Message to young women with diabetes: Marriage and children, you can have it all !
In the last 21 years, I have been working closely with young women who have type 1 or type 2 diabetes
and many of them have voiced a persistent concern and fear: will they
be able to lead a fulfilling life as wives and mothers. They seem to
have received little or no reassurance from family and friends. Social
discrimination, misconceptions and stigma are still creating
psychological and emotional problems for these young women.
Research shows that societal stigma, shaming or discrimination of people with diabetes has a negative impact on patient self-care and leads to poor treatment outcomes.[i] Women face much more of this than men. They are deemed unfit for marriage and motherhood. They face this stigma on all fronts: from their own family, extended relatives, colleagues at work and from prospective spouses and their families.
I would like to clear some of these misconceptions and send out a message of hope and reassurance to these young women.
Never assume, always ask the doctor
Lack of understanding is the source of this stigma, both in rural and urban India. Poor understanding of the disease at all levels - patients, families, prospective in-laws, co-workers - creates a web of fear about the disease, its risks and its impact on everyday living. So many families assume no one wants to wed their daughter, because she has a lifelong chronic condition. They also assume that the young woman will be unable to bear children, and if she does, the child will be at risk of developing diabetes at some point in life.
In light of this, it becomes the doctor’s responsibility to guide patients and their families, give them the information they need on general diabetes management and particularly on pre and post-natal diabetes care. Patients need to be told that while diabetes does increase the risk of certain complications, advancements in medicine and technology have made these well manageable today.
Do not hide your condition, and never neglect your medication
I have met several young women patients in the process of finding a marriage partner, struggling with the dilemma of whether to tell their prospective partners and families about their diabetes status. Many have reported that when they did open up about their condition soon after marriage, they were advised to seek alternative medical treatment by their husbands and in-laws and asked to give up insulin therapy! Hiding the fact that they have diabetes has also led to an erratic medication schedule leading to horrifying results. Many patients developed a condition called ketoacidosis (excess blood acids called ketones) and needed to be rushed to the emergency room.
One of my biggest concerns is that newly diagnosed patients sometimes keep their diabetes status a secret from even their immediate family and colleagues for fear of judgement. Some of my new patients admit to taking their insulin or checking their blood sugar only in the privacy of their washroom, and do not do so as often as recommended if they are in a public place.
My message to patients here is simple: no person and no circumstance must ever trump your own health. Neglecting to monitor your blood sugar or to take your medication as prescribed, can put you at high risk of many complications, some of which are life threatening. Patients on insulin therapy should ask their doctor to help pick an insulin type that suits their daily schedule and body requirements.
Remember you are not to blame for your condition
Many have called diabetes a ‘blame and shame’ disease, because patients tend to be held responsible for developing their condition. Feedback from some patients indicates that they have faced open insinuations that they would not have developed diabetes if they had watched their weight or limited their intake of sweets. These ill-advised words from friends and colleagues are further fed by social media comments that describe diabetes patients as overweight people who lead unhealthy lives.[ii] But the truth is that diabetes is a complex disease influenced by several factors such as genetics and the environment and can affect anyone from healthy young children to aging adults.
Can we together change the fear and stigma into hope and happiness?
Yes, we can. The constant stress and fear only add to the physical and psychological pressure that diabetes already imposes on patients. As a society, we can help patients reduce this ‘added stress’ by breaking these stereotypes and misconceptions, and instead offering support to women with this condition. India now has a growing network of diabetes patient support groups, so I urge patients to reach out and be a part of these wonderful communities. And for doctors, family and caregivers, to reassure patients that they are not alone in this journey.
Research shows that societal stigma, shaming or discrimination of people with diabetes has a negative impact on patient self-care and leads to poor treatment outcomes.[i] Women face much more of this than men. They are deemed unfit for marriage and motherhood. They face this stigma on all fronts: from their own family, extended relatives, colleagues at work and from prospective spouses and their families.
I would like to clear some of these misconceptions and send out a message of hope and reassurance to these young women.
Never assume, always ask the doctor
Lack of understanding is the source of this stigma, both in rural and urban India. Poor understanding of the disease at all levels - patients, families, prospective in-laws, co-workers - creates a web of fear about the disease, its risks and its impact on everyday living. So many families assume no one wants to wed their daughter, because she has a lifelong chronic condition. They also assume that the young woman will be unable to bear children, and if she does, the child will be at risk of developing diabetes at some point in life.
In light of this, it becomes the doctor’s responsibility to guide patients and their families, give them the information they need on general diabetes management and particularly on pre and post-natal diabetes care. Patients need to be told that while diabetes does increase the risk of certain complications, advancements in medicine and technology have made these well manageable today.
Do not hide your condition, and never neglect your medication
I have met several young women patients in the process of finding a marriage partner, struggling with the dilemma of whether to tell their prospective partners and families about their diabetes status. Many have reported that when they did open up about their condition soon after marriage, they were advised to seek alternative medical treatment by their husbands and in-laws and asked to give up insulin therapy! Hiding the fact that they have diabetes has also led to an erratic medication schedule leading to horrifying results. Many patients developed a condition called ketoacidosis (excess blood acids called ketones) and needed to be rushed to the emergency room.
One of my biggest concerns is that newly diagnosed patients sometimes keep their diabetes status a secret from even their immediate family and colleagues for fear of judgement. Some of my new patients admit to taking their insulin or checking their blood sugar only in the privacy of their washroom, and do not do so as often as recommended if they are in a public place.
My message to patients here is simple: no person and no circumstance must ever trump your own health. Neglecting to monitor your blood sugar or to take your medication as prescribed, can put you at high risk of many complications, some of which are life threatening. Patients on insulin therapy should ask their doctor to help pick an insulin type that suits their daily schedule and body requirements.
Remember you are not to blame for your condition
Many have called diabetes a ‘blame and shame’ disease, because patients tend to be held responsible for developing their condition. Feedback from some patients indicates that they have faced open insinuations that they would not have developed diabetes if they had watched their weight or limited their intake of sweets. These ill-advised words from friends and colleagues are further fed by social media comments that describe diabetes patients as overweight people who lead unhealthy lives.[ii] But the truth is that diabetes is a complex disease influenced by several factors such as genetics and the environment and can affect anyone from healthy young children to aging adults.
Can we together change the fear and stigma into hope and happiness?
Yes, we can. The constant stress and fear only add to the physical and psychological pressure that diabetes already imposes on patients. As a society, we can help patients reduce this ‘added stress’ by breaking these stereotypes and misconceptions, and instead offering support to women with this condition. India now has a growing network of diabetes patient support groups, so I urge patients to reach out and be a part of these wonderful communities. And for doctors, family and caregivers, to reassure patients that they are not alone in this journey.