The Angry Type 2 Diabetic: Keeping the Patient Dignity

Friday, April 11, 2014

Keeping the Patient Dignity

I've had type 2 diabetes for nearly 4 ½ years. Though not a very long period of time, it's still been very challenging...

I've lost weight, gained weight, lost weight; I've low carbed, extremely low carbed, and eaten intuitively; I've exercised myself to death, been a couch potato, and a simple walk around the block lover; I've quit soda, drank only water, and then gotten on diet soda, again... I've had highs and lows, and lows, and highs. I've been proud of myself, and disappointed in myself -- and I've learned just how HARD it is to change myself -- all willpower aside. I've even dealt with some very angry type 1 diabetics and some very unhealthy diabetes forums and communities.

All of these challenges aside, none of these compare to the one big challenge I've had to face while living with type 2 diabetes... keeping my dignity as a patient.

I'm no stranger to the discussion of keeping the patient dignity. I've challenged various prominent diabetes writers on their own biases and deliberate fact twisting, I've written various letters to television programs, to diabetes programs like Take Care of Your Diabetes, to celebrities like Conan O'Brien, and have even hosted an online Diabetes Ice Cream Social event to get people thinking differently (and been skewered for it). My most famous of these discussions on patient dignity, however, happened as an ePatient Scholarship recipient, when I attended Stanford University's Medical School, for their 2012 Medicine X conference. (For that little escapade, I got editorialized by Esther Dyson as someone who was wanting to pass the buck for being fat.

And therein lies the rub. We want to find people to punish and blame. We want to skewer people for "giving themselves" type 2 diabetes. 

This is not an abnormal thing. It's actually a part of human nature to want to find vindication for issues -- it's a form of 'negative altruism.' The problem is that the social dialogue that has been crafted in the media, and in part thanks to illness advocacy organizations like the ADA, various medical groups, and those who want to exploit the obesity and diabetes medical communities -- has been centered on discussing obesity and diabetes as though they were a crime against society (i.e., obesity and diabetes are going to bankrupt the economy, destroy the healthcare system, our children, bring governments to their knees, destroy third world countries, bring a second coming of Christ, etc.) So, people with either obesity or type 2 diabetes, are not seen as persons struggling to take ownership of their health issues -- but as people failing to take accountability for a crime against society. "Be accountable for your health," they say. Obesity and diabetes are not seen as personal struggles for personal health ownership -- but as a moral failing of the individual, a crime against society, and as a justification for social outcasting.

This is a HUGE undercurrent in the diabetes dialogue at large! 

It colors the mindsets of many an educator, clinician, registered dietitian, media or TV personality, people trying to sell us goods and services, and of course... persons presenting new technology at a conference like Medicine X. It's a problem. It's a HUGE problem. And when one addresses such a problem, one is portrayed as though one were trying to pass the buck for being obese, or having diabetes. There's a certain self important arrogance about it all... If I point out your moral failing for having 'given yourself diabetes,' then I must be a more moral, and worthier, contributing citizen to the society at large. 

Now, this blog post is not about whether or not one can 'give oneself' diabetes. That would be an entirely new blog post -- and I think I've spoken on that before... My overall view on whether one 'gave oneself' diabetes, however, is that it's IRRELEVANT. Yes, it's irrelevant. Once a person has diabetes, whether or not they 'gave' themselves diabetes is, quite frankly, irrelevant. One can analyze a person's decisions and life style choices till the cows come home... but once that person has AIDS, cancer, diabetes, heart disease, etc... is it now time to start treating them without respect, or dignity? Should we spit on their faces, and socially mock them while at the same time claiming to try to help them? "I'm going to help you, fatty, because you can't help yourself! You have no self control, and you can't stop eating!" 

I think many misunderstand my words here, when I speak of patient dignity. Patient dignity is NOT a patient passing the buck; it is not a patient not taking ownership of their health... Dignity simply means treating someone with a certain basic level of respect for being a human being in the midst of a trying, and challenging situation -- whether of their own doing, or not. We are all human; none of us is above the struggle to make the best choices. Though this is another topic worthy of further exploration in a different blog post, the food choices many of us make day in, and day out, cannot be completely and genuinely labeled as 'mistakes,' for they are the product of our programming as children, as members of some particular society, and as mammals evolved (thanks to natural selection) to prefer more nutritionally dense foods, especially in order to better face periods of famine. While many have had the blessings of genetics, and a healthier food environment overall (familially and culturally), it takes enormous effort to change oneself as an individual, because it is not simply a product of will -- it is a product of reprograming, and reprogramming is HARD. You aren't just fighting your family's bad eating choices, you are also fighting millions of years of evolution! So it is thus, unfair to treat these issues as though they were black and white, and as a people's moral failings, or as a crime against society. Also -- the person with type 2 diabetes is NOT accountable for their health to you -- so get over yourself. Type 2 diabetes has many different triggers (not causes), of which obesity is just one of them, and the others are not quite as uncommon as people want to think. The scientific and peer reviewed studies showing this are there -- but they seldom get public light, because they are NOT media-attention worthy. Sensationalism is simply what sells. 

