When Mal Martin was first diagnosed with Type 2 diabetes, he could not help but notice his doctor’s coldness and the lack of guidance for his recent diagnosis.
“My doctor called me and said ‘You have diabetes. Your blood sugar is 494 mg/dL.’ I didn’t know what that meant. I had nothing to base it on,” Martin said. “The next thing she said to me was ‘I’ve called your prescriptions into the pharmacy.’”
Martin is one of 37 million Americans with Type 2 diabetes — a chronic disease where the body has difficulty utilizing insulin, a hormone that turns glucose in the blood into usable energy. The disease can be managed through dieting, exercise, weight loss and/or insulin therapy.
According to the New York State Department of Health, 6.2 percent of the population in Tompkins County has diabetes, a number lower than all other counties in New York state. However, Tompkins County has an uneven distribution of Type 2 diabetes, disproportionately impacting marginalized communities within the county.
Individuals with Type 2 diabetes, like Martin, experience trying levels of misrepresentation, assumptions and stigmatization surrounding their diabetes. According to research published in the National Library of Medicine, 76 percent of Type 1 diabetics and the majority of Type 2 diabetics reported experiencing stigma after their diagnoses.
“There is a misconception that excess body weight is the de facto cause of Type 2 diabetes, which can lead to prejudice and discrimination against heavier people,” said Dr. Reilly Coch, the Medical Director for Cayuga Diabetes and Endocrinology.
Type 2 diabetics often encounter narratives that frame them as weak, incapable, lazy or at fault for their diabetes. Martin’s diagnosis was 18 years ago. Since then, he has endured the difficulties of accessing proper guidance for managing his blood sugars, the fluctuations of the disease itself and a slew of stigma.
“One of the things people would often say to me is ‘Oh my God, you're eating ice cream. You're diabetic. You're going to die.’ No, I'm not going to die. I just have to be careful,” Martin said.
For Martin, the stigma carried into healthcare. As he recalled his last doctor’s visit, Martin felt that his doctor was making false assumptions.
“She had looked at me and thought, ‘Well, here's a big guy. He's got to eat ice cream all the time. He's got to eat cake all the time. He doesn't eat healthy, and that's why he's a diabetic.’”
An inactive lifestyle, a lack of healthy food intake and being overweight are factors that typically increase one’s risk for Type 2 diabetes. However, socioeconomic factors complicate one’s health. People of color and low-income individuals who live in areas with less access to fresh, healthy foods are also at a higher risk. Genetics also plays a role. Martin, for example, comes from a line of Type 2 diabetics.
“Genetics plays a big part of it. My grandmother was one of nine children and all nine of them had diabetes. My mom was one of four children, and three of them had diabetes,” Martin said. “Part of it is out of our control.”
The view of Type 2 diabetes as a personal moral failing can prove especially harmful given the difficulties many individuals face in leading healthy lives. Factors like race, age, socioeconomic status and location are large indicators of Type 2 diabetes in Tompkins County. This stigma can produce internalized shame, stress and failure to fully access treatment and accommodations for diabetics.
“One of our biggest concerns is access to fresh, healthy foods,” said Gunnar Madison, Senior Program Director at the YMCA of Ithaca and Tompkins County. “We have a lot of people who are struggling to get by because of the high cost of living here in Tompkins County.”
Nutrition-related diseases, associated with Type 2 diabetes, are particularly common in low-income residents, older populations and the African American community. Black residents of Tompkins County are two times more likely to develop Type 2 diabetes than white residents.
Transportation challenges also often exacerbate food insecurities. The Tompkins County Health Department reported that residents of Caroline, Enfield, Groton, the outskirts of Newfield, Dryden and Candor often experience difficulty in accessing fresh, healthy and non-processed food.
“If you live out in some of the rural parts of our county, like in Danby and Newfield, transportation can be an issue. You might have the bus come once or twice a day, and that's it,” Madison said. “Getting people to the grocery stores could be an issue because not all of our communities have grocery stores.”
Low-income individuals may not have the time to exercise and prepare healthy meals as well.
“A healthy lifestyle is strongly correlated with income,” Coch said. “Food preparation, preservation and distribution are expensive and time-consuming. The recommended amount of exercise for people with Type 2 diabetes is 300 minutes per week, which can significantly reduce the income potential of the people who need it.”
Madison also identified parenthood as another potential barrier to leading an active life. Without childcare, it can be difficult to find the time to work out.
According to Madison, the Ithaca YMCA used to run a Diabetes Prevention Program, which was discontinued in 2015 due to the lower rate of Type 2 diabetes in Tompkins County relative to other areas.
Tompkins County Whole Health ran a similar program, which was also discontinued due to staff changes and a decrease in enrollment. Currently, Cayuga Health runs a National Diabetes Prevention Program which aims to create behavioral change in its participants with an emphasis on healthy eating and increasing physical activity.
For many Type 2 diabetics, like Martin, these programs can help increase access to healthy lifestyles and provide education around Type 2 management, but he says that more is needed. High levels of stigma around Type 2 diabetes, which characterize it as a moral failing, often prevent individuals from fully accessing accommodations or treatment.
“Hopefully, we can try to break the stigma of the disease,” Martin said. “[We need to] get people to understand that a lot is happening, and there’s a lot that’s contributing to it.”
Anna Hooper can be reached at [email protected].