I brace myself for my doctor’s words.
“So, your A1C is high. It’s in the diabetic range.”
After our televisit, I hang up and try to bring myself to say or even write, “I’m diabetic” or “I have diabetes.” The words are bitter in my mouth and turn my stomach. I think of all the “diabeetus” memes and jokes I’ve seen, especially since it’s around Easter, and “If I eat all that candy, I’ll be diabetic!” types of comments abound. No, no you won’t, because that’s not how diabetes works.
I feel emotionally punched in the gut when a favorite Facebook page, all about a front porch gargoyle, makes such a “joke,” related to Peeps candies. I privately message the page owner about the negative impact of such jokes on people already facing enough stigma and stress just living with diabetes. I get no response, so I unfollow the page.
I imagine the field day “my” trolls will have when ― if ― I ever choose to share this information. I remind myself that I’m under no obligation to share this, or any other health information, with the world, just because I write about being fat. It’s no one’s business. I’ve never once claimed to be “healthy” by anyone’s definition, nor would I.
Still, I know that once I feel stronger, once I adjust to the diagnosis, I’ll write about it. Not because I’m a masochist. But because I know there are other fat diabetics who will feel all the same shame and anguish I’m struggling to unpack at this moment.
You can’t live in a fat body in a thin-centric, diet-obsessed culture without picking up on the idea that fat automatically equals unhealthy.
When it comes to fat hatred (frequently called fatphobia) and weight stigma, there are two groups of “trolls” that fat people encounter. There are those who straight up hate fat people and make no pretense about caring for our health. But then there are concern trolls ― people who claim to have a fat person’s best interest (“But what about your health?”) at heart, but who also won’t listen when fat people tell them they’re not helping. Anyone who actually thinks this method helps is wrong, as fat-shaming people in the name of better health just intensifies stress and anxiety, neither of which are great for one’s health. Not to mention that everyone, whether they are “healthy” or not, is entitled to be treated with human dignity and respect.
As I come to terms with this diagnosis, I know very well that if I speak of it publicly, I will have to deal with both types of trolls. I may even have people in my real life try to give me “advice” that, while possibly well intended, is not going to help make any of this easier or less complicated.
Prior to my disastrous decision to have gastric sleeve surgery, my A1C was also in the diabetic range, though it had been managed successfully with medication. As is typically the case, I woke up from surgery with very, very high glucose levels (high enough they gave me insulin injections at the hospital), even though it had been days since I’d eaten food at all.
But by the time I was discharged, I was off the meds, with instructions to check my blood glucose regularly at home. It was normal most of the time, though they did put me back on meds for a couple of weeks, as it was sometimes high (despite the fact that at that point in my recovery, I was eating literally nothing and existing on liquids, all of which were sugar free).
My A1C levels were in the low 4s after this, but slowly (and before I gained weight) creeped up into the high 4s, low 5s. (Anything over 6.5% is indicative of diabetes.) Since I’d previously been in the diabetic range, I had every expectation I would be again, despite the surgery and temporary remission.
No one entirely understands the function of bariatric surgery on diabetes. Why is it gone for most patients almost immediately, even before any significant weight loss can happen? Why does it return for some patients, sometimes without weight gain?
Though some surgeons will still claim it “cures” diabetes, I’ve more often seen it referred to as a “remission.” Remissions are, of course, all too often temporary. So selling these surgeries as a “cure” is disingenuous at best and unethical at worst.
I went into the surgery knowing all this, and it wasn’t something I did to “cure” being diabetic. Diabetes runs in my family, on both sides. I have polycystic ovarian syndrome. I had a horrible case of pancreatitis that caused my liver to start failing. All of these are risk factors for the development of diabetes.
I know right now there are fat haters reading who are jumping for joy ― and to conclusions. It’s twisted, but they seem to get off on a fat person having any kind of illness, especially one they can “blame” on the fat person’s body size. I won’t pretend I understand this logic because I never could.
One thing none of them ― and sadly, not enough medical professionals and family members and friends ― will consider is the impact of chronic stress. When you live in a state of constant stress, that negatively impacts the body in so many ways, most of which are also correlated with body size. But consider just this one sentence from Cleveland Clinic’s page about stress and diabetes:
Hormones from stress increase your blood pressure, raise your heart rate, and can cause blood sugar to rise.
That alone covers high blood pressure, high blood sugar and an impact on cardiac health (all things also considered to be caused by larger body size). This isn’t groundbreaking news by any means. Researchers have known for a very long time that chronic stress significantly and negatively impacts health.
Now consider that I have lived my entire life hearing about how “bad” being fat is, whether for health reasons or not. I grew up with a fat father that my mother’s family largely despised; making fun of his weight was a favorite pastime of my mother’s family.
They loved to tell me how I looked exactly like him, often right after one of these jokes. What message is a small child to take away from this? Especially when I was put on my first diet by my mother’s sister at the tender age of 8.
I’ve lived my whole life learning to internalize all of these messages. Since it started with my family, it makes it harder to dismiss messages from strangers. When the government goes on and on about the “war on obesity,” that takes a toll on every single fat person (and plenty of thin people, too).
It negatively impacts our health in every possible way, from the weight bias of medical providers, to the lack of accessibility for medical equipment that is illogical when you consider the “obesity crisis” is something we’ve been hearing about for decades now. If you know fat people exist, but you don’t make changes in medical care to accommodate them, how worried are you, really, about their “health”?
We are berated constantly, frequently, for our size, in the name of health. Then, when we need care, we can’t get it because of the implicit biases held against us by medical professionals.
I’m lucky. My doctor has been my doctor for a long time, and she was supportive when I chose to stop dieting for my mental ― and yes, believe it or not, physical ― health. I know with her help, plus support from fat positive/weight inclusive programs, like Self Care for Diabetes, I will figure out the best ways to manage my condition. It will take some trial and error, but I’ll get there.
Still, it’s not easy to get any new diagnosis, let alone one you know people will say is all your fault. It won’t matter to them that this is not necessarily how diabetes works, nor will they care that plenty of fat people never develop diabetes, or that plenty of thin people will.
To the trolls, I say: Feel free to revel in my diagnosis. Just be honest about it. You don’t care about my health, or that of any other fat person. If you did, you’d stop demeaning fat people.
In fact, you not only don’t care, you actually want us to be unhealthy. If you didn’t, you’d stop contributing to the chronic stress that absolutely negatively impacts our health outcomes. You’d use your considerable energy to fight for change, to make our lives ― and health ― better instead of worse.