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This year’s eye screening appointment had aspects that were comfortingly familiar, and anxiously new. And I’ve come home with a very different feeling to the way I usual feel.

I’ve been going to the same private eye clinic for twenty years. I usually see the same orthoptist and always see the same ophthalmologist. This year, I saw a (new for me) orthoptist who opened with the clanger ‘Do you check your glucose levels?’ (I wasn’t aware it was a choice…) and followed up with ‘What is your glucose level usually?’. (This is not a question.) The rest of that appointment was comfortingly familiar – no changes in what I can read on the eye chart, excellent eye pressure and no vision changes. She put in drops and sent me to the next waiting room to wait to see my dreamy ophthalmologist.

And he is dreamy. I adore him. I mean, I hate seeing him and I tell him that each year. Then he laughs and thinks I’m neurotic, because I am neurotic, and that is how pretty much each and every year’s appointment starts. Comfortingly familiar. 

This year was no different. He always asks how I am, how my family is, how work is going, what’s going on with my diabetes and other friendly chatter to settle me in and get an idea of what is going on in my world. He asked if I’d had much of a chance to travel and how I was dealing with COVID times, or, as I now think of it, normal life. Comfortingly familiar.

As was the way he shone the Very.Bright.Light in my eyes, made reassuring ‘hmmm’ noises and told me that there was absolutely no hint of any diabetes-related eye stuff going on in my eyes and that was truly great after twenty-four years of diabetes. I always do appreciate the way that he is such a great cheerleader for diabetes longevity and acknowledges what a slog it can be. Comfortingly familiar. 

So,’ he said. ‘It’s all great news again from a diabetes perspective. However…’

Huh? ‘However…’? We don’t do ‘However…’. We do me standing up and promising to return the following year. Not ‘However…’ Yet, here we were. The anxiously new part. 

‘…However, I can see really early age-related macular degeneration in one eye. Really early. There’s nothing to worry about at all.’ He looked at me. ‘You don’t need to worry.’

And then I laughed, and he laughed because the idea of me not worrying is hilarious, and I had already jumped beyond worried and landed somewhere near stressed, anxious and ready to burst into tears. (I at least managed to wait until I got home for the last part.) 

I had questions and he patiently answered all of them. We spoke about family history. Apparently if a parent has AMD, their kids have a 50% chance of developing it. (Looking at this as a positive because it means that my sister might be right. Happy to take this one for the team, Toots!) He then spoke to me about things to do at this stage that help. The first is to not smoke. I’ve never been a smoker, so that’s an easy one. Then he asked, ‘Do you eat well?’ My heart sank. Another food-related thing? Turns out that eating leafy greens is protective which is fine because I love vegetables and it’s mandated in the hipster suburb where we live to eat three serves of kale a day. And finally, keeping up with regular appointments. Annual visits are still final.

‘So, Renza, It’s not diabetes. This is because of your age. After all, you’re 50 next year.’

‘Settle down!’ I said and suggested he dial things back a little. ‘I’m not even 49 yet.’ He looked at my chart again and needlessly pointed out that regardless of my current age, I am still turning 50 next year. (I’ll just point out that this was also comfortingly familiar because he frequently mentions that I am getting older.) 

I sighed. And got into the car with my dad and told him my news, opening with the comfortingly familiar and then moving onto the anxiously new. We went for a coffee, and I tried to focus on the positives. And then I got home and had a little cry. 

Because here’s the thing. I expect things to break. I’ve been told that things are going to break thanks to diabetes since the day I was diagnosed. And so, whenever something doesn’t break, it comes as a huge surprise. I’ve been holding my breath all week in anticipation of today’s appointment. I know that this is just a tiny hairline crack at this point, but it still has triggered a lot of stuff in my head right now. Sure, this may not be a catastrophe and sure, there is enough rational thinking to know that it’s early, I’m linked in with great healthcare professionals, and we know what to look for. But still. It’s another thing. Another worry. Another concern. Another part of my body not working completely properly, or at least indicating that it’s not going to work properly in the future. 

And so, I’m home now with a very different feeling to the way I usually feel after my annual eye screening. I’m already turning to the community to see who I can find there who might have some advice and understanding. I’m involved in a European ad board which relates to AMD and DME, so know that there is a whole network there who I can talk to. And I’m writing here to see if anyone out there has an experience to share. Because that’s what I do. Turn to community. I have the HCP stuff sorted. Now I’m looking for my people in the real world…

Waiting with diabetes (after dilating drops are in.)

