Diabetes stigma in a digital world: What CGMs, celebrities, and communication have in common

Unfortunately, people with diabetes have had to deal with stigma and misinformation about their condition for a long time. Most people I know with type 2 diabetes have faced stereotypes about being lazy or gluttonous and have been made to feel their condition is their own fault.¹ Many people diagnosed with type 1 diabetes as kids may grow up feeling self-conscious about their condition, and it may affect how consistently they self-manage.² I’ve spoken to so many people with type 1 diabetes who felt ostracized by their peers for getting special treatment or needing to test blood sugar and take insulin at school. 

In diabetes, preconceived notions abound—if you want more examples, just ask your patients. Whatever form it may take, diabetes stigma can be harmful. It can change people’s self-perception and may lead to poor or inconsistent diabetes self-management.¹

As I see it, anything people can do to minimize stigma is a step toward managing diabetes with confidence, and in recent years I’ve seen 3 strategies that may help. Spoiler alert: Diabetes technology plays a role in all of them.

1. Keeping a low profile with discreet wearable tech

I was diagnosed with type 1 diabetes in my 30s, and it was a rude awakening to feel the gawking and judgmental stares I got from strangers when injecting my insulin in public. Sadly, this feeling of vulnerability is common; it can happen to people with diabetes anywhere that others can see their self-management.¹

A person who works in a factory or on a sales floor may not be allowed to do finger sticks out in the open, and then they might be inconvenienced or feel embarrassed that they have to make frequent visits to the restroom. Someone wearing an insulin pump may hear remarks from well-meaning strangers that they’re “bionic,” or they might have to listen to others talk self-centeredly about how they’d hate to have such a condition.

I wish I could wave a magic wand and fix society’s insensitivity and misunderstandings about diabetes, but I can’t. Fortunately, some of today’s wearable diabetes technology may help people with diabetes feel less on display. 

Many of today’s CGMs are relatively small, discreet sensors or even implantable ones, and some modern insulin pumps are small enough to be hidden under clothing.^3,4 Many wearable devices may also be controlled via smartphone apps, letting users camouflage their diabetes management. If I’m out in public looking at my phone, I may as well be texting or watching cat videos—no one has to know I’m adjusting the dose on my insulin pump. 

Preventing awkward encounters without missing a beat in self-management? That may strike a helpful balance for someone who’s cautious about keeping their diabetes out of public view.

For some people, concealing their CGM or insulin pumps may help them avoid feeling self-conscious about managing diabetes.⁵

2. Achieving a sense of belonging through role models, empowerment, and community

Of course, no one with diabetes should have to feel judged or embarrassed about managing their condition. 

So it’s been really encouraging to see people with big platforms talk publicly about their experiences with diabetes technology. You may have seen them—accomplished athletes, musicians, a reality TV show contestant who traveled the world while lugging her diabetes supplies in her backpack, and 2 different pageant winners who wore their pumps visibly on national TV. I’m so happy to see these people speaking out to help normalize living with diabetes. 

I think these influential personas are helping facilitate the social acceptability of diabetes tech. I’ve encountered kids with diabetes who had been hesitant to wear an insulin pump or CGM but changed their minds when they saw one of their heroes wearing one. To me, it’s important for people in the diabetes community to see that anyone with this condition can aspire to live the life they choose. 

Help your patients with diabetes seek out support and inspiration by pointing them toward online communities, diabetes advocacy groups, and celebrity influencers who speak publicly about living with diabetes.

Social support also plays a role in destigmatizing diabetes. Groups such as the Diabetes Link (for young adults with diabetes) and Children With Diabetes^TM (for families of children with type 1 diabetes) can provide not only a place to learn about diabetes tech, but also a way to connect with each other and nurture a sense of belonging. Various apps for people with either type 1 or type 2 diabetes can help them plug into online support communities where they can get information, exchange stories, and pick up tech tips.

There’s even a national campaign run by the diaTribe Foundation called dStigmatize. It encourages advocates, health care professionals, and the media to take a pledge to use empowering language that may help shift dialogue away from the long-standing negativity around diabetes.⁶

Collectively, I think all of this support and empowerment makes a statement that diabetes is not a condition that calls for criticism or pity. We no longer have to feel ashamed or bear that stigma.

3. Removing stigma from the clinical conversation

The third way to counteract diabetes stigma may have to come from the professionals who work to treat it. Many people with diabetes feel their health care providers don’t always include them in the decision-making process. Sometimes bias from providers toward certain groups of people with diabetes may stop conversations about tech before they start.^7,8

It's important to look at each patient as an individual and learn about what’s important to them, rather than lumping them into a group based on a demographic.⁷ Here’s what you can do as a provider to actively engage each patient and help set the table for a conversation about diabetes tech.

Remember, you have a chance to connect your patients with technology that may fit their needs and enhance their diabetes management. Help them make informed treatment decisions in an atmosphere that’s free of stigma. 

I’m grateful to have had at least 2 providers who have been encouraging and helpful with diabetes tech. One guided me to a data logging app that I wouldn’t have found otherwise; he was also understanding when I felt burned out and told him I needed to take a break. Both providers have been extremely supportive in reviewing my diabetes data with me and helping make adjustments to my insulin routine. That kind of personalized care has been extremely motivating to me, and I think any person with diabetes would appreciate it.