Issue 62 December 2013
1. The young Indian female with type 1 diabetes: challenges with marriage
Jothydev’s Diabetes Research Centre under the leadership of Dr.Jothydev Kesavadev presented 4 original researches at the International Diabetes Federation World Diabetes Congress early this month at Melbourne, Australia. The oral presentation by Dr.Jothydev Kesavadev was on the challenges with marriage faced by young Indian females with type 1 diabetes.

The diagnosis of type 1 diabetes poses a threat and challenge to both the life of a child and of parents. The situation is worse in female than in male. Even in literate parts of India, hiding disease from school, friends and even from close acquaintances are extremely common despite widespread awareness and education of risk involved in not disclosing disease.

Women find it extremely difficult and impossible to get a suitable spouse and stressors get multiplied once they manage to get married and start living with husband and his parents which is the norm in Indian culture. Obviously the majority that eventually happen are by bribing (dowry) or by cheating (hiding the disease).

Here we discuss some of the major issues we have encountered in type 1 married females and the solutions for a couple of challenges,admitting the fact that major obstacles are too complex and critical and lacks a justifiable solution due to the limitation imposed by the fear of indigenous culture, tradition and societal norms.

Challenges Reasons

Skipping insulin shots and avoiding insulin pump/MDI

hiding the disease from family, for sake of convenience and not to be conscious of the disease

Lack of monitoring

difficult to cope up with the new family and apprehensive of their reactions

Recurrent abortions

Poor glycemic control, preconception A1c very high and fear of death of foetus in utero; patient gets demotivated and anxious

Dyspareunia and post coital hypoglycemia

feeling of guilt of hiding the disease from husband

Stress of eating together with
new family members

anxious about pricking frequently before other family members and lack of healthy eating

Stress of impending hypoglycemia/DKA

lack of frequent monitoring and poor glycemic control

Insecurity feeling

fear of separation

Living with type 1 diabetes involves not only diabetes self management skills but also skills to cope up with the day to day challenges involved in married life. Increasing awareness in the society on the serious long term consequences of diabetes has negatively affected the future of young/unamarried individuals with diabetes. Diabetes mass education and awareness projects should aim at specific modules, underscoring the importance of adhering to treatment protocols, helping young individuals stay healthy and the truth that normal life is possible with diabetes. Premarital and post marital counseling for the couple and family members customized to address the specific concern should overcome all the existing challenges before and after marriage.
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