More about eyes

How having a brilliantly kind ophthalmologist means I never miss an eye screening.

A chance encounter with an optometrist friend.

The comfort of knowing how eye screening appointments go.

The time I had a needle in my eye.

Always a worrier when it comes to eye screening.

All about my first cataract surgery. And after my second surgery.

What my dad has to do with my annual eye screening.

Advocacy is a slow burn. I say those words every day. Usually multiple times. I say it to people with diabetes who are interested in getting into advocacy, not to scare them off, but so they understand that things take time. I say it to established advocates. I say it to people I work with. I say it to people in the diabetes world who want to know why it takes so long for change to happen. I say it to healthcare professionals I’m working with to change policy. I mutter it to myself as a mantra.

Slow. Burn.

But then, there are moments where there is an ignition, and you realise that the slow burn is moving from being nothing more than smouldering embers into something more. And when that happens I can’t wipe the smile of my face and I start jumping up and down. Which is what I was doing in my study at home at 2am, desperately trying to make as little noise as possible so as not to wake my husband and daughter who were sounds asleep in other rooms off the corridor. 

The World Health Organisation conducted the first of its two focus group sessions for people with diabetes yesterday (or rather for me, early this morning), and I was honoured to be part of the facilitating team for this event. In the planning for the questions that would be discussed in the small break out groups, the WHO team had gone to great pains to workshop the language in the questions so they were presented in a way that would encourage the most discussion possible.  That was the start of those embers being stoked.

I think that the attention to how we framed the discussion points meant that people thought about their responses differently. 

The topics last night were about barriers to access of essential diabetes drugs, healthcare and technology. Of course, issues including affordability, health professional workforce, ongoing training and education were highlighted. These are often the most significant barrier that needs to be addressed.

But the discussion went beyond this, and time and time again, people identified stigma and misconceptions about diabetes as a significant barrier to people not being able to get the best for their diabetes. It certainly wasn’t me who mentioned language (at least not first), but communication and language were highlighted as points contributing to that stigma.

This recurring theme came from people from across the globe. It was mentioned as a reason for social exclusion as well as workplace discrimination. There was acknowledgement that perceptions of diabetes as being all about personal responsibility has affected how policy makers as well as community responds to diabetes – how serious they see the condition. 

In the discussion about diabetes-related complications, the overall language had been changed from ‘prevention’ to ‘risk reduction’ and this was recognised in many of the discussions as a far better way to frame conversations and education about complications. This isn’t new – it was a recurring theme when a focus in the DOC was the hashtag #TalkAboutComplications. I wrote and co-wrote several articles about it, including this piece I co-authored with the Grumpy Pumper for BMJ

The direction the discussions took were a revelation. No. It was a revolution!

So often at other events and in online debates when language and communication has been raised, conversation has been stalled by people pushing agendas about wanting to be called ‘diabetic’, as if this is the first and only issue that needs to be resolved. That didn’t even come up last night because the people who were highlighting the implications of language understood that when you look at the issues strategically and at a higher level, those details are not what matters. 

What matters is looking at Communication with a capital C and understanding its influence. It elevated the discussion so far above the ‘it’s political correctness and nothing more’ that it would have been ridiculous to drag the discussion back to that level. 

For years, there has been push back regarding communication because people have not stood back and looked at impact. That has changed.

When I wrote this four years ago highlighting that diabetes’ image problem diabetes – all those misconceptions and wrong ideas about the condition – has led to fewer research dollars, less understanding and compassion from the community, more blame and shame levelled at individuals … it was to emphasise that the repercussions have been significant. 

Thankfully as more people started stepping back and considering big picture – health systems, policy, community education – I could see that there were shifts as some people stopped talking about political correctness and started asking what needed to be done to really move the needle. It seems that’s where the very, vast majority of people were during the WHO focus group 

This diabetes #LanguageMatters movement stands on the shoulders not of the people who have elevated the issue in the last ten years (although those contributions have been massive!) or the position papers and guidelines that have been published (although those have certainly aided the discussion in research and HCP spaces), but rather, the people in the diabetes community who, for years, knew that language and communication was a driving factor in our care. People like those in the (Zoom) room yesterday.

Looking for more on #LanguageMatters

Click here for a collection of posts on Diabetogenic.

