How Changing Your Diabetes Language May Improve Your Health

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How Changing Your Diabetes Language May Improve Your Health

Words like ‘blood sugar’ and ‘diabetic’ may do more harm than good in type 2 diabetes care. Here, one woman with the disease discusses why tweaking our diabetes vocabulary may lead to better health outcomes.

By Ilene Raymond Rush

Ilene Raymond Rush is a health and science journalist based outside of Philadelphia. Her articles and essays regularly appear in the Philadelphia Inquirer, WebMD, Diabetic Lifestyle, Next Avenue and many other national publications.

Medically Reviewed by Justin Laube, MD

Research suggests some words used in diabetes management and treatment can have an unexpected impact.

language of diabetes is filled with upsetting words — blood, fasting, dieting, testing, cheating, obesity — that prompt feelings of dread, pain, and shame.

As a person living with type 2 diabetes for 30 years, I rarely think about the common vocabulary surrounding diabetes and how it shapes my day-to-day vision of the disease. But John Zrebiec, a licensed independent clinical social worker and director of behavioral health at Joslin Diabetes Center in Boston, brought this idea home to me in a recent interview.

Zrebiec points out that people with diabetes often talk or are talked to about “diets,” when we might be speaking about meal plans or healthy eating. “No one can stay on a ‘diet’ forever,” says Zrebiec, explaining that by contrast, a “healthy eating plan” is more sustainable.

Other terms also seem to have a disparaging effect. Take blood sugar “testing.” What is a test but an opportunity to fail? “Blood glucose testing is all about good, bad, right, and wrong,” says Zrebiec. “Instead of an indicator on how to treat diabetes, it becomes an indication of moral integrity.”

He notes that the original idea of glucose testing was to “be a kind of compass to help you find direction, but it very quickly turned into a ‘test’ that you could pass or fail.” The point was to use your blood sugars to give you an idea of what to do next — up your medication, eat fewer carbohydrates, or reduce your medication — not as a measure of moral virtue.

Why Words Matter

Apart from making people with diabetes feel ashamed or blamed, the words you and your healthcare provider use to discuss your diabetes care can impact your condition.

Depending on the choice of words or phrases, language can be “demotivating, inaccurate, or even harmful,” reports a paper published in September 2012 in the journal Diabetes Research and Clinical Practice by Diabetes Australia, which set out to find how language used by medical professionals and people with diabetes may impact individuals’ care.

In a move to shift diabetes messaging in the United States, many doctors and nurses are encouraging healthcare providers to consider their word choices when talking to patients with diabetes. The outcome may be that doctors and nurses will begin to take a “patient-centered” approach to language, where they avoid negative judgments and strive to send more empathetic messages.

“We’re trying to help people see that we’re working on this condition together, while acknowledging how hard it is to deal with diabetes day in and day out,” says one of the paper’s authors, Jane K. Dickinson, PhD, RN, a certified diabetes educator and director of the diabetes education and management program at Columbia University Teachers College in New York City.

Changing Your Diabetes Language

While the vocabulary of diabetes may seem like an intractable problem, there’s good news: Once you become aware of how language can potentially impact your care, you can try to turn it around. Here are a few common words and phrases in the diabetes vocabulary, along with suggestions on how to switch them up to make them more supportive, accurate, and encouraging:

‘Bad Blood Sugars’ Rather than punishing yourself for “bad” blood glucose readings, think about noting if your numbers have been running “high” or “low.” Labeling readings as “bad” suggests that they can’t change, but in truth they're simply an indicator of where you are at a moment in time.

‘Blood Tests’ and ‘Testing’ “Checking,” “monitoring,” or “self-monitoring” are all preferable to “testing,” notes Diabetes Australia. “Tests imply success or failure and an end result, but people with diabetes need to monitor their blood glucose levels throughout the rest of their lives.”

‘Control’ When referring to terms like “diabetes control” or “blood glucose control," substituting the words “manage” or “influence” for “control” acknowledges that control can be elusive, since there are many factors outside of your command when it comes to blood sugars. After all, says Dr. Dickinson, “People with diabetes can’t control what’s going on in the body — it’s simply not working."

‘Diabetic’ This suggests that the condition is the defining characteristic of your life, while “a person living with diabetes” emphasizes that you are doing just that.

‘Failure’ and ‘Failing To’ Diabetes is filled with chances to fail: at dieting, at reaching blood sugar goals, at taking medication. Think about replacing failure with “did not,” “has not,” or “does not” — as in, “You didn’t check your sugars but you can start tomorrow.”

‘Obese’ and ‘Normal Weight’ Diabetes Australia recommends substituting “unhealthy” or “healthy weight” for these terms. The difference is between a “trait and a state.” Obesity, a trait, intimates something that is fixed and unchangeable, while a state, like an unhealthy weight, suggests something that can be changed.

‘Should Not,’ ‘Have to,’ ‘Must,’ and ‘Can’t’ Avoid restrictive phrases in favor of phrases that give you a choice. “When you tell someone to take out the garbage, chances are it’s not going to happen,” says Kim Olson, NP, of the Penn Rodebaugh Diabetes Center in Philadelphia, who actively works to improve communication between patients with diabetes and healthcare providers. “People have to feel they have options.”

Speaking as a person with diabetes, none of this is easy. Some of us (myself included) have thought of good and bad sugars and testing for far too long. But I’m convinced if — at the very least — I can start considering my diabetes without moral judgment, it can help my emotional well-being, and maybe even my diabetes self-care.

Last Updated:7/27/2017

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