Diabetes Forecast

9 Diabetes Terms We Can Do Without

By Ellen D. Davis, RN, MS, CDE, FAADE; Michelle Pearce, PhD; and Bryan C. Batch, MD, Duke University Health System , , ,

Let's get one thing straight: Your diabetes doesn't define you. Character is forged by your life experiences and your environment—not by how well your pancreas works. Yet we allow certain terms to creep into our vernacular until we're defining ourselves and others, too. That needs to stop, starting with the words and phrases below.

1. diabetic, n.

There's a reason the American Diabetes Association, Diabetes Forecast, and most scientific journals avoid using the term "diabetic" as a noun: People with the disease are diverse individuals, not a single entity. Some people identify themselves as "diabetics" and find that the term provides a useful narrative framework in which they manage the realities of living with the condition. But not everyone feels that way.

Many people with diabetes see the term as stigmatizing. They advocate that the language used to describe the condition and the person living with the condition be carefully distinguished. Another reason "diabetic" should be scrapped? Defining a group of individuals with a similar disease by their condition may prevent others, including family members and health care providers, from thinking about their experiences and needs as individuals.

2. bad, adj.

People speak about "bad" glucose readings, a "bad" A1C, or an overall "bad" day. But the data don't define you. That is, you are not your number.

The idea of a "bad" number can unintentionally discourage self-monitoring by focusing attention on a so-called mistake. It's a poor motivator for ongoing, upbeat self-care, especially when a person already carries around guilt (such as, "It's my fault I have diabetes"). Using the word "bad" to refer to blood glucose or A1C numbers also hinders collaboration with health care providers. Revealing blood glucose records to a doctor can be intimidating, especially if you anticipate hearing about how "bad" your numbers are.

That's why doing away with the idea of "bad" numbers is crucial. Sharing home-monitoring trends and engaging in mutual problem solving enables people with diabetes and providers to evaluate and, if necessary, try other strategies.

3. brittle, adj.

"Brittle" has been loosely used to describe erratic blood glucose levels that are difficult to control. The term "brittle patient" (or the double whammy, "brittle diabetic") implies that attempts to manage diabetes are futile. Those labeled "truly brittle," a term without any definition, may feel that health care providers have given up on them. Fortunately, if people with erratic blood glucose levels work with their providers, their diabetes can usually be managed with enhanced treatment, technology, support, and education.

Because "brittle" carries so much baggage and doesn't help improve health, the overused label should be put to rest. The next step: encouraging scientists to define solutions for people whose conditions defy the best that medicine has to offer.

4. cheat, v.

We all cheat. And often. It's human nature. But ruminating on cheating doesn't help people with diabetes move toward better outcomes. This pejorative term is only good for one thing: promoting self-punishment and feelings of shame. It's much more effective to focus on all the healthy choices you make each day. Praise is a much better motivator than criticism.

5. complications of diabetes, n. pl.

The phrase "complications of diabetes" assumes that complications are inevitable. Although uncontrolled blood glucose levels do correlate with some complications, there are genetic and unknown factors that play a role, too.

Repeatedly being hammered with the possibility that you'll develop life-altering complications as a means to motivate health behavior ("Take better care of yourself or you'll lose a leg") is harmful. Terror can be paralyzing, making diabetes management difficult. Let's blame the insidious nature of diabetes for the damage, not the people living with it and caring for it as best they can.

6. denial, n.

Denial is a normal reaction to many things in life, including a diabetes diagnosis, but it can be a barrier to self-care. Some people are mistakenly labeled as "in denial," and their state of mind is blamed for their poor control. The true barrier may actually be a lack of understanding about diabetes management or other factors, such as lack of enough family support
or money, or depression (treating it can help).

The closer you can get to describing the issues that are bothering you, the better you and your support teams can work together. Remind yourself that you are the expert on your life and that providers advise you based in part on what you share. When you shrug off good advice by saying, "I'm in denial and can't make any changes," you sell yourself short. An attitude of denial can prevent you from moving forward and managing your condition. When this is the case, mental health providers are great assets.

7. failure, n.

Given that there are so many things that people have to do to manage diabetes, it is not surprising most report feeling like a failure at times. Sometimes, other people's feedback only reinforces this idea. It's hardly empowering to hear that you're a "diet failure" or an "oral agent failure." The same goes for telling yourself you failed to meet A1C goals. Negative talk like that does more harm than good.

Because diabetes is a dynamic process, not achieving a goal can be redefined as a moment of opportunity, one providers and people with diabetes can use to assess the elements of treatment that aren't working and look at other options. So, if oral medications are no longer effective, it may be time to consider taking insulin. People with diabetes experience better health and quality of life when treatment plans are individually chosen based on needs and modified through the years.

8. noncompliant, adj.

Do you do everything your providers tell you to do? All of the time? If not, welcome to the club. (We're members, too!) We all have reasons for why we don't do the things we know are good for us. Maybe you've experienced hypoglycemia in the middle of the night and have stopped taking your nighttime long-acting insulin. Your doctor might call this noncompliance, but you call it self-preservation. Being labeled "noncompliant" doesn't help get to the root of these issues. Nor does it prompt people with diabetes to change.

Too often individuals with diabetes bear the sole responsibility for implementing effective diabetes management. Yet diabetes care is complex and challenging. To meet your unique health-related goals, collaboration with your health care team is essential. Look for providers who actively listen and create a safe environment for talking about why you are not doing a particular element of your treatment. Together you can discuss what is getting in the way and brainstorm other approaches.

9. unmotivated, adj.

People with diabetes are too often judged by themselves and others as not being motivated. The reality is that often people are motivated—but not necessarily to do what someone else wants them to do. That is, being motivated to lower blood glucose levels because you want to keep up with your grandchildren is very different from being told you have to manage your diabetes.

When the term "unmotivated" is tossed around, it can frustrate both people with diabetes and their providers and wreck the hope and motivation needed for effective care. Instead, motivation is enhanced by working with providers who collaborate with you to find the best approach for your care. It can also be helpful to identify discrepancies between what you are experiencing in your life (say, exhaustion from high blood glucose levels) and what you want to experience (such as a game of tag with the grandkids). Finding meaningful reasons to invest the time and effort needed to take good care of yourself is a positive start. After that, motivation is built one step and achievement at a time.

Your Turn

Any other words we should strike from our vocabulary? Tell us.



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