The Diabetes Australia Language Position Statement (Disclosure: I work at Diabetes Australia and am a co-author on this statement.)

The Diabetes Language Matters website which brings together much of the work that has been done globally on this issue. (Shout out to diabetes advocate Jazz Sethi for her work on this.)

DISCLOSURE

I was invited by the WHO Global Diabetes Compact team to be part of the facilitators at the Focus Group on Advancing the Lived Experience of People Living with Diabetes. I am happily volunteering my time. 

Over the last two days (or last two middles of the night if you’re perpetually in the wrong part of the world as it seems I am), I participated in the excellent first World Health Organisation Global Diabetes Compact Forum. (You can read the Compact which was launched earlier this year here.)

Once again, the WHO team had brought together stakeholders, including diabetes advocates, from across the world to talk about some critically important challenges facing people living with diabetes. These included access to insulin, research and innovation and prevention, health promotion and health literacy. The Forum was definitely not a ‘sit and be lectured to’ event. It was interactive, with everyone having the opportunity to participate and share their experiences and perspectives. The chat function was open and there was a constant stream of engaging, energetic discussion and sharing. 

The final session was about prevention and in his introduction, James Elliot, who expertly moderated the event, laid the foundation for the discussion. As with the previous sessions, there were no pre-conceived ideas or narrow focus about the topic. 

Prevention isn’t just about prevention of type 2 diabetes. There is a lot of work also going on looking at prevention of type 1 diabetes. And also, once living with diabetes, looking to do what we can to prevent diabetes-related complications.

When I spoke, the first thing I wanted to highlight was the problem I feel with the word prevention, and I revisited previous discussions in which I’ve been involved which highlight the struggle I feel with the word prevention. For too many people it is a word that offers a promise – a promise which guarantees that we can prevent aspects of diabetes that are often well beyond our control. I presented my case for instead focusing on how reducing risk is a far more accurate description of what efforts are truly about, a perspective that I have noticed is being used more and more.

The discussion pivoted to being about complications and associated stigma. Thankfully, this is not the start of the conversation about diabetes-related complications and the way people see them. When I wrote this piece back in 2013, I wrote about the way complications were presented to people with diabetes and how non-modifiable factors such as genetics, are rarely part of the conversation. There seemed to be a very one-dimensional presentation of diabetes-related complications: ‘take care’ of yourself, and you won’t get them. 

With communication around complications starting to be included in the language matters movement, I could see that too many people had been told that over-simplistic tale. 

It all got taken up a very significant notch when there was a concerted effort in the DOC to encourage dialogue about diabetes-related complications in a non-judgemental and safe way. Suddenly, we were seeing the hashtag #TalkAboutComplications accompany people’s stories, or questions others might have. This led to a real shift, as more and more people shared their experiences, with many saying that it was the first time they had seen others being so open about what was often considered a taboo topic. Starting to peel away the shame and secrecy of what can be a scary part of life with diabetes allowed many people to seek support from peers and help from health professionals. 

The legacy of the #TalkAboutComplications idea is that is that there are far more conversations today about diabetes-related complications. There is also a plethora of blog posts, podcasts, journal articles and conference presentations about the topic. I know that there is still significant stigma that we need to chip away at, but actually being able to easily find places online where conversations about complications are normalised and being part of those conversations is contributing to reducing that stigma. 

The session at the Global Diabetes Compact Forum was terrific because it tied together diabetes-related complications and stigma. With the theme of access this World Diabetes Day, perhaps we need to think about what that means when it comes to diabetes-related complications. While we absolutely do need to think about all factors at play when it comes to the development of complications, we also need to acknowledge that access is a factor when it comes to outcomes. Access to the right information, including information about risk reduction, access to insulin, access to glucose monitoring devices, access to complications screening, access to early diagnosis and treatment, access to peer support, access to stigma-free treatment, access to mental health support…all these have the very real potential to influence outcomes. 

I probably should stop thinking of my job as ‘my new job’. I’ve been at Diabetes Australia now for well over five years. But for some reason, I still think of it that way. And so do a lot of other people who often will ask ‘How’s the new job?’

Well, the new job is great, and I’ve enjoyed the last five years immensely. It’s a very different role to the one I had previously, even though both have been in diabetes organisations. 

