Type 2 diabetes can come with a tricky add-along: unsolicited questions and advice. Just ask Julie Rasmussen, 59, who has been fielding comments such as these from the well-meaning since developing the condition a few years ago:
"Are you sure you should eat that?"
"I shouldn't eat this in front of you."
"Are you sure you don't want a taste?"
Or her favorite, delivered over lunch: "How many more pounds does the doctor say you need to lose?"
All of which can try the patience even of a special-education teacher such as Rasmussen.
"People may not mean to be 'judge-y,' but it feels as if they are judging me," the Glenside woman said. "They may mean well, but such questions are exhausting. Some days, life with diabetes is already a lot."
Lynn Nichols, a registered dietitian and certified diabetes educator at Main Line Health, is familiar with the problem.
"Perhaps the biggest question is, 'Should you be eating that?' " says Nichols. "Some people have outdated ideas about diabetes, that certain foods are allowed and not allowed. In truth, people with diabetes can eat anything."
The real issue, she said, is counting carbs of all kinds, from cookies to apples.
"It doesn't mean that you should be eating cookies every day," she quickly clarifies. "But diabetes is complex and individual and some well-meaning people have not gotten that message."
In a way, heightened public awareness of diabetes has made life trickier for patients. For one thing, type 2 has escalated along with the obesity epidemic — a fact that a lot of people seem to understand. What isn't so well-known, though, is that many people with type 2 are not obese, or even overweight.
"I've been at Joslin for about 30 years," says John Zreibec, chief of behavioral health services at Boston's famous Joslin Diabetes Center. "When I first got here, people outside the clinic knew little about diabetes and didn't understand it. But now, most people think they know a lot about diabetes, so they tend to give a lot of advice about diabetes, much of it misguided."
So how do you deal with unsolicited remarks?
"For a person with diabetes, it's incumbent on them to explain to other people what they need in general," says Zreibec. "If you're talking about friends and family, you need to explain what you need and even how to say it."
This means doing some planning, says Zreibec. If you have low blood sugar, your thinking can go off track and even the nicest person can become irritable.
"Just the way a person looks at you can determine whether you throw the orange juice and crackers to raise your sugars in their face," he says.
A better way to handle it is for the person with diabetes to figure out what they want and need in such moments — and communicate those wishes before the need arises. Do you want people to get out of the way? Or, do you want them to baby you? How should they act?
"One thing you can ask friends and relatives to avoid blame and shame," says Zreibec. "If your blood sugars are off track, you don't want family members saying, 'What did you do?' "
Instead, he recommends that you ask people to go straight to problem-solving.
Asking "How can I help you solve this problem?" is preferable to "Whose fault is it?" he says.
Having a chronic disease can put a strain on relationships, he notes, particularly for married couples. Many spouses may take for granted that they know what their diabetic partner needs. But what was once understanding can easily become annoying.
"Figure this out," says Zreibec. "If you're in the supermarket, do you want your partner nagging you about everything you put in the basket? Or not? What do you want them to say? What do you want them to do?"
Words matter, a lot. People often use phrases that restrict: you have to, you must. Instead, try for language that gives people with diabetes choices, such as "You may want to try this." Or "Is there something I can do when your blood sugars are low?"
"People with diabetes need to stand up for themselves when confronted with unwanted comments and questions," says Nichols, who suggests one fallback answer: "I'm doing the best for me."
"Tell people that you're following the advice of your nutritionist or diabetes educator or endocrinologist, and that is the most important thing," Nichols says.
For Rasmussen, sometimes the only thing to do is laugh.
"I remind myself people are well-meaning, even if they don't always know what they're talking about," she says.
But overall, she'd rather people keep their opinions to themselves.
"I'm learning different stuff all the time about diabetes. I'm trying and I'm careful," says Rasmussen. "But with diabetes you can do everything right the day before, then take your blood sugar the next morning and find that it's high. The last thing you want to hear is, "What are you doing to take care of your sugars? What did you eat?"