I spy an odd culture within the diabetic community… where victimization meets groupism. It’s one thing to struggle with a condition. It’s quite another to boldly claim that everyone else who “has diabetes” shares the same journey or even shares the same condition.
“We diabetics don’t heal as quickly as normal people.”
“Diabetics don’t live as long as normal people.”
“Diabetes changes your life forever.”“Every year for the rest of our lives we will need shots, pumps, needles, pricks, sensors, alarms, life ending lows followed by sickening highs.”
“Diabetes is a chronic progressive disease that you will eventually succumb to. Good care will just push that point further out.”
These are all quotes and sentiments I’ve heard numerous times across message boards, spoken by physicians, and shared by friends and family.
First, they cannot be true or accurate statements when diabetes (as established earlier) is a massively polyetiological condition. Because of poor naming, the term diabetes is just not usable in a broad context. It’s bound to be incorrect for someone. Which leads us to the second point: statements like these are grouping statements – designed to drag everyone into someone else’s story about how they see their own condition.
Based on the above two factors, the Type A Diabetic perspective on this is that they are loaded (and mostly universally false) claims designed to reinforce the odd tribal nature of the “diabetes community.”
- “We diabetics don’t heal as quickly as normal people.” – Untrue. It’s the level of glucose toxicity that determines healing.
- “Diabetics don’t live as long as normal people.” – Untrue. It’s the level and duration of glucose toxicity that determines the likelihood of deadly complications.
- “Diabetes changes your life forever.” – True. So does having a child. So does getting old. So can getting into a terrible accident. What’s your point? Every substantial life event changes your life forever. This is one of them.
- “Every year for the rest of our lives we will need shots, pumps, needles, pricks, sensors, alarms, life ending lows followed by sickening highs.” – Not universally true. Many with insulin resistance disorder (i.e., type 2s) will not require shots nor pumps, and, given the rate and pace of technology, pricks, alarms, and shots may be a thing of the past well before the “rest of our lives” are over. In fact, some with insulin production disorders (i.e., type 1s) in the U.S. can even use inhalable insulin and avoid most shots and pumps if they desire.
- “Diabetes is a chronic progressive disease that you will eventually succumb to. Good care will just push that point further out.” – Untrue. If managed well, you may very well succumb to something completely unrelated (aka The Type A Diabetic objective).
Look, as someone recently diagnosed with diabetes, I am all for community. It’s been a godsend as I look to learn, share, and feel connected with others who are diagnosed with the same or similar condition.
In the community, there seem to be two basic camps: The first camp sees diabetes as a challenge that they work hard to overcome by managing it, and integrate it into their lives, like any other challenge. The second camp sees diabetes as a chronic disease state that dominates their lives and, mostly, defines their lives.
In other words, the first camp is Sophie, and the second camp is Scott:
As the writers of South Park so clearly articulate it, every person has a choice to be Scott or Sophie. Sophie certainly has the potential to become Type A Diabetic!
Diabetes as Identity
I’m not going to dance around this one. From the Type A Diabetic perspective,
“I am a diabetic” is an insidious statement.
Why is this so insidious, you ask? It’s mostly the use of the article a, actually. By adding a prior to diabetic, this statement is changing a health condition into a tribal identifier. It’s stating that diabetes is now more than a health condition…it’s now part of your identity.
It’s one thing to say “I have diabetes” or even “I am diabetic” – at least this lays out that you have contracted an illness, disease, or disorder. But it’s an entirely different thing to transform what you have into what you are.
Once you connect a disease to your identity, the disease is now more a part of you than simply your insulin disorder. The disease is now in your mind as well. That’s right:
If you have thought or said “I am a diabetic” you’ve let an insulin disorder metastasize to your mind.
Note: Since releasing this manifesto, a number of people have pointed to the above called-out statement as being offensive. If you find this offensive, I encourage you to look at it from another angle, as it is not written to offend. The statement is highlighted because I am trying to make a fine point about the power of language and identity. You may choose to make diabetes your identity (as many have). I’m stating that the Type A Diabetic credo does not support the conversion of a health condition into an identity unless doing so is an empowering force for you.
<Start Meta Commentary>
If you’re following closely, you might have noticed that, right here, right now, there is a bit of a conflict: I am stating that nobody should consider themselves a diabetic, yet the very title of this document is the Type A Diabetic Manifesto. This irony is not lost on me, but hear me out. There’s a method to my manifesto madness:
Change is a process. There’s an entire field of study called change management dedicated to enabling systematic change. The sheer audacity of this manifesto’s charge will require significant change management if it has any chance of success. Given this reality, I’m acutely aware that we will continue to be calling this condition diabetes and people who have it diabetics for years after this document is published. Given this reality, I need to acknowledge where we are in this time-consuming transformation and meet people where they are. As a result, I’m leveraging (and pivoting from) the existing nomenclature to engage people where they are now, and use this document to move them to a new place. If and when this document succeeds in its mission, the document – and its title – will no longer be relevant or needed.
In other words, this document is designed to self-destruct upon its success.
</End Meta Commentary>
Circling back to the culture of diabetes and disease identity, the Type A Diabetic position is clear and unambiguous: we must resist letting a disease become an identity. To do so, we must stop using language that links the two together.
Diabetics, disband!
In accordance with change management techniques, I recommend the following steps:
STEP ONE: Remove the term diabetic from our vernacular. This simply tribalizes a disease, which is unhealthy. At a minimum, replace with the still-suboptimal “I have diabetes” or, far more optimally, “I have an insulin disorder.”
STEP TWO: Remove the term diabetes from our vernacular and medical lexicon. Brand names and medical conditions don’t mix (see cancer as Exhibit B). Replace with insulin disorder, with appropriate descriptive modifiers (production, resistance, gestational, autoimmune, etc.) so that the name reflects the condition accurately.
STEP THREE: Rename and remove about half of this document, as much of its work will have been done.