All of these things aside -- the overall goal of ANY health initiative by any group is to make positive change. But if we want to help a patient community to make positive changes toward a general health improvement, what we want to do is focus on that 'positive' word. Putting the word "skinny" in front of your company's marketing, cracking jokes about a community's obesity or bad eating habits, how they gave themselves diabetes, stereotyping, claiming diabetes can be cured (or blaming people for not curing themselves), turning them into a 'meme' or down talking to them is NOT going to make positive change. Instead, all it will create is an underculture of social pariahs who are not just denied services and tools, but who do not seek the necessary medical attention they need, the tools and education they deserve, or the new lease on life that they could have. In other words, the culture we have NOW.  

If you make it too embarrassing and shameful to have diabetes -- people aren't going to work toward not getting diabetes... People are still going to get diabetes, and they are going to die in silence, from diabetes. 

In the end, the person who'll end up costing more to a society is not the person with diabetes: it is the diabetes bully. 


  1. jmswierski@yahoo.comApril 30, 2014 at 10:36 AM

    Lizmari, I have to say I really enjoyed your blog. Your comments about being treated with dignity are spot on. I have only recently been officially diabetic, but I know that in reality, I have probably been fighting the undercurrents of this disease for years. I am not someone who is willing to take this lying down and I am fighting in every way I can. I am not overweight, I don't eat much junk food, I exercise, and yet, I haven't lost a single pound, nor a single inch off my waist. I recently spoke to a doctor who said, "It's your genes. You'll just have to live with it." Really? That's all you've got? Anyway, keep up the good work of encouraging people.

  2. I love this blog - I'm gonna be hear all day reading this stuff. My point here is that dignity is key: you take NO shit from people who are paid handsomely to look after you when you fall ill, and you DEMAND service and treatment. Diabetics are in every walk of life and are thin, fat, short, tall, hot, spotty and all shades in between. You don't CHOOSE to be a diabetic - it chooses you. No-one in my family is or was diabetic - I start this chain of events, me, myself. I am a fit, healthy 6'3" hunk of former sports player with a healthy attitude for all things good in life so yeah,I thought, why the hell not give myself the shittiest of all diseases, could be a hoot

    Get in the faces of people who give you a hard time. Make them suffer for their ignorance and make them pay for their lack of vision

  3. Thank you for your honest appraisal of this situation. From one angry diabetic to another, thanks for shattering the isolation I've been feeling.

  4. Thank you! I love this!

  5. I want to share interesting article:

    Metformin prevents goiter in patients with type 2 diabetes

    An enlarged thyroid gland is known as a goiter. There is an increased likelihood that patients with diabetes will develop thyroid disorders. This is higher in patients with type 1 diabetes, which is an autoimmune disorder like many thyroid disorders. Type 2 diabetes is more common and is not an autoimmune disorder. Studies have shown that patients with type 2 diabetes have larger thyroid glands than those without diabetes. Metformin is a drug that is frequently prescribed to control blood sugar in patients with type 2 diabetes. A prior study showed that metformin inhibits the growth of thyroid cells in the laboratory. This study examined the effects of metformin on thyroid size in type 2 diabetic patients versus those without diabetes.

    Ittermann T et al. Metformin inhibits goitrogenous effects of type 2 diabetes. Eur J Endocrinol 2013;169:9-15.

    This study took place from 1997-2006 in West Pomerania, Germany. There are a lot of people in this region with a goiter and, because of this, there has been ongoing screening of the population for thyroid disorders with blood tests, thyroid ultrasound and thyroid measurements to see if they had a goiter. In this study, 2570 people were studied initially and 1088 of this group was followed over an average of 5 years. Records, physician assessments and self-reported diabetes medication use were used to determine if patients had type 2 diabetes.

    Women with type 2 diabetes on medications other than metformin had a larger thyroid volume then women without diabetes and had a higher incidence of goiter. Women on metformin for type 2 diabetes had a similar thyroid volume nd similar incidence of goiter as women without diabetes. There was no such association in men. Interestingly, those patients that were on metformin and then switched to other diabetes medications also had a higher thyroid volume than patients without diabetes.

    This study suggests that metformin prevents growth of the thyroid gland. This is important to patients because this study shows that metformin gives type 2 diabetic patients an additional benefit. This study also suggests that metformin may play a future role in the treatment goiter.

    — Heather Hofflich, DO



  6. I hadn't realized there was so much "passing the buck" messaging out there about type 2. I am so sorry to hear it, and so glad you are speaking up. There is more than enough shaming and blaming in our medical model (my diagnosis is chronic fatigue). And it really is about maintaining one's own sense of self. Remembering what is true, and not taking in what others say as more true is a really good plan. I also completely agree with you about "reprogramming is HARD." So hard. I found your blog a few posts ago and look forward to hearing what you have to say next! You Go LizMari! :-)

  7. newly diagnosed type 2 diabetic gathering info and found your blog. Looking for good resources. Your message really resonated with me american culture is very focused on shaming people and blaming every person that is struggling rather than offering an ear or an arm so narcissistic they can't bother themselves to to understand addiction while they go home and have their own addictions behind closed doors, ppl don't want to be reminded of their own insecurity so they shame you because you look how they feel. Pay them no mind and keep writing loving your voice!

  8. Collette DaCruz, RN, CDEAugust 19, 2014 at 1:06 PM

    I am an RN and a Diabetes Educator who finds your blog so refreshing and honest! As someone without diabetes, (but at risk, and family history) I need to hear things for your perspective so I can work to improve the support I give - keep it up!