Perceptions of diabetes and health: addressing the stereotypes

Sara Marshall, News Editor

At the age of six, I was diagnosed with type 1 diabetes, a condition that has been a part of my life for almost 14 years now. Living with a chronic condition without a cure has been an immutable fact of my life for so long that diabetes has become an inseparable part of my identity, even if I have taken great pains to hide that part of myself. I cannot separate my sense of self from who I am as a person with diabetes. This makes the reinforcement of negative stereotypes painful: not only does my identity as a diabetic feel criticized, but my sense of self does as well.

The stereotypes associated with diabetes and weight have profoundly impacted my perceptions of health and weight. As one of millions of young women exposed to unrealistic beauty standards, the added complexity of diabetes intensified my anxieties around body image. 

I would first like to state that I am not the type 1 poster child. Diabetes affects everyone differently, and I cannot claim that my experiences and generalizations hold true for everyone. My life with diabetes also comes from a place of privilege, as I am white and have been afforded financial security all my life. My parents have always been able to cover the substantial costs of my health insurance, pay for my insulin and medical supplies and spend countless hours caring for me when my diabetes required assistance. 

Many with diabetes, type 1 and type 2, do not have the support system I have, which is in itself a whole other issue. While medical privilege is not inherently tied to race, there are systemic factors in healthcare that disproportionately disadvantage people of color. These include lack of access to quality healthcare due to structural racism, implicit bias from healthcare providers and historical mistreatment of people of color in medical research. These factors can lead to higher rates of undiagnosed or misdiagnosed conditions, inadequate treatment, and poorer health outcomes for people of color. As a result, people of color may be more likely to develop chronic conditions like diabetes and face additional challenges in managing those conditions. It’s important to consider the intersectionality of identities and systemic factors that contribute to medical privilege and disadvantage for different groups.

I want to explain some basic differences between type 1 and type 2 diabetes. Type 1 diabetes is an autoimmune disease in which the immune system attacks and destroys the insulin-producing cells in the pancreas, resulting in little or no insulin production. Insulin is a hormone that helps to regulate blood sugar levels in the body. As a result, people with type 1 diabetes must take insulin injections or use an insulin pump to manage their blood sugar levels. Type 1 diabetes usually develops in childhood or adolescence, but it can occur at any age.

Type 2 diabetes, on the other hand, is a metabolic disorder in which the body becomes resistant to the effects of insulin, or the pancreas does not produce enough insulin to meet the body’s needs. Type 2 diabetes is often associated with obesity and a sedentary lifestyle, but it can also be influenced by genetics and other factors. Unlike type 1 diabetes, type 2 diabetes can often be managed through lifestyle changes such as diet and exercise, oral medications or insulin injections.

Though many people have assumed my life changed drastically after my diagnosis, the medical side was only part of the transition. Diabetes simply required small, constant adjustments to the monitoring of my health and created a more stringent awareness of my activities and diet. 

What really changed was other people’s perceptions and treatment of me. My diagnosis severely curtailed my autonomy. As a young child with no experience caring for a chronic disease, that restriction of freedom was not entirely antithetical, but it is incredibly difficult to explain that to someone so young. No one ever really tried to explain it either. It was more like, “This is the hand you’ve been dealt, now deal with it and don’t complain too much.” It was easier to adopt a mindset of bravery and resilience than it was to come to terms with the reality that living with diabetes, especially during childhood, could be extremely difficult.

Faced with stereotyping and a resulting inability of people to even recognize characteristics that did not fit diabetic preconceptions, it became very exhausting for me to explain and justify my life to every new person I met. It was not always new people either. Often I would have friends or teachers make seriously inaccurate assumptions or comments about diabetes. Assumption and ignorance are easy to perpetuate and difficult to correct.

One of my greatest fears was having someone look at me and only see the disease. If I accomplished enough, if I excelled in everything, there would be no reason for anyone to see me as someone with a disability. Hence emerged my peculiar dilemma of striving for invisibility of the illness while simultaneously conforming to the ideal of an exemplar diabetic.

This strange dichotomy is closely related to the concept of inspiration porn, which is the use of people with disabilities as objects of inspiration for able-bodied people. The pressure to conform to the ideal of an exemplary diabetic was fueled by the societal expectation that people with disabilities should be inspiring to others. This expectation can reduce people with disabilities to mere objects of inspiration, perpetuating unrealistic expectations for individuals with disabilities and reinforcing the harmful notion that their worth is tied to their ability to inspire able-bodied individuals.

Even if I had known about the pitfalls of inspiration porn, I would not have likely been dissuaded from my hyper-determination. As I grew up with diabetes, being told that there were things I could no longer do was only an invitation to try harder. Anytime anyone told me I could not do something, I would take it upon myself to prove them wrong. Being diabetic was just an extra little challenge. It was something to overcome. I never wanted to use diabetes as an excuse. Above all, I wanted to be “normal.” If regular people could do all of these things uninhibited, then I could too, only I could do it better because I was doing it with diabetes. 

