Tuesday , November 21 2017
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2nd Marriage Can Mean Expanded Family Obligations

It’s never too early to start talking about the holidays with our patients. For some, it’s a holiday almost every night. Man, 76 years of age, visits with his wife for obesity and type 2 diabetes management. Despite diabetes education, including medical nutritional therapy and medication, he was not losing weight nor were his glucose levels improving…especially his bedtime glucose levels.

This is the second marriage for both of them. Each of them came into the marriage with 6 children. Between the two of them, they now have 12 children, their spouses and grandchildren.

As they were leaving, they told me they were going out for one of their grandchildren’s birthday dinner. I asked them how often they have these dinner celebrations. They told me, “Whenever there is a birthday.” I usually teach patients it’s okay to “indulge” once in a while for a family celebration, but realized this is way more than once in a while, and could be the barrier keeping him from making progress.

Our visit then consisted of making a decision of how to make “better” weight and diabetes-friendly choices on these many occasions. He is taking a daily GLP-1 agonist every morning. We also discussed moving that medication to late afternoon to see if it would help his dinner appetite.

He returned in one month, having lost 4 pounds. He said he changed the timing of his GLP-1 agonist, was less hungry for dinner, ate less, and his bedtime glucose and fastings had improved

Lessons Learned:

  • Diabetes is 24/7. Much of the management is lifestyle. Know your patients’ lifestyles, which include knowing family and friend relationships.
  • It is not unusual for people to be on their 2nd, 3rd or higher marriages. These include a lot more family members than we may expect. Ask patients about their celebrations, how many of them are there, and how do they handle them.
  • Tailor treatment to target the times that are most difficult for patients.

Anonymous

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