Diabetes: Real against fiction, an article by: GF Willmetts.

Diabetes comes up occasionally in films and TV, and invariably, especially in American films, it is depicted wrongly and very dangerously if you employ such means with a Type One diabetic in trouble. The usual symptom being a drunken or disorganized behavior before leading to a coma doesn’t tend for people to think said person is diabetic and left to sleep it off, which can be fatal. I will continue to include reminders as I write to ensure they become ingrained in the reader’s mind. I should point out that many diabetics carry a card, wearing a bracelet, medallion, or a combination, noting their condition and what to do in an emergency.

The Media

Julian Sands, who starred in the 1989 American horror/fantasy film ‘Warlock’, presented diabetes incorrectly for the first time. The film required a syringe, but instead of depicting the lead character Kassandra (played by actress Lori Singer) as a junkie, they depicted her as a diabetic. The problem lies in the fact that they rendered her unconscious for 12 hours. In such a situation, with blood sugar dipping and no food or insulin, she wouldn’t have woken up and was more likely dead. Without such provisions, diabetics don’t tend to make good lead characters. We have to know our blood sugar, take the right quantity of insulin, and eat regularly. The diet must include carbohydrates, but in moderation. If there is a choice between carbohydrates and other food, the former is the priority. We can’t digest the needed carbohydrate if other foods like meat are in the way.

Although I haven’t watched every movie featuring diabetics, a quick search on Google reveals that there are a few, most of which misrepresent the condition.

Even in the case of the ‘Wednesday’ TV series and various comedians, consuming extremely sugary foods does not lead to diabetes. From our perspective, we’d probably stop on the first taste. Far too sweet. When I first became diabetic, I found that I could only eat regular milk chocolate and one fondant at yuletide without experiencing heartburn. Never again. As you might guess, we’re not ideal yuletide guests as non-diabetics feel uncomfortable about what they eat or offer us. I didn’t really care, but it must seem like spoilers. Ignoring such precautions puts diabetics at risk of extremely high blood sugar levels and poor health, and it requires effort to refrain from overindulging. If you have friends with diabetes and you want to invite them to a meal, make sure they know what they can eat.

Types of Diabetes

So, let’s get some of the details right. There are three types of diabetes, caused by different conditions. The pancreas produces the hormone insulin, which converts sugars into energy the body can utilize. If the pancreas is unable to convert sugars into energy the body can use, the sugar accumulates in the blood, leading to ketosis, which can cause symptoms such as sweet breath, coma, and even death. Before starting treatment, newly diagnosed diabetics tend to drink a lot of water, which can lead to dehydration and increased urine production. Tiredness is fairly common. Oddly, although I have a background in biology, when I was starting to get the condition, it was a line from Samuel Delaney’s ‘The Einstein Intersection’ that triggered the thought: ‘Little Jon pissed like a diabetic on the first day of winter.’ The line is wrong, but going to the restroom and still peeing after 5 minutes should be a warning to all.

Regardless of the age at which it manifests, Type One diabetes is also known as juvenile onset diabetes. The autoimmune system of the body halts or diminishes the pancreas’ capacity to produce insulin. Not all at once, but enough so that insulin has to be injected to take over the pancreas process. I won’t divulge all the specifics, as the amount of insulin required varies among different diabetics.

There are two forms of insulin. Long-acting insulin acts as a background throughout an eight-hour period. We use fast-acting insulin for the upcoming meal. However, it’s crucial to regulate the quantity of carbohydrates and sugary foods consumed during the meal to align with the insulin dosage. Consuming excessive food can lead to elevated blood sugar levels. It’s a balancing act of control, monitored by blood testing equipment. In addition to regular meals, mid-morning snacks are essential, but they should be weighed against the level of blood sugar. The long-term effects of having too high blood sugar in later life include kidney damage, blood vessel damage, among other things. Too low a blood sugar risks coma and death. Because the symptoms of hypoglycemia resemble drunkenness, doctors encourage diabetics to avoid alcohol. If you collapse, those drinking with you are likely to think you’re drunk and sleeping it off when, in fact, you’re in a diabetic coma. They won’t care, as they are also likely to be drunk. Social activities become chaotic, and you swiftly assess your friends to determine who you can trust.

If a comatose diabetic needs to be revived, they need a lump of chocolate or glucose as a fast-acting carbohydrate, provided they can regain enough energy to eat. Occasionally, a diabetic may regain enough energy to eat, and they may carry a small emergency bar of chocolate. Once they’re eating, something that takes a bit longer to digest, like a packet of crisps, will stabilize things. This is due to the fact that while chocolate can revive them, its effects diminish as soon as it is digested. Obviously, if you are unable to revive them, call an ambulance and explain the situation. They will respond and come equipped with the necessary equipment. The revival is very rapid. Why not glucose? I mean, it acts quickly and dips rapidly; however, if you have ever experienced the sticky sensation at the back of your throat after consuming an excessive amount of candy floss, it is not the preferred quick sugar. I found early on that carrying a sachet of glucose in my pocket tended to solidify. Ideally, you should combine it with water, but when you’re out and about, it can be challenging to find a cup or water. Nowadays, carrying a bottle of water is more common than it was when I was younger, and there’s no way to gauge the concentration in liquid.