One thing that is very different is that in my (not) new job I don’t have the day-to-day contact with people with diabetes that I used to have. That’s not to say that I am removed from the lived experience – in fact, in a lot of ways I’m probably more connected now simply because I speak to a far more diverse group of people affected by diabetes. But in my last job, I would often really get to know people because I’d see them at the events my team was running, year in, year out. 

Today, I got a call from one of those people. (I have their permission to tell this story now.) They found my contact details through the organisation and gave me a call because they needed a chat. After a long time with diabetes (longer than the 23 years I’ve had diabetes as an annoying companion), they have recently been diagnosed with a diabetes-related complication. The specific complication is irrelevant to this post. 

They’ve been struggling with this diagnosis because along with it came a whole lot more. They told me about the stigma they were feeling, to begin with primarily from themselves. ‘Renza,’ they said to me. ‘I feel like a failure. I’ve always been led to believe that diabetes complications happen when we fail our diabetes management. I know it’s not true, but it’s how I feel, and I’ve given myself a hard time because of it.’ 

That internalised stigma is B.I.G. I hear about it a lot. I’ve spent a long time learning to unpack it and try to not impact how I feel about myself and my diabetes. 

The next bit was also all too common. ‘And my diabetes health professionals are disappointed in me. I know they are by the way they are now speaking to me.’

We chatted for a long time, and I suggested some things they might like to look at. I asked if they were still connected to the peer support group they’d once been an integral part of, but after moving suburbs, they’d lost contact with diabetes mates. I pointed out some online resources, and, knowing that they often are involved in online discussions, asked if they’d checked out the #TalkAboutComplications hashtag. They were not familiar with it, and I pointed out just how much information there was on there – especially from others living with diabetes and diabetes-related complications. ‘It’s not completely stigma free,’ I said. ‘But I think you’ll find that it is a really good way to connect with others who might just be able to offer some support.’ 

They said they’d have a look. 

We chatted a bit more and I told them they could call me any time for a chat. I hope they do. 

A couple of hours later, my phone beeped with a new text message. It was from this person. They’d read through dozens and dozens of tweets and clicked on links and had even sent a few messages to some people. ‘Why didn’t I know about this before?’, they asked me. 

Our community is a treasure trove of support and information, and sometimes I think we forget just how valuable different things are. The #TalkAboutComplications ‘campaign’ was everywhere a couple of years ago, and I heard from so many people that it helped them greatly. I spoke about it – particularly the language aspect of it – in different settings around the world and wrote about it a lot.

While the hashtag may not get used all that much these days, everything is still there. I sent out a tweet today with it, just as a little reminder. All the support, the connections, the advice from people with diabetes is still available. I hope that people who need it today can find it and learn from it. And share it. That’s one of the things this community does well – shares the good stuff, and this is definitely some of the good stuff!

Want more? 

Check out the hashtag on Twitter here.

You can watch a presentation from ATTD 2019 here

Read this article from BMJ

My favourite answer to give when someone asks me how I went at any diabetes-related medical appointment is ‘Nothing to report.’ I love being able to say that things are boring. If there is ever a time in my life that I want to be unexceptional and routine, it is when I am hearing or sharing news about my diabetes.

For as long as I live with diabetes, I want to forever be told ‘It’s nothing,’ or ‘There’s nothing.’ I want there to be nothing there when my eyes are screened; nothing to report when I have my kidney function checked; nothing new, nothing scary, nothing to worry about.

The thing is: to get to nothing, we put in a lot of effort. We push ourselves and do things over and over and over and over. Because we’re told if we do all the things, all the time, nothing will happen.

But sometimes, despite all that effort, it’s not nothing; it’s something.

We have done everything possible – everything we possibly can – and we walk in and expect to hear another nothing. But instead, this time we’re told there’s something and we can’t help but wonder why we didn’t do more.

That’s just how diabetes works. There is no rhyme or reason. There is nothing fair about it. But we keep doing it – whatever we can manage at that particular moment.

And we ask and hope for nothing – absolutely nothing – in return. Except our health.

Which, as it turns out, is absolutely everything.

Hoping for nothing.

More musings from ADA, this time following yesterday’s diabetes-related complications session.

DISCLOSURES

I am attending ADA as part of my role at Diabetes Australia. My economy flights and accommodation have been covered by the organisation.

Dr Jen Gunter* is a brilliant OB/GYN in the US, and she seems to have to spend a lot of time dispelling myths created by looney wellness gurus and Gwyneth Paltrow about things that help women’s health – most of which seem to involve shoving things up one’s vagina. Their non-science approach has included suggestions of inserting jade eggs, glitter and (most recently) garlic cloves in the vagina for all sorts of weird and not-so-wonderful purposes.

