So I seem to have finally Tweeted something controversial.

While that was not my intent, the following Tweet caught the attention of @iam_spartacus, who reached out to me both via this blog and Twitter. (Correction: My Tweet initially caught the attention of @CALpumper. She reached out via this blog and then posted on hers. @iam_spartacus alerted me to the discussion via Twitter.)

What I thought was a simple Tweet led to this blog post:

Given the level of anger and frustration directed toward me on her blog, I shared the following response there.

Hi. I am the Tweeter with whom you are angry. And I thank you for reaching out.

I get the sense that my Tweet (or at least my intent) is being misunderstood. I think the heart of the anger around this Tweet was my use of the word “lifestyle.” The use of that word referred specifically to the type of magazine that Better Homes and Gardens had created — a “lifestyle magazine.”

I apologize for not making that more clear in my original post.

To further explain, I was in a grocery store and for the first time, I saw a copy of Diabetic Living magazine. Seeing that Better Homes and Gardens identified the escalation of a chronic condition as enough of a trend to create a glossy magazine, in the midst of a traditional media downturn, made me take notice.

Seeing that magazine made me mindful of the recent increase in marketing efforts specifically targeting consumers living with diabetes (late night commercials featuring cookbooks for diabetics are what first came to mind). Given that I am not living with diabetes, I can’t speak to my reaction as a consumer. However, as someone who does work in both health care and PR, it disturbed me to realize that there are enough people in the US now living with diabetes to constitute a “market segment.”

You write above that you are among the many in the nation who cannot afford a healthy lifestyle. In my opinion, it’s a sad commentary on the state of our nation that good health is considered a luxury. I wish I had an easy answer, but sadly, I am often as angry and frustrated as you.

(For the record, I do work for both a health plan and a care delivery system. However, all that I Tweet about and blog about are my own personal opinions.)

The more I think about this subject,  I am curious to hear other people’s opinions. Is the rise in direct marketing to people living with diabetes a good or a bad thing? Perhaps the appearance of these types of mass market products are a positive opportunity to improve understanding of diabetes, and ideally a tool for helping those with diabetes live a more healthy lifestyle.

I just can’t seem to get beyond the concept that we (as a nation) have allowed the rate of diabetes to increase so drastically that the population living with diabetes is now viewed as a “market segment.”


  1. I’m not sure you understood Crystal’s point…She (and I) are type 1 diabetics. What this means is that there was nothing we did to cause our diabetes, it was not a factor of our eating habits or lack of exercise. Type 1’s are a little touchy (often overly touchy) because there’s so much misunderstanding out there. So often diabetics are blamed for our disease even though in our case it’s just an autoimmune response, like lupus. (I was diagnosed when I was 2…and weighed about 22 pounds…Eating too much rice cereal? I think not. Now I weigh 96 pounds, and people still think I got the disease because of bad eating habits.) Even in type 2 (the more common type that’s often associated with weight), there is usually a genetic component. So we hate to see anything/anyone that perpetuates the stereotype and makes people blame us.

    You wrote: “Struck me as a sad commentary of the health of our nation that diabetes is now a lifestyle.” Maybe we misread what you were trying to say, but it really sounds like you were saying it was a sad commentary that our country is so (fat/lazy/etc.) that diabetes is now an epidemic. We don’t blame you for feeling this way (you’re not the only one), but since you work in the health industry, I’m afraid we do blame you for furthering the misunderstanding of our disease.

  2. Also should add, in response to your question above, that yes it’s certainly helpful to have more information out there. Dealing with all types of diabetes is MUCH more complex than most people realize. For example, I personally test my blood glucose 12-15 times a day, am on an insulin pump that delivers 14 different basal rates throughout the day, and need to count every single carb I eat so I can take enough insulin to cover it. Even so, my sugar often plummets dangerously low (where I can pass out and/or have seizures), and sometimes dangerously high for no discernible reason. Everything can affect it, from exercise (even mild exercise like shopping) to stress, to illness, to where I am in my cycle, to weather. I consider myself in excellent control (my A1C which is a measure of long-term control is in normal range), but at the age of 39 I’ve been through multiple surgeries for retinopathy (starting when I was 25) and I have chronic kidney disease, and I know there’s a very good chance diabetes will kill me within the next 20 years.

