How is diabetes a family affair?

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


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.



Please contact Noy Pullen if you would like more information: [email protected] or 072 258 7132.



My family support

Aiden Nel, a teenager with Type 1 diabetes, tells us the highlights and challenges of the support from his family concerning his diabetes.

My family tries to support me with my diabetes as much as possible. Most of the time their support is good, but to be honest there are times that the way they go about supporting me does upset me.

The positives

One of the positive ways that my mother supports me is when she cooks; she tries to cook with the least amount of sugar, and as a family, they try their best to not have more carbohydrates than necessary.

As a family, we also only drink sugar-free cold drinks. It’s very rare that we will have a sugar cold drink, like Coke or Cream Soda, in the fridge.

My sister likes sweets, but she is very considerate and won’t eat them in front of me. I still do eat sweets, but not as much as other non-diabetic children. I just need to have my insulin immediately.

The negatives

One thing that does upset me though, is that we don’t often eat dessert. I sometimes feel that this is because of my diabetes and what child wouldn’t be upset if they could not have pudding?

The biggest bugbear is the constant asking of what my reading is. Every night, before I go to bed, they ask me what my reading is. Before I leave for school, in the morning, they ask me what my reading is. Sometimes I do get irritated by all the asking and checking of my readings. However, I do know that it is for the best and they are asking out of concern and love for me. So, I do not stay upset for long. I just go and test myself, and then everyone is happy again.

Even if my family sometimes upsets me, they still do their best to help me, and I am very grateful for their support and love.

Aiden Nel lives in Port Elizabeth. He is 14 years old and has Type 1 diabetes.

The flexible family

One of your family members has diabetes, but in a way, the whole family has diabetes because each of you experiences this chronic disease in one way or another. Rosemary Flynn expands on the flexible family.

A family can be a single parent family or a large family, including others like a grandmother or a cousin.

The ups and downs of diabetes can bring emotional highs and lows that each of the family members must deal with, and that requires flexibility.

Family stressors, like arguments, divorce, or loss of a family member, can make blood glucose levels higher and that will negatively affect diabetes control in the long run. The family needs to be able to work together to resolve the problems and also to manage the diabetes.

In any family, the spouse or parents often worry about the person with diabetes. Have they eaten right? Are they managing their control enough to prevent complications? Have they exercised enough and safely? Are they losing weight as has been advised by the diabetes team? Worrying is a natural response in families, because they love each other.

The family worries a lot less when the person with diabetes takes responsibility for their diabetes and practises good management. It works the other way around too: if the person has family support, he or she worries a lot less.

Each family member must understand diabetes well

On the medical side, for the family to be supportive, each member needs to understand diabetes well. They need to know how to deal with hypoglycaemia and high blood glucose levels, the eating plan, the exercise plan, the medical plan and the management plan. Even the young ones can have an understanding at their level of development.

Understand that if the person with diabetes is a child, siblings can be resentful of all the attention given, or feel guilty, or feel anxious for their brother or sister. So, give them the space to talk about their feelings.

A balanced family

Family balance goes a long way to making diabetes self-care successful. Creating a balanced family can be done in the following ways:

  • Have family meetings to talk to each other about the things that concern you (include all who live in your home, even the little ones). Give everyone a turn to speak and respect what each family member has to say. Any diabetes information can be discussed this way. It allows for creative solutions to the problems to be found.
  • Talk to other families who have a member with diabetes. Attend family events organised by diabetes organisations or interested parties. This offers you support and helps you feel less isolated as you deal with the day-to-day care of diabetes. Sometimes other families, especially those who have many years of experience, can give good ideas on how to deal with family issues that arise because of diabetes.
  • Spend time with your family, doing things you all enjoy, and listen to what is going on in each member’s life. This makes each member feel they belong.
  • If you need to speak to one family member, set aside a special time to do this.

Create a flexible family by:

  • Having clear limits, expectations and rules which can be adapted to different situations.
  • Being committed to the decisions that are made in the family, but carry these out in a reasonable, flexible way.
  • Being respectful and kind to each other.
  • Solving problems together.
  • Valuing each member’s feelings.

Having a flexible family means that each person feels valued, understood and secure in their relationships at home. They can develop confidence and positive self-esteem both at home and outside of the home. They are less likely to struggle with anxiety and depression.

