I was listening to a recent podcast about the life of physician Michael Dillon when the hosts mentioned Dillon was diabetic.

Host 1: We should add here that Dillon had diabetes, which turned out to be an interesting sort of good thing in some ways because he’s at the doctor because he has diabetes and…

Host 2: He really loved his cake.

(Laughter)

Host 1: I couldn’t tell if it was type 2 or type 1.

I felt like I had been slapped. Yet again, I was stung by a callous quip — with my illness as the punchline.

When you live with type 2 diabetes, you often face a sea of people who believe it’s caused by gluttony — and therefore ripe for ridicule.

Make no mistake about it: The distinction often made between type 1 and type 2 is intentional, too. The implication is that one can be joked about, and the other should not. One is a serious disease, while the other is a consequence of bad choices.

Like the time someone eyeballed my dessert and said, “That’s how you got diabetes.”

Like thousands of Wilford Brimley memes saying “diabeetus” for laughs.

The internet is, in fact, overflowing with memes and comments conflating diabetes with indulgent food and larger bodies.

Often diabetes is just the set-up, and the punchline is amputation, blindness, or death.

In the context of those “jokes,” a chuckle on a podcast may not seem like much, but it’s part of a larger culture that has taken a serious disease and reduced it to a joke. And the result is that those of us living with it are often shamed into silence and left riddled with self-blame.

Now I’ve decided to speak up when I see jokes and assumptions that contribute to stigma around type 2 diabetes.

I believe the best weapon against ignorance is information. These are just 5 of the things people should know before they joke about type 2:

1. Type 2 diabetes isn’t a personal failing — but it can often feel that way

I use a continuous glucose monitor with a visible sensor implanted in my arm all the time. It invites questions from strangers, so I find myself explaining that I have diabetes.

When I reveal that I’m diabetic, it’s always hesitantly. I’ve come to expect people to make judgments about my lifestyle based on stigma around the disease.

I expect everyone to believe I wouldn’t be in this position if I had tried harder to not become diabetic. If I had spent my 20s dieting and exercising, I wouldn’t have been diagnosed at 30.

But what if I told you I did spend my 20s dieting and exercising? And my 30s?

Diabetes is a disease that can already feel like a full-time job: keeping up with a cabinet of medications and supplements, knowing the carb content of most foods, checking my blood sugar several times a day, reading books and articles about health, and managing a complex calendar of things I’m supposed to do to be “less diabetic.”

Try managing the shame associated with the diagnosis on top of all of that.

Stigma drives people to manage it in secret — hiding to test blood sugar, feeling awkward in group dining situations where they must make choices based on their diabetes treatment plan (assuming they dine with other people at all), and attending frequent medical appointments.

Even picking up prescriptions can be embarrassing. I admit to using the drive-thru whenever possible.

2. Contrary to the stereotype, diabetes is not a “punishment” for bad choices

Diabetes is a malfunctioning biological process. In type 2 diabetes, cells don’t respond efficiently to insulin, the hormone that delivers glucose (energy) from the bloodstream.

More than 30 million people in the United States (10 percent of the population) have diabetes. About 29 million of those people have type 2 diabetes.

Eating sugar (or anything else) doesn’t cause diabetes — the cause can’t be attributed to one or a few lifestyle choices. Many factors are involved, and several gene mutations have been associated with a higher risk of diabetes.

Anytime a link is made between lifestyle or behavior and disease, it’s latched onto as the ticket to avoid the disease. If you don’t get the disease, you must have worked hard enough — if you do get the disease, it’s your fault.

For the past 2 decades, this has rested squarely on my shoulders, placed there by doctors, judgmental strangers, and myself: total responsibility for preventing, stalling, reversing, and battling diabetes.

I took that responsibility seriously, took the pills, counted the calories, and showed up for hundreds of appointments and assessments.

I still have diabetes.

And having it isn’t a reflection of the choices I have or haven’t made — because as a disease, it’s much more complex than that. But even if it weren’t, no one “deserves” to suffer from any disease, including diabetes.