    All this to say, anything that can help me control this disease and feel like I’m not alone is more beneficial than you can probably understand. I’m lucky to have diabetic friends and access to information/blogs online that help me manage the complexities of this disease (in most cases better than any of the magazines out there), but many people do not, and so anything that can help them better understand their own illness and maybe prevent complications is helpful.

  3. Hi Elizabeth-

    Thank you for your comment and clarification of the concern. I certainly never intended to suggest that diabetics (either Type 1 or Type 2) are at fault for their condition.

    My background, as you will see in other posts in this blog is public health. There are an enormous number of factors that contribute the escalation of rate of diabetes and I truly believe that too much emphasis is placed on individual behavior alone. (I recognize that was not, nor could it be, conveyed in my original 140 character post.)

    Ultimately, I do believe that we as a nation (not as individuals), we do a poor job creating the means to 1) prevent diabetes, 2) make healthy choices affordable (another important point in Crystal’s post) and 3) ensuring access to high-quality affordable care.

    So my musing about the “state of our nation,” was not about the individuals (diabetics or otherwise) within the nation, but the entirety of our national will to address escalating health problems (particularly diabetes and other chronic conditions).

    Hope that does a better job explaining my perspective.

    However, I am very curious, since you do live with Type 1 diabetes, what do you think of Better Homes and Garden creating a magazine about Diabetic Living?

  4. Elizabeth- Thank you for your second comment. It looks like we posted simultaneously. Thank you for sharing.

  5. Holly, I still think you’re kind of not getting it. You say “Ultimately, I do believe that we as a nation (not as individuals), we do a poor job creating the means to 1) prevent diabetes.” Do you see how it might be frustrating for someone with an UNPREVENTABLE condition (ie. Type 1 diabetes) to constantly hear that the country needs to do more to prevent it? (And what exactly would that be?) Type 1 diabetes has nothing to do with lifestyle. Nothing. Nothing whatsoever. It is an unpreventable autoimmune disease like lupus or MS, and you never hear people talking about how we need to do more to prevent those diseases.

    And incidentally, as someone with Type 1 diabetes, I find the idea of a Diabetic Living magazine supremely stupid.

  6. I just want to add that when Crystal was saying she can’t afford a more healthy lifestyle, she was referring to the astronomical cost of diabetes supplies. Even with insurance, I pay thousands a year. I know Crystal eats healthily and exercises, and although that does help to some extent, it’s not even close to a cure. Because test strips can cost upwards of a dollar each, most people without insurance can’t afford to test anywhere near as many times as they ideally should, and can’t afford to see the plethora of doctors they should be seeing. THAT’s what I think she was referring to.

    As far as the Diabetic Living magazine, I have to disagree somewhat with Arielle. I personally won’t get much from that magazine, which I’m sure primarily focuses on exercise and healthy eating and the different (but just as complicated) challenges type 2’s face. But for type 2’s and people who can’t get that information elsewhere, people who need advice and can find inspiration from other people’s challenges and success stories, I think a lifestyle magazine could be quite valuable.

  7. “Perhaps the appearance of these types of mass market products are a positive opportunity to improve understanding of diabetes, and ideally a tool for helping those with diabetes live a more healthy lifestyle.”

    The answer is yes. Of course it is. If you’re in public health as you say you are, then obviously any means to help promote healthy living when facing a chronic condition – regardless of the etymology of the disease – is going to be a good thing.

    Yes, it sucks that diabetes exists. No one *asks* for diabetes. Diabetes is not a lifestyle of choice but a lifestyle of necessity.

    “I just can’t seem to get beyond the concept that we (as a nation) have allowed the rate of diabetes to increase so drastically that the population living with diabetes is now viewed as a “market segment.””