A flexible family will enable both the person with diabetes and all the other members of the family to go into the future in a positive way.

Rosemary Flynn


Rosemary Flynn is a clinical psychologist at the Centre for Diabetes in Johannesburg. She has worked with children, families and adults with diabetes for 24 years, enabling them to overcome their anxieties about their condition and to deal with the difficult events in their lives.

Family ties

Research has shown that families play a key role in how well people with diabetes adjust to the disease, integrate it into their lives, and manage it well. This suggests that good diabetes control depends on a healthy psychological environment. Rosemary Flynn advises on how to achieve this.  

You have diabetes, but in a way your family has diabetes too because you are one part of a whole family, whatever the family looks like: a partnership, married parents with children, grandparents or extended family. Each member of the family has an influence on all the others. On the one hand, how you deal with your diabetes will have an impact on your partner and family, and on the other hand how your partner and family supports you will impact you and how you handle your diabetes.


Creating a healthy psychological environment

If you manage your diabetes well and show that you can cope with the daily demands of diabetes, and get it right, your partner will relax and leave you to it and only be involved when you need it.

If you don’t take responsibility for your diabetes and either ignore it or defy it, your partner will become very anxious and will possibly try to persuade you to do the ‘right thing’ whether it is to do with what you eat or how you exercise or taking medications. They may do it in an annoying way and perhaps will need to learn how to do it more gently, but when you think about it, they have to deal with the stresses that diabetes brings too, particularly if you have Type 1 diabetes.

When your partner has these worries, he or she is not paranoid or unreasonable; they are natural responses because they love you. You may want to be totally independent and cope with your diabetes on your own, but if you are not being responsible about managing your diabetes, your partner will want to help. The more responsible you are, the less they will feel they need to nag you. Some of your partner’s worries would be the following:

  • Partners worry a lot about your lows when you have Type 1 diabetes. They’re afraid that you’ll have a low in the night and not wake up, or you’ll become unconscious, or have a seizure, and that they will not wake up to help you. So they often have disturbed nights, because they want to check on you at some time during the night.
  • They worry that you’ll ignore the symptoms of a low or not have the glucose you need to address the symptoms.
  • Since diabetes is not curable, they fear for your future. They really worry about complications developing, especially when your control is poor.
  • They often feel very sad that you have diabetes. They feel it as a loss as much as you do. They may fear that you will die and they will lose you. They also need to be reassured that you can overcome your diabetes.
  • When they’re being bossy, it may be because they’re afraid that you’ll get it wrong and they’ll lose you.
  • They may feel that the good relationship you had before the diabetes has been lost, and they miss what you had before.

Striking a balance is not easy. How much does your partner play a part, and how much do they leave you to get on with it? This needs to be negotiated between the two of you, until you find a way to work together without conflict. And then there are life stressors that complicate your relationship. Things like:

  • family arguments.
  • the loss of a loved member of the family or a friend.
  • the loss of a job.
  • financial strain.
  • a traumatic incident such as a car accident.
  • a violent crime that touches you.
  • excess alcohol consumption.

All of these stressors will have an impact on your relationship while you’re dealing with the difficult circumstances. Both of you will be more anxious and your responses to the anxiety can create uneasiness in the relationship. Add to that, the fact that the stress is pushing your blood glucose levels up and the situation can become quite volatile.

If the difficulty in your relationship with your partner is not resolved in a satisfactory way, conflict and reactions to the dispute can become ongoing. It is so important for you to find a way to normalise your relationship. This is vitally important to your family and to your diabetes! If you need outside help and support to do this, find the help you need.

What can families do to cope with these feelings?

  • Talk to each other about diabetes and things that have happened. Talking can help to strengthen the family bond. The idea is to communicate about the issues that are of concern to each other and the way everyone feels about it. Everyone should have a turn to speak, and each person should feel understood and supported so that the issue can be addressed constructively. Respecting each person’s individuality and situation helps to create an atmosphere of acceptance and allows for creative solutions to problems. Any diabetes information or issues can be discussed in this way.
  • Talk to other families who also have a member with diabetes. Attend family events organised by diabetes organisations or interested parties. This offers you support and helps you feel less isolated as you deal with the day-to-day care of diabetes. Sometimes other families, especially those who have many years of experience, can share good ideas on how to deal with family issues that arise because of diabetes.
  • Be committed to the decisions that are made in the family, but carry these out in a flexible way.
  • Be respectful and kind to each other.
  • Solve problems together.