I know many diabetics who have no problem giving themselves insulin in front of others, who wear their insulin pumps clipped on waistbands or put them in pockets with tubing trailing outward. I used to have a fanny-pack type belt that I wore in elementary school on the outside of my clothes. As a young kid, I did not mind displaying my insulin pump because no one had made me feel bad enough to hide it yet. As the years went on and unsolicited comments grew in frequency, my desire to conform to perceived normalcy grew as well. It has become a difficult habit to break. 

My desire to be normal took shape in many forms. Though diabetes is not always thought of as an invisible disability, I sure treat it that way. My insets for insulin injection and constant glucose monitoring sensors are never inserted on my arms or where people can see them. I never give myself insulin without shrinking under the table to pull out my insulin pump or go to the bathroom so people will not see me dose. I have to wear my insulin pump at all times, but that does not mean I want to let everyone see it. I have a pouch/belt that I tuck into my waistbands, which only ever shows a rectangular outline when pressed against my clothes. Most people do not pay enough attention to ever notice it. 

As a rather anxious person by nature, being faced with unpredictable disruptions morphed into an extreme need for control. If my blood glucose levels were in range, I had nothing to worry about. Of course, it is not that easy. There are so many factors that are frankly impossible to predict and correct for, even in the course of a single day. Diet and exercise are the most predominant factors, but there are so many things non-diabetic people would never have to account for when planning their day. 

At the height of my burgeoning anxiety, my need for control manifested itself in the form of a minor eating disorder. For a period of time, I limited myself to one meal a day with the intention of becoming thinner and maintaining glycemic control. However, this approach was ultimately detrimental to my overall health and well-being, as regular and balanced nutrition is crucial for overall health, not just diabetic health. Having diabetes means that carbohydrates have to be consumed at some point, which was at times my only motivation for eating at all. If I did not have diabetes, I would most likely be severely anorexic. 

I found myself wondering how many times someone could compare me to their overweight grandparents before I began to internalize the idea that there was something wrong with me. It was hard enough to deal with my own self-hatred and body dysmorphia over feeling fat and ugly, but it was even worse when others assumed that my diabetes was the reason for my appearance. It was as if they could only see me as a type 2 diabetic, which made me feel even more ashamed.

Apart from the notion that being overweight or obese is not inherently bad, and instead a socially constructed idea driven by capitalist productivity, Western beauty standards and patriarchal structures, my aversion to being perceived as such shed light on the societal mistreatment of individuals with type 2 diabetes. The hurtful comments and assumptions made about individuals with diabetes, particularly type 2 diabetes, being solely the result of poor lifestyle choices such as lack of exercise and unhealthy diet, are not only untrue but also harmful. 

These assumptions can lead to stigmatization, blame and discrimination towards people with diabetes. This can result in a lack of access to adequate healthcare, employment discrimination and social exclusion. Moreover, these assumptions disregard the fact that diabetes is a complex condition with various causes, including genetics and environmental factors. The idea that individuals can simply “cure” or improve their diabetes by changing their lifestyle can also place a significant burden on them to conform to societal norms of health and beauty, and they can result in feelings of shame and self-blame.

I developed obsessive behaviors around health management and physical activity due to the fear of being seen as the overweight, inactive person with type 2 diabetes. However, this desire to distance myself from negative stereotypes has also led to increased self-criticism and control issues, which have become deeply ingrained and continue to challenge me to this day.

While I have personally experienced marginalization, I have at times failed to acknowledge the struggles of others and have instead been constrained by the limitations of my own experiences. This narrow perspective can be attributed to societal conditioning and the pervasive nature of systemic inequalities that shape our lives.

As someone with diabetes, I have experienced firsthand the societal stigmatization and assumptions surrounding my condition, which has led me to often keep it hidden from others. However, I’ve also found that in certain social justice circles, my marginalized identity as someone with a disability is sometimes used as a tool to assert my opinions and perspectives. While it’s important to acknowledge and address systemic discrimination based on our identities, we must recognize that our identities do not exempt us from accountability for our words and actions.

We must hold ourselves accountable for our words and actions, regardless of our identities. As someone with diabetes, I have at times used my condition to justify my emotions and actions. Doing so is not only unproductive, but it can also be harmful to the broader social justice movement. Instead, we must approach conversations and debates with open minds and a willingness to learn from others. By striving for genuine understanding and empathy, we can move towards greater inclusivity and intersectionality, recognizing that our identities are complex and multifaceted; they do not define us or limit our potential for growth and change.