    While I agree that the state of the health – especially the obesity epidemic – in the U.S. is a crisis. But *please* remember that there is more than one type of diabetes and they are not at all related to weight. Please remember that no one allows children to get an autoimmune disease. Please remember that type 1 diabetes, LADA and gestational diabetes are not preventable. Please try to be more open-minded about where we get our education and how we are able to advocate for ourselves and share inspiration with those who are newly diagnosed.

    Thank you.

  8. Also, Diabetic Living, while focusing primarily on healthy eating for people with type 2 diabetes, also features people with type 1 diabetes. In fact, I was featured in Diabetic Living for my work mentoring teens with diabetes in spring 2008.

  9. Oh my goodness. Not sure if my delay in responding makes me look bad or…well, I sure love my Dtribe.

    I hope some of my Type 2 friends respond.

    This is becoming more Type 1 centric, which is ok and good, it is the minority when it comes to types of Diabetes and we tend to be a bit more of the educating advocate types.

    I was six years old when my islet of langerhans decided to stop working. I, nor my parents, did nothing to make that happen. No one wants to live with a chronic illness. Insulin helps me manage, survive, live. I am forever grateful for it’s discovery in the 1920s when the disease was a death sentence.

    Believe me, we all agree the state of the US, health insurance and general health wise, is a definite issue. We live it, we know, all to well.

    As for me, I do not have insurance. To buy it as an individual or within the small business I work for, well, I don’t make that kind of money.

    I could go on and on but each person, all over the world, has their story, their issues.

    Coming together for a common cause to help all is, sadly, less common then it used to be.

    That is why dialog across all levels is so important. Patients living with a chronic illness provide key information into what they need to manage. It’s the rest of the world that does not always listen. Too much is about profit, as you say, market. It is unfortunate but Elizabeth makes a point. Not all people can access the Diabetes Online Community or any chronic online community. Magazines help. But it Has to come from Doctors first. That is a bigger issue. Then, insurance companies need to fall in line along with Pharma but that is a whole other slew of madness I have no energy for today. Or anytime soon.

    Please know, Holly, I am very pleased, Very, that you responded. You help continue a much needed dialog. There is no slandering or mudslinging against people as themselves. I don’t roll that way. I debated for a long time on the post I wrote. It was a first for me and you were, lack of better word here, the target because of your position at the company you work for.

    Either way. Please keep asking Any questions you have! The Dmob concept is a humorous way to help each other keep our sanity but we are more than willing to discuss. We all know how important that is.

    Thank you again. And sorry for my long-winded, rambling response.


  10. I’m one of Crystal’s type 2 pals.

    I ended up on the wrong end of the genetic stick. Until I was out of college, I tended to be underweight. One of those people who could eat anything and not exercise…and not gain weight.

    Then I got out of college and began living an even more sedentary life than one that requires walking all over a college campus. That coupled with a slowing down of my metabolism in the form of undiagnosed hypothyroidism contributed to a large weight gain and my eventual type 2 diabetes diagnosis.

    Now that I’m five years out from diagnosis, I’m healthier than ever. I’m luckier than many out there, though. I can afford to pick and choose what I eat, to buy expensive exercise equipment to have at home (or a gym membership should I choose). And I am active in the online diabetes community, learning about latest research and nutrition news.

    What does this have to do with Diabetic Living…or a lifestyle…? Well, without magazines and online media out there focused on the disease, fewer people receive the knowledge they need to even improve their lives just a little, regardless of income. I don’t always agree with publications, based on my own idea of nutrition guidelines, but I’m glad they’re out there for the general diabetes public.

    Yes, it’s sad that there is a diabetes public. But it’s reality and there has to be a way to support those who have diabetes.

    (P.S. There’s another publication out there, Diabetes Self-Management, whose title is even more mind-boggling – but that’s what it comes down to. We find what works to achieve blood sugar control with our doctors, but it comes down to us managing our own diabetes – type 2, type 1, or the others all alike.)