This way, feelings are valued and the connection between partners and between all family members is restored and maintained.

Also remember that diabetes is in the family genetics, so each member of your family could also be at risk of developing diabetes.  It is helpful to educate your family members on leading healthy lifestyles in order to prevent another member of your family having a diabetes diagnosis.

MEET OUR EXPERT - Rosemary Flynn

Rosemary Flynn
Rosemary Flynn is a clinical psychologist at the Centre for Diabetes in Johannesburg. She has worked with children, families and adults with diabetes for 24 years, enabling them to overcome their anxieties about their condition and to deal with the difficult events in their lives.

Healthy eating – a family affair

A healthy meal plan isn’t just for people with diabetes. In fact, the dietary guidelines recommended for people with diabetes are the same as those recommended for the rest of the population. That means your family doesn’t need to prepare separate meals for you at home – they can simply adopt your healthy habits. Follow these 10 tips to build a balanced and healthy meal plan for your whole family.

  1. Enjoy a variety of foods.

Not one food can deliver all the necessary nutrients for you and your family, so you should make sure that your family eats different types of food.

  1. Make starchy foods part of most meals.

A small portion of good quality carbohydrates helps to give the body energy. Choose high-fibre starchy foods – like high-fibre breakfast cereals, whole grain bread and wholewheat pasta – over more refined versions for sustained energy to help your family through the work or school day.

  1. Eat dried beans, split peas, lentils and soya regularly.

Beans and legumes are good sources of protein, fibre and B vitamins, and they also help to improve blood glucose control. Aim to include beans and legumes in your family’s menu at least twice a week.

  1. Eat plenty of vegetables and fruit every day.

Vegetables and fruit contain loads of different nutrients, like fibre, vitamins and minerals. Your family should eat at least five portions of vegetables and fruit daily to make sure they get a variety of nutrients needed for health.

  1. Have milk, maas or yoghurt every day.

Encourage your family to enjoy at least three servings of dairy foods per day to ensure they develop strong, healthy teeth and bones. Aim to choose versions with less added sugar where possible.

  1. Drink lots of clean safe water.

Water is the best way for your family to stay hydrated and should be their first choice when choosing a beverage. It is the cheapest yet best drink of all. Start your children on water when they are young and it will remain a good habit for the rest of their lives.

  1. Use salt and food high in salt sparingly.

Eating too much salt increases your risk of high blood pressure (hypertension) and health conditions in the long term. Let your family enjoy the natural taste of foods by not adding salt to meals and avoiding salty ingredients in your cooking, such as stock cubes and soup powders.

  1. Use sugar and food and drinks high in sugar sparingly.

Limit foods with added sugar, like cookies, sweets, chocolates and sugar-sweetened drinks. Keep sugary foods as ‘special occasion’ treats, and practice portion control when you do enjoy them.

  1. Fish, chicken, lean meat and eggs can be eaten daily.

Protein helps to provide the body with strength and structure, while repairing damage and promoting growth. Including protein in your meals also helps to improve blood glucose control. Oily fish is also a great source of omega-3 fatty acids which helps to protect against heart disease.

  1. Choose good quality fats.

Beware of eating excess saturated and trans fats. When you and your family use fats, choose unsaturated sources like olive and canola oil, oily fish, tub margarines, avocado, peanut butter and nuts.

Pick n Pay Health Hotline

Did you know that Pick n Pay employs a registered dietitian to provide free food and nutrition-related advice to the public? Whether looking for guidelines on managing your condition, weight loss tips, healthy eating tips for kids, how to manage food allergies, how to interpret food labels or any other food-related query you have always wanted answered, our registered dietitian is just a phone call away.

Contact the Pick n Pay Health Hotline on 0800 11 22 88 or email [email protected] to start your nutrition conversation.

MEET OUR EXPERT - Leanne Kiezer

Registered Dietitian BSc Diet, PgD Diet UKZN, MSc Nutrition NWU. Leanne joined Pick n Pay as the resident dietitian in May 2014. She is the voice behind the Pick n Pay Health Hotline, providing advice to customers on a range of nutrition and health-related topics. She also provides nutrition input as part of the Pick n Pay food development team, and ensures that all communication is in line with the most recent advances in nutrition science and research.