What We Talk About When We Talk About Diabetes

Never one to keep my mouth shut, this blogpost is in response to a really stupid tweet from Crossfit as well as a few responses to it including Steve @livingvertical and Anna Floreen for Glu as well as countless tumblr and twitter comments.

First….some numbers:

29 million Americans have diabetes - almost 10 percent of our population. Of the 29 million Americans with diabetes, only 5 percent of those have type 1. The vast majority of Americans with diabetes suffer from type 2 diabetes. The epidemic that our nation is facing in illness and in cost is associated with type 2 diabetes – so we talk about it a lot. And I understand this. the increase in type 2 diabetes associated with overweight and obesity (and processed sugar...the list goes on) IS a national health crisis. It is worth talking about, worth working to remedy. It is also the reason that in media channels, in pop culture, and in colloquial usage “diabetes” refers to type 2 diabetes.

Crossfit’s use of "diabetes" to mean type 2 diabetes in a tweet is not an exceptionally surprising blunder when you take into account that news outlets like the New York Times and the Huffington Post (take a look at these headlines) - even the CDC - do the same thing.

As type 1 diabetics, our first response is defensive - we bristle, we defend ourselves, we remind everyone that we couldn’t prevent our disease, we didn’t eat too much sugar and that we are healthy people, active people, athletes. We’re trying to get ourselves out from underneath the “diabetes” stereotype by reinforcing the differences between type 1 and type 2 diabetes. This is well founded. We are not wrong. I do this all the time. Sometimes I think there should be better, more distinct names for two separate conditions to try to alleviate some of this misinformation about type 1 diabetes. I’ve fielded all the classic questions and statements: “oh, did you eat too much sugar when you were little?” … “yeah, my grandpa has that”... or my personal favorite: “you’re not THAT fat!”. People are misinformed and it is frustrating and damaging to our community. 

Better health education and literacy that promotes the differences between type 1 and type 2 diabetes is one way to try to combat this. But this solution, while important, misses the more insidious underlying problem - that we live in a culture content to place the responsibility of “health” on individuals while systematically making people unhealthy. Removing ourselves from the stigma associated with “diabetes” by yelling “not type 1 diabetes!” does not alleviate the stigma faced by more than 27 million Americans with type 2 diabetes.

I agree with what some others have said that the crossfit ad does not come from malice but from well-meaning ignorance. (I do sort of feel like it’s coming from a self-righteous high horse of hyper-fit people who think they’re better than others because they already don't drink coke … but I digress) They aren’t wrong that sugar is bad and is certainly a contributing factor to our nation’s expanding waistlines. Obesity is a problem, sugar and our food industry are contributing to it. Rates of type 2 diabetes are rising, and not coincidentally. But we will not begin to fix these problems by stigmatizing a serious disease or by blaming people’s individual diet and exercise habits. When we write off the cause of “diabetes” to something as simple as “he ate too much sugar” we’re ignoring the nuanced and complex nature of both of these diseases as well as the systematic, environmental factors that influence our health. Why do we allow so much sugar in school lunch rooms? Why can Coca-Cola market itself as a wholesome family drink? How are government subsidies for corn (high fructose corn syrup) playing into all this? The problems are so much bigger than one individual's choice - and the solutions are too. 

As type 1 diabetics, our primary goal is typically to try to differentiate ourselves and to raise awareness for a very serious and exceptionally frustrating chronic illness. This is important work, and something I hope to continue to do every day by writing, spreading awareness and talking to my peers. But we cannot allow the conversation to stop at an attempt to remove our condition from the stigma associated with type 2 diabetes. Because we know first hand the damaging effects of these stereotypes, we need to work to expand the conversation and direct it away from the pervasive individual-blaming narrative so people with both diseases can get the care and understanding they deserve.