This is not about what causes diabetes. Nor is it about medication, food, treatment or management. It's about the words we use to talk about those things.
Language shapes thought. Here's a textbook example that semanticists sometimes use to make the point:
"Which of the following would you rather have? A segment of undercooked muscle tissue from the corpse of an immature, castrated bull? Or a thick, juicy, charbroiled steak?"
Two ways to say the same thing, but what different mental reactions they produce!
Words matter. Words have power. How we describe something determines what we think about it, how we feel about it, and how we act towards it. Language shapes our thoughts and actions -- profoundly.
My purpose here is to begin a conversation about how our language helps or hinders us in all facets of dealing with diabetes: management and control, diet, interacting with providers, etc. Any aspect of diabetes is potential discussion fodder.
Just to start the ball rolling, I'll begin with one of my own individual pet peeves: "insulin dependent."
I hate that term and what it connotes. Everyone is insulin dependent! Every person alive "depends" on insulin. Every one. I just need to get mine from an outside source. But how that phrase forever separates us, in most people's thinking, from the rest of humanity. Yes?
How about "non-compliant"? I hate that term. Are there other groups of patients with other conditions who are termed "non-compliant" ? Or is that just reserved for PWD who don't "comply" with the rules imposed on them ?
Insulin Dependent, Sorry I'm guilty of using that term. I use it because I am a T2 that requires insulin from an external source. I use it to describe my D and the challenges I face in controlling it. If you are T1 it is a given that you take insulin but there are so many variables with T2. The term doesn't describe me it describes how I treat my D.
Personally I have never found the phrase objectionable but I'm all for a better term. How about "Insulin Challenged" or "Additional insulin Required". I'm sure there are more creative ways to says this.
That's a good one to hate, since it's medically *charged* and can be used as a diagnosis that may impact your level of support adversely, which really sucks since I suspect those folks may be the ones who need the treatment and support the most! There was a thing I saw somewhere, maybe twitter or something, that mentioned that PWD have a *much* higher rate of being labeled non-compliant than any other disease, like 60% compared to 30% or something like that.
I am not a big fan of the "ic" word and will work around it whenever possible. I like a person with a disease more than the more ontological "ic" word.
I don't object to the term as far as its descriptiveness is concerned, and there may in fact be no better way to say it. My point was just that it tends to foster an "us / them" mindset, if only subliminally. Probably, in fact.
I don't know a good answer, just dragging it into the light for inspection.
I am very word conscious and the misuse of words by diabetics drives me crazy.
It is not blood sugar; it is called BLOOD GLUCOSE. We do not have sugar running through our bodies and the terminology harms us in the general populace: Don't want sugar in your blood, don' eat any. Cured.
I do not like things like T1, PWD, etc. It is what it is and the correct terminology should be used. Insulin dependent--yea everyone is, but no one but a diabetic ever considers the term. There are a lot of those type of phrases and words.
I abhor the words that create misunderstanding. We need to talk to the general populace (friends and relatives) with the correct, educated words.
Interesting how we can look at the same thing and see it in such different ways.
On the matter of "sugar" v. "glucose", I have a somewhat different reaction. Glucose is sugar -- sugar in its simplest form. One of my own personal bugaboos is the affectation of using language to obfuscate, i.e., using a fancy or polysyllabic word when a simple one conveys the meaning just as well. Among the general public, everyone knows what sugar is; glucose is a word that is unfamiliar to many. So a reference to "sugar" will be always be understood; "glucose" may not be.
Language is meant to convey meaning. That is its only purpose as far as I am concerned. The primacy of form over content rings my alarm bells more loudly than just about anything else.
I also hate the term “non-compliant.” When used in the medical setting, I see it as an attempt to shift the entire responsibility (and assign blame) onto the patient. The patient could just as easily view the doctor as non-compliant with the patient’s idea of a supportive doctor. This could easily escalate in a “non-compliant” arms race of sorts!
Medical professionals that engage in this dismissive line of attack obviously have no appreciation for the formidable enemy that diabetes is. They choose to see us in the two-dimensional world of A1c numbers and lab reports.
Now I realize that there are truly non-compliant patients that have deliberately chosen to ignore their diabetes. But there are far more patients just trying to live life and take care of their diabetes. And diabetes has roughed them up and continues to challenge them as the ever changing puzzle that it is. For a doctor or a nurse to prematurely heap “non-compliance” onto them represents a shameful case of “piling on.” Just kick the struggling patient when they’re down!
The non-compliance label needs to be used much more sparingly and judiciously. Words do matter!
And even for the ones who are truly "non-compliant" to label them as such is saying that what they are doing (or not doing) to manage their Diabetes is done to please, satisfy or "comply" with someone else's expectations. Eveyone deep inside has a desire to thrive and if someone is not doing what is necessary to do that, then either they don't have the knowledge of how to do so or there are emotional issues that need sorting out. In the Mental Health field people have begun to acknowledge that helping people to access their self-motivation is the key. It would be nice if the medical profession would also understand how to empower their patients. Empower...that's a word I like!
Hi David. It seems to me that there is a problem with hating certain Diabetes phrases, because we keep running into them. Not only do those offensive phrases keep cropping up, but different people hate different phrases, so there is a lot of unintentional aggravation out there. I'm embarrassed to say that I say Dia-beet-us, which most people hate and I can't remember to say correctly for the life of me. Oh well, I certainly do agree that "Words have power"!
Given that the ADA approach to treating diabetes is 25 years out of date, I regard the term "non-compliant" as a glowing complement. Something to be proud of. I'm also non-compliant in refusing to substitute margarine for butter and refusing to take statins simply because I am diabetic.
I need a bumper sticker "Non-compliant diabetic on board".
I was at a D conference recently and one wife of a PWD kept referring to her husband's "affliction". This was a well managed Type 1 in, I believe his late 60s or 70's who was an avid cycler. :::shudder::::
Wonderful point, Zoe! I love your perspective on things, for it is deeply humanist and empathetic. If only more people were able to look at matters this way, we wouldnt have half the societal problems we are dealing with, not only concerning medical issues but all sorts of challenges.
