World Diabetes Day (November 14)

Improving Diabetes Care: Recognizing and Reducing Diabetes and Weight-Related Stigma

November 14 is World Diabetes Day and this year’s theme is “Access to Diabetes Care”.

Diabetes is a serious chronic disease characterized by the presence of high blood sugar. This occurs because the body is unable to make enough of the hormone insulin (type 1), the body is not able to use its supply of insulin properly (type 2), or both. Having high blood sugars over a long period of time can lead to serious health complications including increased risk of cardiovascular disease, kidney disease, blindness, nerve damage, wounds, and amputations.

Type 1 diabetes occurs when the immune system attacks the cells of the pancreas that make insulin. It is often diagnosed in children and young adults, and requires insulin injections for life to survive. Many individuals living with type 2 diabetes are still able to produce insulin, but their body is unable to use it properly and over time their body’s ability to make insulin can decrease.

It is estimated that up to 30% of Ontarians are living with diabetes or prediabetes. You, or someone you know, is likely living with diabetes. And unfortunately, approximately 50% of individuals living with diabetes have reported experiencing diabetes stigma.

Diabetes stigma is the negative judgements, discrimination, and attitudes individuals experience because of their diabetes. It can be experienced externally at home, work, school, or in health care. It can also be internalized as feelings of guilt, shame, and self-blame. Diabetes stigma often results from a lack of knowledge around diabetes including the different types, their causes, or understanding the constant challenges of managing diabetes.

While type 2 diabetes is caused by numerous complex factors, the most common misconception is that individuals living with diabetes caused their disease solely through their behaviour and by making poor lifestyle and food choices. Type 2 diabetes can be related to weight, activity levels, and eating habits but the connection is not simple or straightforward. Many individuals living in larger bodies will never develop type 2 diabetes and many individuals who eat nutritious food, engage in regular physical activity, and/or live in a smaller body will develop type 2 diabetes.

Diabetes stigma disproportionately impacts individuals living in larger bodies due to the connection between diabetes, lifestyle, and weight. Individuals are regularly subjected to unfair beliefs that they are lazy and have poor self-control. They are also regularly food shamed. Friends, family, coworkers, and health care providers may believe that they are being helpful by commenting on food choices; however, this is not the case. Research shows that these comments can have the opposite effect and contribute to an increase in disordered eating patterns to cope with stress.

Diabetes and weight-related stigma can lead to depression, anxiety, feelings of shame, and decreased quality of life. These individuals often experience lower self-esteem, sense of well-being, and motivation, which can negatively impact their ability to manage their diabetes. Individuals experiencing this stigma may refrain from monitoring blood sugar levels, wearing technology devices, injecting insulin, seeking health care, and even disclosing to friends and family that they have diabetes due to the fear of judgement and blame. As a result, these individuals often have suboptimal blood sugar management and higher rates of diabetes-related complications.

Public education and raising awareness of the lived experienced of people with diabetes is crucial to reducing diabetes and weight-related stigma. All of us, including health care providers, can make a difference by acknowledging and examining our own biases. The language we use and how we think and treat people living with diabetes is key to reducing discrimination and judgment, as well as improving health outcomes for those living with diabetes.

To learn more about diabetes care in Northwestern Ontario, visit bit.ly/TBRHSC-CCDC.