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Why Language is Important in Diabetes Management

explains UMass DCOE health psychologist Kristin Macgregor, PhD


The words we use to describe something shapes the way others perceive and value that thing.  The same can be said for diabetes.  Negative terms and phrases such as, “my blood sugar is bad” and “my A1c is bad” should be replaced with “my blood sugars are out of range” and “my A1c is out of range.”  The culture in diabetes tends to be the disease defines the person, such as, “he/she is a diabetic.”  Changing that language to “he is living with diabetes” or “she is thriving with her diabetes care” can make a world of difference.  

kristin-macgregor-diabetes-behavioralA1c and blood glucose numbers should simply be used as data to devise a treatment plan and action plan.  Not a definition of the person,” says Kristin L. MacGregor, PhD, a behavioral psychologist at the UMass Diabetes Center of Excellence."  The truth is, you have the power to manage the disease, it doesn’t control you.” 

It’s easy for people living with diabetes to shoulder the blame for a high blood sugar.  Some people even go so far as to avoid checking their blood glucose because they know it will be high and they'll feel bad about themselves.  Many factors can cause blood sugar levels and A1c numbers to be out of range.  It is most important to use these numbers as information to drive your next decision, not as a judgment about how “good” or “bad” you are at managing your diabetes.  MacGregor and many others feel that word choice can be improved by both people living with diabetes as well as their care team, in order to empower people to take control of their condition.  

Behavioral change begins with feeling empowered 

Most patients know what they need to do.  The difficulty is putting it into action.  It must be a collaborative effort.  The medical model is set up such that providers tell patients what they should do, and then patients are expected to go home and do those things.  That's only half the battle. 

“It should be a conversation about how to implement the necessary changes to fit into their personal lifestyle and daily schedule,” says MacGregor.  “The care team must work together with the patient.  When someone feels overwhelmed, it’s very easy for them to give up.” 

Health professionals must change the language they use

Physicians and the entire diabetes care team must help patients figure out why their numbers may be out of range.  Why have they not been taking their medication?  Why have they not been checking their blood glucose?  Once they identify the issue, they can then address the issue.  MacGregor suggests that all people who care for people living with diabetes should get away from using words like “compliance.”  Saying a person “is non-compliant” makes it sound as if they are not following orders and puts blame on the patient.

People living with diabetes must change their thinking

People must take control of their diabetes self-management and do it for themselves, not because “my doctor told me to.”  People want to feel empowered, not that they’re being “punished.”  Negative language such as “I got in trouble with my wife or husband or mother” or, “I'm a bad diabetic,” makes it sounds like you're getting scolded.  Diabetes is a lifelong condition.  It’s unrealistic to think that people can adhere 100% to their diabetes self-management plan 24/7.  It is not “all or nothing.”  We must focus on the good things that we are doing and build on those.  Own your slip-ups and get back on track.  Focus on what you're doing correctly as opposed to what you have not been doing.  Saying “I’ve been checking my glucose levels a few times a week” or “I’ve been eating more fruits and vegetables lately,” takes a positive approach and says that you are slowly making changes for the better, instead of trying to do it all at once.  By doing this, you increase your self-confidence in your ability to make changes, which then increases motivation to do more!  

Focus on the health behavior, not the health outcome

Don’t focus on the numbers, instead focus on the fact that you're doing what you should be doing, such as checking your blood glucose, eating healthy, exercising and taking your medication.  That is good diabetes behavior.  If your numbers are still not in range, work with your care team to figure out why.  “If you're doing the behavior, you’re doing your job as a patient,” MacGregor says. “If the results aren’t there, it’s up to your health care team to work with you to figure out why, and perhaps change the treatment plan.” 

Words to avoid

Instead of saying “suffering from” - use “living with diabetes”

Instead of saying “diabetic” - use “person with diabetes.”

Instead of  “testing my blood sugar” say “checking my blood sugar. 
Testing implies a pass or fail result.  The action is most important.   

Focus on what the person with diabetes is doing right and encourage more of it 

"A person’s weaknesses will always be their weaknesses and are difficult things to change.  A person’s strengths will always be their strengths and can be built on much easier," says MacGregor.  "It’s important to use the numbers as data to inform the next decision, not an evaluation of behavior or a definition of who they are."

Related Articles:

Behavioral Health Integration in U.S. Diabetes Care: How Close Are We to ADA Recommendations?

Psychosocial screening of youth with type 1 diabetes at the UMass Memorial Diabetes Center of Excellence

Kristin MacGregor studied the impact of integrated behavioral healthcare in diabetes and the data shows measurable benefits


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