Diabetes in the Shenandoah Valley 

Ann’s story begins around the birth of her first daughter. She recalls the moment she was told she had diabetes; she ran to her car and cried. Ann blamed herself, feeling sad and frustrated that she’d let this happen to herself. As a new mother, being unsure of the future made the diagnosis especially challenging. Since then, her life has changed in ways that people without type 2 diabetes wouldn’t even think of. At restaurants, Ann has to ensure that she is provided with artificial sweeteners, she has to monitor and manage her blood sugar levels daily, and she struggles with feeling judged by her healthcare providers - even though they should be the ones who understand her most.

Ann talked to us about how type 2 diabetes is portrayed in the media - “I feel like a lot of those commercials are being put together by big pharmaceutical companies that are trying to sell the latest pills or products that they have for managing. They're less put out by healthcare professionals that are trying to put out the public awareness around diabetes.” It’s unfortunate, but Ann is right. Many commercials are not about public health information, but are about selling a product to a vulnerable population. Without solid facts and statistics about diabetes, it’s challenging for the general public to grasp the magnitude disease. This leads to judgement and demands from people who don’t have the disease - for instance, her thin healthcare provider will tell her to “eat better” without acknowledging the struggles that come along with it.

Unfortunately, many individuals with type 2 diabetes face stigmatization against their condition. Diabetic individuals are often seen to be at fault for their condition. This disregards the important role of genetics, age, and other factors beyond the individual’s control (Diatribe.org). After all the obstacles Ann has faced with type 2 diabetes, she’s finds motivation through her daughter and granddaughters. Ann explains that through acknowledgement of the issues portrayed through the media, we can work together to end the stigma of type 2 diabetes.

It’s harder to be spontaneous, but type 2 diabetes isn’t a death sentence. That’s what Maria wants people to know. “It’s not fun, but it’s not as terrible as you might think from watching commercials and thinking you’ll need all these injections and special medications.” Maria’s attitude about having type 2 diabetes has always erred on the side of acceptance, she hasn’t felt judged for her condition, nor does she allow the opinions of others to influence her emotional health. However, this isn’t to say that she hasn’t struggled with her diabetes management in social, personal, and medical situations.

In social settings, Maria tells us that she’s likely to follow along with the behaviors of others, such as consuming sweets, rather than disclose her diagnosis and deviate from the group. “I guess I’m trying to fit in more and not bring attention to myself.” Like many of us, Maria has a sweet tooth. Of course, this isn’t conducive to her diabetes management. “I do get resentful or angry sometimes, when I want to have an ice cream sundae, or if we go out to dinner and I have to look at calories.”

Maria’s viewpoint has been influenced not only by social situations, but also by professional/clinical interactions. When asked if she thought her doctor understands what it’s like to live with type 2 diabetes, Maria told us that although her doctor likely understands diabetes from a medical standpoint, she doesn’t know the reality of living with the condition. Luckily, Maria is compassionate and tries to understand what it’s like to be in her provider’s shoes “I chalk [her lack of understanding] up to her being a doctor and having a lot of patients.” Maria does note however, that if her doctor understood the day-to-day of living with diabetes diabetes, it would change their relationship and “make it more personal.”

Cynthia learned an immense amount about diabetes through her family members’ own diagnoses. By learning from her grandmother’s, parent’s, and husband’s experiences, she has learned how to manage her own diabetes and appreciates the support she has received from them. For example, she explained that her father would tell her “how sensitive [blood glucose levels] are to … stress” over; this is a crucial part of understanding how those with the condition feel with extra burdens diabetes brings besides its immediate hindrances.

Cynthia has taken control over her own condition through reading, watching television, browsing the internet and subscribing to sources that broadens her knowledge about diabetes and how to manage it. However, Cynthia notices that magazine articles are often surrounded by distracting advertisements. It is important when seeking information on diabetes to keep an eye out for misinformation that can sometimes arise from misconceptions and stigma surrounding the condition. Cynthia acknowledges the importance of asking questions that can improve her learning about the condition. Much of this communication with others occurs during diabetes education classes, which she enjoys because it allows her to “talk to other people [who] are struggling with the same things that you're struggling with.”

Unfortunately, Cynthia has been limited by the options that her insurance plan provides for her. Since her insurance plan limits the number of educational classes she can attend, Cynthia feels prohibited from learning more about her condition. “Diabetes education classes are only approved once. And once is not enough…. If you're not quite ready, you're not gonna get the benefit from it. Recently diagnosed is not necessarily the best time to get it all.” Cynthia’s push for more education and support from insurance providers shows her own care, and the need for care for people with the condition. Cynthia’s drive to take care of herself to the best of her ability shows that diabetes is manageable, and her passion for education should encourage us to have conversations surrounding diabetes and seek more information that can help benefit those with the condition.

For Harrisonburg resident Anita, she believes a holistic approach to type 2 diabetes management is important in effectively treating the condition. “I would look at it in the context of everything else that is happening, not as a separate, manageable thing,” she says. Luckily, her doctor agrees and looks at her condition from multiple angles, rather than treating her diabetes as a stand alone issue. “[My doctor] is really good at explaining to me how all of this fits together, so he doesn't see each of my conditions as a separate condition, but he sees them as intersectional pieces.”

While this holistic approach is beneficial, it isn’t a cure, and many challenges to managing type 2 diabetes remain. Changing one’s lifestyle is a process-- if you’ve ever tried to implement an exercise routine or mandate that the family eat dinner at 6:00pm sharp, you can understand the difficult nature of implementing this kind of change. Anita expressed that it is hard to change her eating habits, because there are so many options that it can make her feel overwhelmed. “There is some part of me that’s still confused about how much, or what, I can and cannot eat.” To address this confusion, Anita visited a nutritionist, but didn’t come away with the specific guidelines she was seeking. While Anita hoped to be told what to eat and what to avoid, the nutritionist wanted to educate her so that she would be able to make decisions herself. Miscommunications such as this can be frustrating for patients like Anita who have to handle the direct repercussions of their diet and aren’t sure where to begin.

Not only is it difficult to change one’s habits, it is also hard to adhere to those changes. For example, Anita shared that she’s “not a strict follower of any dietary restrictions.” Part of this stems from her confusion around what to eat, but another aspect is that Anita is simply too busy to plan each meal. Being busy is a cultural phenomena, and for people with health concerns, this lifestyle isn’t conducive to the management of their condition. This rings true for Anita, who mentioned that “the truth about it is, my life is so hectic and there's just so many roles that I have to play for so many different people.” With a multitude of responsibilities in her personal and professional life, Anita has little time for self-care, including diabetes management. To overcome these challenges, it is essential to have an open communication with one’s medical practitioner, and work to maintain a holistic approach to this condition. By making these alterations, it is possible to effectively manage type 2 diabetes while still enjoying a quality of life, even in the face of a busy schedule or difficult lifestyle changes.