Jennifer Dyer, MD, is an endocrinologist and Assistant Professor of Pediatrics in the Division of Endocrinology at the Ohio State University College of Medicine. In addition to all her hard work as a doctor, she also is passionate about consumer health communications and health media to improve health literacy. She also happens to be one of the few endos you can find using social media on a regular basis; you can follow her on Twitter at @EndoGoddess. Today, Jennifer shares her thoughts on one of the leading causes of diabetes misconceptions: Hollywood...
As a pediatric endocrinologist, I meet many young patients and their families when they first hear the news that they have type 1 diabetes. Fear is a common reaction, and understandably so. The fear in their eyes is often preceded by thoughts of the challenges of the characters with diabetes in the movies. Many families and patients do not know about the daily life of a person with diabetes. Thus, their only experience with diabetes is through the movies. I always try to point out that diabetes in the movies is often NOT an accurate portrayal of what life with diabetes is like.
I remember the first time that I saw Steel Magnolias. I didn't know anyone with diabetes at the time, and I would have thought that frequent hypoglycemic seizures and kidney failure following childbirth were the norm for those living with diabetes — if I hadn't learned otherwise in medical school. In the movie, Julia Robert's character (Shelby) has a dramatic hypoglycemic reaction while getting her hair done at the salon owned by Dolly Parton's character (Trudy). The dramatic seizure scene follows her mother's accusations regarding Shelby's poor diabetes self care due to the stress of her wedding planning. Shelby begins convulsing due to hypoglycemia we assume is related to her own neglect. Then her low blood sugar is treated quickly by her mother giving her orange juice. The mood in the salon quickly turns to one of fear over Shelby's diabetes.
Shelby later becomes pregnant, suffers resultant kidney failure requiring a kidney transplant from her mother, and subsequently dies from complications of kidney failure. The movie implies that Shelby's diabetes condition would not have progressed if she had not decided to have a child.
Not only is this misleading, but it's absolutely out-of-date. A few important points regarding this movie and the facts of diabetes today in 2009 (versus 1989 when the film came out):
• Improved overall diabetes care: The improved accuracy and portability of glucose meters we use today have allowed diabetes care to also be much more accurate and portable. Shelby didn't have the benefit of knowing her most precise glucose levels because these meters were not available to her in the 1980s. If the script writers even had a clue, they were probably implying that Shelby missed opportunities to modify her insulin doses to improve her glucose levels. In addition, new insulins such as Humalog/Novolog and Lantus/Levimir were introduced within the past 5-10 years. These newer insulins have resulted in much more accurate glucose control than the older NPH/regular insulin shots that Shelby was probably taking. Furthermore, insulin pumps are now available which make diabetes care more convenient. Perhaps if Shelby had had an insulin pump, she would not have neglected her diabetes care while planning her wedding. However, insulin pumps were not available in the 1980s.
• Hypoglycemia: Shelby must have been very hypoglycemic unaware. As you know, low sugar levels can be treated before a seizure occurs in most cases because they can be caught be checking the glucose level on a meter. Also, continuous glucose meter systems (CGMS) are now available which check glucos levels every 5 minutes and can help warn about oncoming lows.
• Diabetic pregnancy is considered safe with strict glucose control and close glucose monitoring! Women with diabetes have healthy pregnancies and health babies every day. Strict adherence to insulin shots and glucose checks is required, however — just as they are when not pregnant in order to maintain health. If Shelby had poor overall diabetes care throughout her entire life, it's likely that she would still have had kidney failure, regardless of the pregnancy.
It goes without saying that Hollywood over-dramatizes (or sometimes even twists) the medical facts.
This goes for most all medical conditions. Over-dramatizing is common practice, as it drives home a point within the story arc. Take The Godfather Part 1: did Michael Corleone (Al Pacino) really have a bruise on his cheek for the entire year while in exile in Sicily? No, the point was to foreshadow that he was running away from danger after shooting Sollozzo and McCluskey, yet danger was still following him...
Shelby's hypoglycemic seizure and early death are used as an allegory for the fragility of life and the strength of female friendships. Too bad the general public generally takes Steel Magnolias at face value as a lesson in what life with diabetes is really like.
So, all you PWDs can go forth with confidence that your daily diabetes life and Hollywood are usually not on the same page. Better yet, make sure you tell everyone around how misleading these Hollywood images can be. Or one better: try writing the next Oscar-winning dramatic movie screenplay with a story line touching on life with diabetes in a much more accurate way... Isn't it dramatic enough already?
Good points, Jennifer. We do hope the screenwriters' guild hires you as their next expert consultant!