minutes with a friend four nights a week for the next three weeks.”
- Help them identify a partner who will provide coaching and accountability towards the maintenance stage. Such individuals could be a health care professional (e.g., dietitian, nutritionist, trainer), a family member or friend. It is important to recognize that certain family members, including yourself, may not be the best choice for this role.
- Encourage the family member with diabetes to choose their own goals. Family members should not project their own goals during this stage. Family members can make this successful by listening non-judgmentally.
- Family members can show support and encouragement by incorporating similar goals in their lifestyle.
In the action stage, create opportunities for success.
- Allow for the family member to accomplish their goals and help them by continuing to show non-judgmental support.
- Opportunities for success can be created by working together, such as: attend cooking classes, changing family habits, exercising, and having conversations.
In the maintenance stage, continue to support successful behavior change.
- Maintain a plan for support that is easy to follow.
- Continue to praise your family member for the positive changes they have made.
If a relapse becomes inevitable, identify the stage of change the person with diabetes did not complete and follow again the recommended strategies for changing behavior.
- Relapses are common and research suggests that three to four relapses may happen before a habit is developed.
- Try to help the family member with diabetes identify why the relapse occurred by asking open-ended questions and using non-judgmental “I” statements.
- “I understand how hard it is to make these changes. What can I do to help you start again?”
Family members without diabetes should be aware that their own attitudes and behaviors can be extremely influential to the diagnosed person’s success or failure (Beverly, Miller, & Wray, 2008). For example, non-diagnosed family members’ unhealthy food choices might sabotage the individual with diabetes efforts to follow a meal plan. It may be a stretch to try the new recipes for other family members but this is an easy way to show support. In other instances, undiagnosed family members might try to control food preparation which can lead to rebellion by the person living with diabetes or even cause the hoarding of sweets. Family members with diabetes should be engaged and allowed to make meals and decisions about the food they eat.
Being a caregiver or supporting a family member of someone with diabetes can be challenging. Poor relationships between family members can lead to poor diabetes self-care, high blood sugars, stress, and many other negative health outcomes (Connell, Davis, Gallant, & Sharpe, 1994; Helgeson, Mascatelli, Seltman, Korytkowski, & Hausmann, 2016; Trief, Himes, Orendorff, & Weinstock, 2001). Using the previously mentioned Stages of Change strategies could improve relationships by promoting communication, cooperation, and a mutual understanding of diabetes.
Beverly, E. A., Miller, C. K., & Wray, L. A. (2008). Spousal Support and Food-Related Behavior Change in Middle-Aged and Older Adults Living With Type 2 Diabetes. Health Education & Behavior, 35(5), 707–720. doi.org/10.1177/1090198107299787
Connell, C. M., Davis, W. K., Gallant, M. P., & Sharpe, P. A. (1994). Impact of social support, social cognitive variables, and perceived threat on depression among adults with diabetes. Health Psychology, 13(3), 263–73. doi.org/10.1037/0278-6184.108.40.2063
Gordon, T. (1977). Effective Leadership Training. New York: Wyden Books.
Helgeson, V. S., Mascatelli, K., Seltman, H., Korytkowski, M., & Hausmann, L. R. M. (2016). Implications of supportive and unsupportive behavior for couples with newly diagnosed diabetes. Health Psychology, 35(10), 1047–1058. doi.org/10.1037/hea0000388
Kubler-Ross, E., & Kessler, D. (2005). On Grief and Grieving—Finding the meaning of Grief Through the Five Stages of Loss. New York: Shibler.
Prochaska, J. O., & Di Clemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy, 19(3), 276–288. doi.org/10.1037/h0088437
Steinberg, M., & Miller, W. (2015). Motivational Interviewing in Diabetes Care. New York: The Guilford Press.
Trief, P., Himes, C., Orendorff, R., & Weinstock, R. (2001). The Marital Relationship and Psychosocial Adaptation and Glycemic Control of Individuals With Diabetes. Diabetes Care, 24, 1384–1389.
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