There is a saying, “When one person feels better, the whole family situation improves”, Noy Pullen explains why this is true.

Some years ago, I interviewed Credo Mutwa, the renowned traditional practitioner. He told me that when he was newly qualified, diabetes was hardly ever diagnosed among his patients. He said with the continuing growth of what he called American cold drinks and the American lifestyle, he noticed a marked increase in diagnosis of diabetes.

When I first started writing for Diabetes Focus, in 1996, I would ask any random group of people in any social setting how many of them had diabetes in the family. If two people put up their hands, it was unusual. During the many years we have run Diabetes South Africa’s Agents for Change courses with healthcare providers and patients, I continued to ask this question. Presently there is always more than 80% of the group raising their hands.

How does diabetes affect you?

Type 3 diabetes is a term that has been used colloquially (even though there is a medical definition for it) in the diabetes community to include all those who do not have diabetes themselves, but are living with someone who has diabetes and are affected by the condition. It has become clear that diabetes affects more than 80% of our population. Everyone’s diabetes affects family, friends, colleagues, in fact the whole community. Diabetes affects us all.

Challenges to lifestyle changes

Participants who attend the first Agents for Change module become motivated to change something in their life. Most of them have families to consider. Many of them would also like their families to change. For example, habits that have led to obesity amongst family members, or perhaps an inactive lifestyle. Questions are asked – How does one change the habits of others? Is it possible?

When the participants return for the follow-up module three months later, they fill in questionnaires which indicate a mixture of success stories and challenges. Some of them managed their goals, others found it difficult to change their own habits. While others met with resistance from the family, who, for example, did not want to eat more vegetables, or give up unhealthy options. Some participants’ lives are dependent on their families who are not prepared to make special dishes for them.

Some risk factors to developing diabetes (which affects all family members eventually):

Age – over forty

Central obesity – waist circumference of over 88 for women and over 102 for men

Family history – heredity factors

Alcohol consumption

Smoking

Side effects of certain medication e.g. steroids, statins and others

Inactive lifestyle

Consumption of high carbohydrates meals and fast foods

Stress levels

High blood pressure and cholesterol levels

Lifestyle changes will alter this picture. Yet this knowledge is clearly not enough to facilitate these changes. None of this information is new. We hear it on the radio, we see it on screen. How can we help change come about? Do we have to get diabetes before we make changes?

The 5 As

These are based on a counselling style called Brief Behaviour Change Counselling¹.

Ask about individual risk situations in the family; for a family chat and request permission to speak about your concerns.
Alert the person to what your concerns are, and add any information that you have agreed to talk about. Ask for support for any change that comes from the discussion.
Assess the relevance of the situation to others in the family – risk factors, possible outcomes. Determine the readiness of each member of the family to change.
Assist in making plans for agreed changes, behavioural skills and confidence to succeed e.g. graphs, charts, incentives.
Arrange for agreed appointments e.g. with the gym or dietitian, etc.; follow-up family check-ins, community based resources.