Proper wording can have a huge influence on the interpretation of the dialogue and further discussion in most conversations, especially when they concern diabetes. Words are “powerful” and can’t be retracted once said. Words can shape feelings and attitudes and may even cause discrimination. The Diatribe Foundation created “a language toolkit” hoping that certain words when related to people with diabetes would “empower them” instead of using words that “cause anxiety, disappointment, depression and frustration.” Diatribe is a patient focused online publication which is part of the Diatribe Foundation. It offers all patients with diabetes the latest cutting-edge information. The Foundation’s mission is “to improve the lives of people with diabetes.”
Powerful and appropriate words can enable the patient to feel engaged, supported, helped and motivated which is an extremely important aspect of diabetes self-management. Spoken, negative language can and will affect relationships with our family, friends, working associates as well as your physicians and health care team. Which words can be positive or influential as opposed to offering negative connotations when it comes to diabetes? Let’s take a look:
Patients are not “diabetic” and should be considered “PWD or people with diabetes.” Anyone who has diabetes knows there are so many more aspects to them than just diabetes. They are a complete person with diabetes.
Testing Blood Glucose
When patients think of the word “test” it immediately establishes anxiety. It brings up the days of studying while in school. People usually prepare to take a test but that is impossible with blood sugars. A better term would be “checking blood glucose levels” since that is what you are doing. It is less judgmental. This phrase removes the guilt and pressure of getting a “poor result.” Checking is just that: finding out what the present number is.
Being Good or Bad
I have had so many conversations when patients said “I have been so bad lately. I ate 3 cupcakes and did not exercise all week.” Often people are told “they have been good or bad” which just places judgement. Good or bad are subjective words which do not tell the whole story. Is someone really “bad” because they ate dessert or did not go the to the gym? Is someone really “good” because they did everything their physician told them to do? What about when a reference is made about a “good or bad blood sugar reading?” Blood sugars vary throughout the day. Is a blood sugar reading “bad” when someone has an underlying infection verses being “bad” when they eat a dozen sprinkle cookies? Consider the improved words when talking about blood sugars. The results are “in or out of range.” Different patients may have varying ranges set up depending on other aspects of their health. For example, patients with severe heart disease need to have a higher blood sugar range to prevent hypoglycemia. The guilt and frustration may dissipate when using the word “range.” Instead of offering praise or punishment, you may be constructive with your words and cause them to act.
Being Healthy or Unhealthy
Patients can be “healthy” with controlled diabetes. Many other people who do not have diabetes can be “unhealthy” for other reasons. Diabetes is just one aspect of the entire person. A patient with diabetes who has no complications, does not smoke, exercises 30 minutes daily, sleeps 7-8 hours a night, takes medications on time and properly, practices stress management, attends physician visits and watches their diet may be much healthier than someone with no known ailments or chronic problems who has a poor lifestyle. Using the term “abnormal” is even worse. Patients who live with diabetes should not be termed “abnormal” since there is nothing abnormal about it. Diabetes is a condition. People without diabetes are no more or less normal than someone with diabetes.
Suffering From or Living With Diabetes
“Suffering” from anything conjures up negative feelings, negative connotations, feelings of guilt, anxiety and overall causes non-constructive behavior. When you address someone with diabetes it should be referred to as “living with diabetes” not “suffering from diabetes.” A positive existence is very possible and more probable now, more than ever, with so much new technology and knowledge.
Compliance or Non-Compliance
One of the most frequent terms used by physicians about patients in discussion and documentation is “patient is non-compliant.” This means the patient is not following the rules set by that physician. It is a “catch all phrase” for anyone not following physician’s orders. Patients with diabetes can be non-compliant with eating, exercise, taking medications as prescribed among other things. Being compliant means you are obedient and being non-compliant indicates you are disobedient. Non-compliance can also mean you are stubborn, lazy or simply uninterested. It also can be that you do not understand the severity of the diabetes. Following orders, with no explanation or plan is not how diabetes should be treated. Being engaged, having a realistic understanding without fancy, medical jargon or adhering to well-documented guidelines offers a more positive approach to diabetes management.
Disease, Illness or Condition
People often consider the word “disease” as something catching – measles, cold or chicken pox. Diabetes is not contagious or catching. Having diabetes means the “condition” is chronic but it does not mean you are sick.
Diabetic Diet or Healthful Eating
For years, during diabetes education, patients have asked, “what is the best diabetic diet?” The answer is always the same: there is no diabetic diet. People with diabetes should be encouraged to eat a variety of foods like vegetables and fruits, lean protein, low fat dairy and whole grains. Each of these food groups need to be consumed in portion control at specific time intervals. They should have an individualized plan based on height, weight, age, activity level and overall health. The DASH or Mediterranean plans are very acceptable for people with diabetes. You should always work with a dietitian who is a CDE and specializes in diabetes to find the best approach for only you.
The Better or Worse Kind of Diabetes
This question is often asked by many of the patients in diabetes management classes. They are referring to type 1 verses type 2 diabetes. Patients always think type 1 is worse. There is no better or worse type of diabetes. It is all based on how the diabetes is managed. Each type is caused by different variables. Type 1 continues to be considered an autoimmune problem. It can occur at any age but is most common in youth especially during adolescence. It may be related to a virus. Having type 1 still requires multiple daily insulin shots or using an insulin pump which does not make type 1 “worse,” it just requires more intense and specific treatment. Type 2 is often found in family genetics with higher rates in different ethnicities with Hispanic, African-American, American Indian, adults age 40+ and in those who are insulin resistant. People with insulin resistance and have type 2 diabetes are generally overweight but 20% of the cases of type 2 are seen in thin people. Someone with type 1 diabetes who is controlled with medication and lifestyle is much better off physically than a patient with type 2 who is uncontrolled and unmanaged.
You Caused Your Own Diabetes
Many patients with type 2 diabetes are led to believe that “they caused their diabetes by eating too much sugar.” This is a common misconception. As stated above, people are at risk simply based on genetics. Not everyone who is obese or overweight has type 2 diabetes. Not everyone who eats sweets has diabetes. Diabetes is caused by multiple things including family history. Diabetes is a complicated condition which should not be considered self-induced. I am still encouraging you to lead a healthy lifestyle which may or may not ward off type 2 diabetes for years.
“Language stigmas “can and should be reduced through education. Discussion, counseling, social support and health promotion are all successful tools to help change wording and language giving it a more positive twist. Everyone reacts differently to words. Some people are more sensitive yet others barely take notice. If you know words can make a difference, then think before you speak. Let the person with diabetes take charge of the conversation and follow their lead. It can have a huge impact on how they handle their diabetes!!
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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.
She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.
She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.