November 14 marks World Diabetes Day, established by the International Diabetes Federation and the WHO. Discourses on how to care for oneself when living with diabetes are nearly homogeneous. In the debate, the diabetic patient is placed at the center, the heart, and the foundation of public policies. This situation is not so simple: a chronic illness sets in motion the entire apparatus of the patient's affective relationships. Patients are no longer a kind of passive entity.
Today more than ever, patients are involved in their treatment.
In this sense, as sociologist Claudine Attias-Donfut points out, we should advocate for medicine in favor of the person and, incidentally, without stripping them of their social context. In France, since the 1980s, the first therapeutic educational interventions were initiated to inform patients about the care required by a silent disease like diabetes. In Mexico, educators trained by organizations such as the Mexican Diabetes Federation carry out patient education from the earliest ages, as well as for their families.
We read or hear everywhere news about alarming figures of obesity and diabetes. Popularly, these are often conceived as a kind of “punishment” for people “negligent” with their health (we have already devoted other posts to discussing this point). However, being obese does not necessarily mean one will eventually be diabetic, and a person of normal weight can also suffer from the disease. Moreover, type one diabetes also affects children from an early age. Here, therapeutic intervention shakes all family structures at emotional and practical levels. How do you explain to a child that they must pay special attention to “counting” the carbohydrates they eat? These children, when diagnosed early, become experts in medical terms compared to others their age. For parents, the news is often received with denial and, subsequently, guilt about their child's condition. Undoubtedly, as philosopher Martine Segalen expresses, the individual is no longer at the service of the family, but the family is at the service of its members. The way of caring for a sick person is culturally determined, and in the case of diabetes patients, it is not enough to simply support them, but to be an active part of their treatment.
Diabetes, as some philosophers note, is a matter of early or late reward; that is, if I eat a piece of cake today, I get an immediate reward for that craving. However, not eating it gives me a long-term reward in controlling my blood glucose levels. Sometimes this reward is so abstract in time that it is the reason many people oscillate between strictly following their treatment and indulging in small pleasures.
To maintain good diabetes control, says Gerard Reach, a French endocrinologist researcher, one must be able to project oneself into the future. Harry Frankfurt says that when we care about something, someone, or ourselves, it is because we consider it important, and conversely, when something is important to us, we have that concern. Eating a cake or an ice cream is not as important as when we have concern for our health. As the physician indicates, sometimes a biomedical model is not enough to treat the patient, whom we commonly treat as someone with a physiological anomaly, but we forget that they are a person who suffers the decisions they must make day by day to control their disease.
— This article was originally published in Spanish by Liliana Martínez Lomelí. Translation generated with AI from the original text.