3. Food is far from the only thing that impacts glucose levels

Many people (myself included, for a very long time) believe that blood sugar is largely manageable by eating and exercising as advised. So when my blood sugar is outside the normal range, it must be because I misbehaved, right?

But blood sugar, and our body’s efficacy in regulating it, is not strictly determined by what we’re eating and how often we’re moving.

Recently, I returned home from a road trip overtired, dehydrated, and stressed — the same way everyone feels when reentering real life after a vacation. I woke up the next morning with a fasting blood sugar of 200, well above my “norm.”

We had no groceries so I skipped breakfast and went to work cleaning and unpacking. I was active all morning without a bite to eat, thinking surely my blood sugar would drop to the normal range. It was 190 and remained uncharacteristically high for days.

That’s because stress — including the stress placed on the body when someone is restricting their food intake, exerting themselves too much, not sleeping enough, not drinking enough water, and yes, even social rejection and stigma — can all impact glucose levels, too.

Interestingly enough, we don’t look at someone who’s stressed out and warn them about diabetes, do we? The many complex factors that contribute to this disease are almost always flattened to “because cake.”

It’s worth asking why.

4. The cost of living with type 2 diabetes is immense

A person with diabetes has medical expenses about 2.3 times higher than someone without diabetes.

I’ve always lived with the privilege of being well-insured. Still, I spend thousands on medical visits, supplies, and medications every year. Playing by the rules of diabetes means I go to a lot of specialist appointments and fill every prescription, easily meeting my insurance deductible by mid-year.

And that’s just the financial cost — the mental burden is incalculable.

People with diabetes live with constant awareness that if uncontrolled, the disease will lead to devastating consequences. A Healthline survey found people are most worried about blindness, nerve damage, heart disease, kidney disease, stroke, and amputation.

And then there’s the ultimate complication: death.

When I was first diagnosed at 30, my doctor said diabetes would definitely kill me, it was just a matter of when. It was one of the first flippant comments on my condition that I wouldn’t find amusing.

We all eventually face our own mortality, but few are blamed for hastening it like the diabetic community is.

5. It’s not possible to eliminate every risk factor for diabetes

Type 2 diabetes is not a choice. The following risk factors are just a few examples of how much of this diagnosis exists outside of our control:

  • Your risk is greater if you have a brother, sister, or parent who has type 2 diabetes.
  • You can develop type 2 diabetes at any age, but your risk increases as you get older. Your risk is particularly high once you reach 45 years old.
  • African Americans, Hispanic Americans, Asian Americans, Pacific Islanders, and Native Americans (American Indians and Alaska Natives) are at higher risk than Caucasians.
  • People who have a condition called polycystic ovarian syndrome (PCOS) are at increased risk.

I was diagnosed with PCOS in my teens. The internet barely existed at the time, and no one knew what PCOS really was. Considered a malfunction of the reproductive system, no acknowledgement was made of the disorder’s impact on metabolism and endocrine function.

I gained weight, took the blame, and was given a diabetes diagnosis 10 years later.

Weight control, physical activity, and food choices can only — at best — reduce the risk of developing type 2 diabetes, not eliminate it. And without careful measures in place, chronic dieting and overexertion could place stress on the body, having the opposite effect.

The reality is? Diabetes is complex, just like any other chronic health issue.

With time, I’ve learned that living with diabetes also means managing fear and stigma — and educating those around me, whether I like it or not.

Now I carry these facts in my tool kit, hoping to turn some insensitive jokes into a teachable moment. After all, it’s only by speaking up that we can begin to shift the narrative.

If you don’t have firsthand experience with diabetes, I know it may be hard to empathize.

Instead of joking about either type of diabetes, though, try to see those moments as opportunities for compassion and allyship. Try offering support to people who struggle with diabetes, just as you would for other chronic conditions.

Far more than judgment, jokes, and unsolicited advice, it’s support and genuine care that will help us live better lives with this illness.

And to me, that’s worth a whole lot more than a chuckle at someone else’s expense.


Anna Lee Beyer writes about mental health, parenting, and books for Huffington Post, Romper, Lifehacker, Glamour, and others. Visit her on Facebook and Twitter.