I’ve only been in a coma once, caused by my diabetic specialist wanting to ‘improve’ my blood control. Leading up to my coma, I had just eaten a mid-morning snack. There was a lot of disorientation as I wandered around a supermarket, not recognizing where I was. The nurse said later, when I collapsed, my heavy coat stopped my head hitting the floor and getting a concussion, a regular problem for diabetics who collapse. The ambulance personnel injected glucose into my vein while I waited in the outpatients department. Later that day, a repercussion gave me seasickness, and I had to go home for more medication. If you do encounter such a situation, try waking the diabetic first. It’s the closest I’ve ever been to death, and it’s like turning off your lights and not dreaming. You become a born-again atheist.

You learn to be cautious when interacting with others and rely heavily on your friends to monitor you in case something goes wrong. You can’t sleep off a coma, and you need to be able to tell the difference between that and a normal nap.

No two Type One diabetics are alike in insulin dosage or diet. The most common concern among Type One diabetics is how to revive themselves in a coma situation. After some time, you recognize the symptoms when something is going wrong and mostly sort it out. I should note that blood sugar levels can be affected by colds and other infections, so it’s important to manage these conditions accordingly.

I know some people are needlephobic, even amongst Type Ones themselves. However, the needles tend to be thin and disposable. While certain parts of your body may not be extremely sensitive, it’s advisable to vary your injection locations. This isn’t due to the risk of needle damage, but rather because insulin injections can temporarily disrupt the fatty layers beneath the skin. The upper arms, backs of the thighs, and belly are the usual choices. You quickly become accustomed to this.

Type 2 diabetes and pregnancy diabetes share a common problem. The body’s pancreas cannot handle the excess body mass. After pregnancy, it is possible for the woman to revert to normal. Diet and tablets primarily regulate type 2 diabetes, stimulating the pancreas to produce more insulin and allowing for a largely normal diet. If you achieve a healthy weight under your doctor’s guidance, you may be able to stop taking the tablets. However, this will only be possible if you maintain a consistent diet that limits your intake of carbohydrates and sugary foods. Type Twos have a lower risk of coma, likely due to their bodies’ propensity to metabolize body fat. To my knowledge, no films or TV shows incorporate them into the plot.

Healthy Diabetics

Are there any positive aspects of having diabetes? Well, you do tend to avoid high-sugar fast foods for obvious reasons. Smaller proportions of carbohydrates mean a better controlled diet, which would probably work for non-diabetics as well. I’ve also noted I’m immune to food advertisements and cooking programs. Sensible people steer clear of cakes, pies, and anything with a sugary coating due to their high carbohydrate content. Plain biscuits are safer. That doesn’t mean you can’t have the ‘odd’ treat, but it would be foolish to make it habitual. I tend to view festive seasons as more dangerous than something to enjoy. In later life, the repercussions will make you regret temptation just to please your peer or family group, as they are unintentionally poisoning you.

Medical Equipment

Type One diabetics might be carrying a blood test meter. In the past, a blood test meter was a color strip that, upon applying a drop of blood, displayed the level of blood sugar. It did make it easy to show a non-diabetic what it was like. I should point out to you ‘normal’ people out there that approaching meal times, your blood sugar dips and only your pancreas works normally, but it does explain why you get hunger pangs.

These days, the blood meter is more precise and tailored to the individual. I’ve only seen those new circular meters attached to the arm in advertisements, but I view them with suspicion due to the hype surrounding them. It might tell you how high your blood sugar is, but it doesn’t mean you can eat more than you should.

Some diabetics have a pump more or less permanently plugged into their stomachs and can regulate their insulin that way, but this tends to be for Type Ones who have poor control. Insulin pump-attached diabetics must exercise caution to avoid displacing the needle.

Fatal Ends

Medically, diabetics rarely die of diabetes. Often it is kidney failure or artery damage, especially to the brain and heart. Damage to the finer capillaries causes eye damage. Extremities such as toes are susceptible to gangrene, necessitating immediate removal to prevent its spread. The switch from pig or cow insulin to ‘human’ insulin has significantly reduced the incidence of gangrene. It’s not really ‘human’ insulin, by the way, but a microbe that can generate it, and probably the most significant development since the 1970s. The better the control of diabetes, the less likely it is to occur.

Any Cure?

Something to end on. The press frequently announces cures for type 1 diabetes. None of the announced cures for type 1 diabetes have materialized, but they appear promising in the news and often require at least 15 years to pass the necessary tests. The pancreas is one organ that quickly dies when someone dies, so a transplant isn’t viable. Furthermore, if a transplant were feasible, it would require replacing insulin injections with tablets to prevent your body from rejecting the organ.

I once had to correct my mother about my diabetes going on all the time. I hadn’t as far as I realized, but I did say diabetes doesn’t take a holiday. It’s a 24 hour, 7 day a week thing. Using it incorrectly in movies and television shows could put all diabetics at risk.

I hope this piece has been informative and not frightening, and I urge the fictional media to correct their facts.

© GF Willmetts 2024

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