So, the good doctor writes blog posts and Twitter threads about why sticking ground up wasp nests (I’m serious) inside our vagina is a very, very bad idea. (I know – that should be self-explanatory. Alas, for some in this world, it is not.)

We get to do this in the diabetes world too. While I’m yet to see anyone suggesting inserting household items, bulbs or crushed up stinging insect homes into our orifices as a potential cure, there certainly are other myths that seem to regularly come our way and have people wondering if maybe, just maybe, they would work better than insulin.

They will not.

Cinnamon will not cure diabetes. I even have a little n=1 study to prove this. I ate nothing but cinnamon buns for two weeks while in Copenhagen and Stockholm and my diabetes did not disappear.

Okra water may have improved the glucose levels of pregnant rats (in one study), but it will not work as a substitute for insulin, so don’t load your pump up with it.

And while I can honestly say I have no interest whatsoever in any of the klusterfuck of Kardashians (I just created that collective noun for them), as soon as one of them trespasses into my diabetes world, you bet they become fair game and on my radar. This little gem from Khloe gets a regular show in diabetes presentations I give:

Myths and misconceptions everywhere! We may laugh about them, and share silly memes, but sometimes, they do more than just cause us to roll our eyes. Sometimes they can be a little more damaging.

Hello Easter, and hello myth that low A1c guarantees zero complications.

The reason this was getting a run was because Easter for many means chocolate, and chocolate is like kryptonite for some low-carbers. Out came their claims that carbs are a one-way street to Complicationsville.

Diabetes-related complications don’t work in a logical, or especially fair, way. There is no formula that you can go to that works it out for you and is accurate every single time. Much like there is no pie for low-carbers, there is no Pi for diabetes.

It would be great if there was. I would love something that worked like this all the time:

A1c <5% = 0 complications ever, ever, ever.

Alas, it doesn’t work that way.

Diabetes-related complications are fucked up for many reasons. Before we even get them, they can be terrifying. We live with this fear hanging over our heads and for some of us, that terror can be horrid.

They come with all sorts of blame and shame and judgement and finger pointing, plus a good measure of guilt. Isn’t that fun?

There are other factors at play that contribute to the development of diabetes-related complications. And we don’t know what they all are. That’s why we see examples of two people running the same A1c for the same number of years yet one has complications and the other doesn’t.

And then, if we are diagnosed with them, we need to readjust our lives to work around this new reality that can be debilitating. And that’s just the physical side of it – the psychological side adds a whole other level.

There is evidence to show that an in-range A1c lowers the risk of developing diabetes-related complications. We have that information and it is regularly and repeatedly banged into our heads. One of the first acronyms I learnt when diagnosed with diabetes (literally day 1) was DCCT!

I know that the idea of developing diabetes-related complications after ‘doing everything right’ and living with a super low A1c doesn’t seem fair. I also know that people are terrified about what diabetes may hold, so gripping onto a promise that the bad stuff won’t happen can be reassuring. We all want reassurance. We all want hope.

But a reduced risk does not equal no risk. Diabetes doesn’t work in absolutes. And people who think that it does are, quite simply, wrong. I really wish they would stop spreading myths about it. (That goes for you too, Khloe.)

*Dr Jen Gunter has written a book and it’s due out later this year. I’ve pre-ordered and you can too here. It’s called The Vagina Bible, or as it has become known in our place thanks to the fourteen-year-old kidlet’s wordplay: ‘The Vible’).

I regularly say that I wish I had an assistant to take care of all the diabetes admin. I’d like to be able to hand over all the scheduling, paperwork and the general keeping track if it all that takes time, brain power and forces us to find room that those not living with diabetes can dedicate to making sure they remember if there is milk in the fridge or when the new season of The Good Place starts.

It would be a thankless job, and I doubt that anyone would be interested in doing it, but I can dream.

A couple of weeks ago, Diabetes Australia officially launched KeepSight, the first ever national eye screening program for people living with diabetes. It’s actually a super easy concept: PWD register to be part of KeepSight and then receive reminders when it is time to have an eye check. No more needing to remember the last time you had a check-up.

This is similar to the cervical screen program that has been around for a number of years now. I have relied on reminders from that program to alert me when it is time to make an appointment for a screening check. KeepSight will help us keep track of our eye checks.