  11. Before the weekend ended, I wanted to take a moment to thank all of you for your very thoughtful comments about your personal experiences. Your insights are extraordinarily valuable and I appreciate the time you took to share them.

    My one concern, which seems to be a common thread in many of the posts, is the insistence that Type 1 diabetes cannot be prevented. Now, don’t get me wrong, I absolutely understand that at the INDIVIDUAL level, that while there may be ways to prevent the onset of the disease or resulting complications, there clearly is no way to prevent it entirely. However, when I talk about “prevention” I typically am not referring to individual behavior or medical care. (For more info on how I view “prevention,” see “The Spectrum of Prevention” here:

    When I referred to the rise in diabetes rates in my original post, there was an inclination to assume I was talking about the rise in Type 2 (or that I didn’t know what I was talking about in the first place). Please remember that while we have not seen as drastic an increase in Type 1 diabetes, the incidence of Type 1 has been rising year over year. (I have not read this book, but the summary looks fascinating: When the incidence of a disease doubles over the course of 20 years, the public health advocate in me says we have a responsibility to examine how to prevent that rate escalation.

    Like each of you, I am grateful that there is now the ability for sharing among individuals on how to better manage health conditions — be it via magazines or online communities or otherwise. I’m in favor of anything that improves the quality of life for those living with chronic conditions. However, that doesn’t change my core belief that I’d rather see increased focus on how to eliminate those conditions in the first place.

  12. “At the INDIVIDUAL level…there may be ways to prevent the onset of the disease.”

    Except there aren’t. Have you heard of ways in which Type 1 diabetes can be prevented on an individual level? What are they?

    “We have a responsibility to examine how to prevent that rate escalation.”

    Before you can prevent something, you have to know the cause. We don’t know the cause of Type 1 diabetes. There are many theories but no definite answers.

  13. I’m really sorry I missed all this yesterday. That’s what happens when you spend all day preparing for meals that you’ll be eating over the next week, because it’s just tough to eat out most of the time! (Just part of MY diabetic “lifestyle.”)

    I just wanted to respond to the question of the magazine. I was originally misdiagnosed as a Type 2 in July of last year. This is often the case with Type 1 LADA. . and I have recently had my diagnosis corrected.

    As a newly diagnosed PWD (person with diabetes) I have found the magazine to be full of information that helps me better manage my diabetes. Even as a Type 1, I try to manage my carb intake and it’s really nice to have recipes that I don’t have to calculate myself.

    I also have found many stories in the magazine to be inspirational and as people share their stories, I don’t feel so alone AND I pick up on management ideas I otherwise would’ve had to learn through trial and error.

    I’ve know two PWD (person with diabetes) in my lifetime. I haven’t seen either of them in 25 years and one of them passed away recently. My doctor has admitted he knows very little about Type 1 and sends his patients directly to an Endo. . so where does one go for the information we so badly need?

    I’m a subscriber because the information is useful, the stories of others is inspiring and they report on advances I would otherwise not hear about. . .except on twitter.

    As for twitter. .the DTribe there is AMAZING! They are the reason I am doing so well today. Having shared my issues on twitter over time, many of them jumped in and suggested I have additional lab work done. Because THEY’D EXPERIENCED THE SAME THING. . THEY recognized my misdiagnosis before my Dr. did, helped me get in to see an Endo and have helped with questions I’ve had about insulin treatment and everything else. I am convinced they saved my life.

    I don’t know how to end this except to say that:
    1. your use of the word “lifestyle,” implies we had a choice in the matter and this is the lifestyle we chose. That’s what I read, and it did upset me as well. I would NEVER choose a lifestyle that required me to calculate every single bit of food I put in my mouth, every body movement and how it will burn glucose, test my blood sugar 8-10 times a day and leave my belly looking like I have chicken pox from all the injections.
    2. If people find useful information or inspiration about something that so overtakes their lives, their mindshare, their time, in a magazine, I say, let it be. If you’d like to comment about a lifestyle magazine, maybe you could look at the porn industry. The objectification of women is a bigger issue to me than someone offering me some recipes to keep my BG down.

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