When was the last time you heard a “diabeetus” joke? The answer is likely all too recent. Type 2 Diabetes is an extremely stigmatized condition — the majority of Type 2 diabetes patients report feeling stigma.[1] The public perceives Type 2 diabetes as a self-inflicted disease, worthy of derision. Unfortunately, some healthcare professionals also feel this way.
When patients feel shame and judgement around their diabetes, their health outcomes worsen.[2] For example, because of fear of judgement from their healthcare providers, some people with diabetes under report their blood glucose numbers.[3] The solution? Changing the way our culture thinks and talks about diabetes. To best help patients with diabetes, we need to understand diabetes as part of larger social and economic issues.
Youth with Type 2 diabetes are leading this movement. Young poet Gabriel Cortez explores the complexities of diabetes in his poem “Perfect Soldiers.”[4]
It is impossible to tell the difference between a roadside bomb victim
And someone who just forgot to take their insulin.
Grandpa keeps at least two 12-packs of soda in the fridge at all times.
Sunny Delight, Tampico, High-C, a jug of Kool-Aid in the back.
Dr. Pepper lines our refrigerator door like a vest of dynamite,
An arsenal of ways to self-destruct.
It is how you learn to drink growing up in a country where soda is cheaper than clean water,
Where hunger is a canal carved deep into your belly.
[…]
I learned to drink like Grandpa.
Gabriel’s message is clear. Although lifestyle choices impact Type 2 diabetes, lifestyles are not easy to change, and are deeply tied to heritage, family, and community. For example, exercise and a healthy diet are known to reduce a person’s risk of Type 2 diabetes. But shifting one’s healthy eating and exercise habits can be deceptively difficult.
Consider the cost of fruits, vegetables, and whole grains. Unhealthy food is often significantly cheaper.[5] Even when healthy foods are affordable, struggling families are often poor in time as well as money. Healthy food may take longer to prepare.
Exercise operates on similar logic. After a long day on his or her feet, exercise may be the last thing on a retail worker’s mind — assuming he or she even has the time to exercise, and a safe place in which to do so. Gym memberships are expensive, and low-income communities often have few safe, clean public parks or jogging trails.[6]
Of course, lifestyle changes are still necessary to combating diabetes. But as a healthcare provider, show your diabetic and pre-diabetic patients compassion and empathy — it may be the first time someone has. Here are some tips for having the conversation.[7]
Speak respectfully. Many diabetic patients report their doctors imply they are “out of control,” or treat them like misbehaving children. Remember that your patients are often trying very hard, and that diabetes is difficult to manage. To emphasize your patient’s personhood, use “person with diabetes” instead of “diabetic.”
Use active listening. Connect with your patients, ask them clarifying questions, and reflect what they are saying so they know you understand. When you listen actively, patients feel more comfortable asking questions and speaking openly.
Don’t moralize the medical. Find ways to talk about health without implying diabetes makes your patients lesser. Even if your patient gains weight or needs insulin, they are not “bad diabetics” and they have not failed.
Be hopeful. Studies show that messages of hope, delivered right at diagnosis, can affect patients’ attitudes and diabetes management behaviors for years to come. Your patients need to know that you believe in them.
[1] http://clinical.diabetesjournals.org/content/35/1/27
[2] https://www.tandfonline.com/doi/full/10.1080/13548500600595053?
scroll=top&needAccess=true
[3] http://care.diabetesjournals.org/content/40/12/1790
[4] https://www.youtube.com/watch?v=tgh8NxNnhoI
[5] https://cola.unh.edu/sites/cola.unh.edu/files/student-journals/P12_White.pdf
[6] http://frac.org/obesity-health/low-income-food-insecure-people-vulnerable-
poor-nutrition-obesity
[7] http://care.diabetesjournals.org/content/40/12/1790