I could give stats about the number of people who are missing out on regular eye checks, and even more stats about rates of diabetes-related eye complications. But I won’t. Because that is not what is getting me excited about this program.

I’m excited because this is one of those simple ideas that goes towards making our lives with diabetes easier. And, quite frankly, there’s not enough of that happening!

Click on the link below; it takes literally two minutes to register.

Now, if we could just find a way for insulin scripts to never run out, diabetes supplies to be endlessly replenished when running low and all our other appointments sorted, we’d be halfway to making this condition just a tiny but easier to manage.

Disclosure

I work for Diabetes Australia, but I am not writing about this because I have been asked to. I am doing it because I genuinely think this is a program that goes towards helping those of us living with diabetes and I will always share anything that does that.

But you do need to be aware of who pays my salary each week and consider my bias when I share things by my employer. You have a right to know that, which is why I will always make sure that it’s clear – each and every time I write about anything in which I am involved. Transparency is important.

Back in February, the BMJ published a piece The Grumpy Pumper and I wrote about why language matters when talking about diabetes-related complications. After we submitted the piece, the team at BMJ we were working with asked if we would like to record a podcast to accompany our article. Of course we said yes, because we both like the sound of our own voices. Plus, we figured that we should jump at any opportunity to talk about this subject.

And so, last month while in Europe, we teed up a time and had a fantastic chat with BMJ Patient Editor, Emma Cartwright. Have a listen to us talking about our own experiences of being told about complications, and how the work we’ve been doing has been received in the diabetes community and more broadly.

Thanks so much to the BMJ for having us on this podcast and talking about this important issue. (And thanks to Emma and Duncan for being so patient and accommodating as we wrangled builders who were – it seemed – drilling into the wall right next to where we had organised to do the recording. We may or may not have bribed people to stop drilling for forty minutes so we could get the recording done!)

 

Last week, the BMJ published a piece I wrote with the Grumpy Pumper. It was part of their ‘What Your Patient is Thinking’ series which includes stories from people sharing their experiences of living with a variety of health conditions, or using health services.

We wrote about the intersection between language and diabetes-related complications and why language matters so much any time this topic is raised. This is our latest piece on the issue (read the PLAID Journal article here, and something we wrote for diaTribe here). We may appear to be one trick ponies, but it seems the appetite for this issue has not in any way diminished – which is good, because there’s lots more to come! (We’re not one trick ponies – I for one can talk for hours about why the fax machine should be made extinct in healthcare.)

It’s been fascinating – and a little overwhelming – to read the responses to the article after it was shared on a variety of social media platforms at the end of last week, and then again over the weekend. It’s also been heartbreaking when people have told stories about how HCPs have spoken about diabetes-related complications in ways that have had negative effects.

It’s refreshing to see many HCPs (including those from outside the diabetes world) sharing and commenting on the article. Much of what we have written is applicable beyond diabetes. It doesn’t matter what health condition someone is diagnosed with; everyone wants to be treated with kindness and compassion and to not be blamed or shamed.

A couple of HCPs have said that after they read the article, they will now consider changing the way the speak. I love this piece from a CDE in the US who said that she honestly thought the words she was using when discussing diabetes-related complications were reassuring until she read our perspective, and now understands that there are better ways to frame the conversation. We only hope that this will lead to PWD feeling less judged and more supported, and not afraid to talk about what is still a taboo topic for so many.

The diabetes and language landscape is broad. I know that there are many who roll their eyes and say that actually, language doesn’t matter, and perhaps we should be focusing on more pressing issues, but I wonder if they are perhaps focussing on issues that they don’t think are really important.

But there is a lot more to this issue than, for example, the debate between being called ‘a person with diabetes’ or ‘diabetic’ – or if it even matters. Regardless of what the specific issue is, we are hoping is that people understand that words really do matter; they have far-reaching consequences; they determine how people feel about their diabetes; and that the right words have the potential to make people feel better equipped to manage their diabetes as best they possibly can.

Please read the BMJ article – it is freely accessibly – and share it with your networks. If you have diabetes, take a copy to your next HCP appointment and leave it for them to read. The way that we make real, sustainable change is to keep pressing a point, and explain why it is important. Hopefully this piece has gone some way to doing that.

The illustration that was commissioned for the print version of the article. Artist Rose Lloyd did such a great job of getting across the messages in the article!

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