It’s time we stop blaming and shaming people who live with diabetes. Diabetes is a complex and serious condition that no one asks for.
In general, stigma refers to the experiences of exclusion, rejection, prejudice, and blame that people unfairly experience based on a characteristic or perceived difference. Stigma may be expressed as negative attitudes or outright discrimination. It can be external, coming from other people and society, or it can be internal, meaning an attitude you hold about yourself.
Diabetes stigma stems from the idea that poor choices and unhealthy behaviors cause diabetes. This belief oversimplifies a complex biological condition and overlooks key factors such as genetics or a person’s environment and socioeconomic context. As a result, people with diabetes experience misplaced judgment and blame. (Yan, 2021)
In 2021, as part of National Diabetes Week, Diabetes Australia launched the Heads Up on Diabetes and Stigma Campaign which included the following videos highlighting the ways in which people with diabetes may experience stigma.
Courtesy of Diabetes Australia, from its National Diabetes Week 2021 Campaign
In addition to these videos, read and listen to the poem, “Take it in,” by Josh Kuntzman which paints a unique and compelling portrait of the emotions and challenges of a chronic condition – and of being unfairly blamed and judged.
Well-meaning people sometimes act as though blame and criticism will motivate people with diabetes to engage more actively in their health. In fact, an abundance of evidence shows that stigma can worsen health outcomes (Schabert et al., 2013). People with diabetes report feelings of fear, embarrassment, blame, guilt, anxiety, and low self-esteem as a result of experiencing stigma. These negative emotions can result in depression and higher levels of stress, which drive unhealthy behaviors and increase the risk of developing health complications.
Blame and judgment may also result in worse self-care and diabetes management. For example, people with diabetes have reported injecting insulin only in public restrooms or at home, making unhealthy food choices to avoid declining what is offered, and manipulating glucose logs to avoid criticism from significant others or healthcare professionals. Stigma may also inhibit people from seeking necessary care, particularly when the source of the stigma is healthcare professionals. (Yan, 2021)
For people and populations who may be at risk for diabetes, stigma can also act as a barrier to awareness and prevention. Stigma makes people with diabetes fear being exposed or labeled as disabled, and discourages them from being open about their diagnosis.
Diabetes stigma exists everywhere, including in family, school, social, workplace, and healthcare settings.
People with type 1 and type 2 diabetes may experience different kinds of stigma. People with type 1 diabetes may face bias or discrimination as a result of a perceived disability or from a reaction to the need for insulin injections. People with type 2 are often unfairly judged based on the misperception that diabetes is their fault because they made poor decisions or have bad habits.
Stigma is prevalent even within the diabetes community. “I hate that I’m categorized as type 2, because people assume I did this to myself and are so judgmental, even fellow diabetics. For a long time it prevented me from taking proper care of myself, so I wouldn’t be judged.” – Anonymous, MyDiabetesSecret
Stigma is directly connected to how we talk about people with diabetes. “Our language matters. The words we choose, and the way we use them, influence, persuade and affect how people view the world. Words do more than reflect reality: they create reality.” — Diabetes Australia
People may not realize they’ve experienced stigma. “Stigma” is not a word that many people use, but that doesn’t mean they don’t feel blamed or shamed by the words and actions of others, or by a stigmatizing attitude they hold about themselves.
Diabetes stigma can be accompanied by other kinds of bias. People with diabetes also experience bias and discrimination related to race, class, disability, and gender, or other conditions.
Explore some of the other ways in which people experience diabetes stigma.