Managing Diabetes. Jeffrey A. Bennett
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This widely consumed and circulated scene is perhaps most problematic because it suggests that people with diabetes are unable to gauge the intractableness of their disease. Shelby is lovable, yes, but also represented as being in serious denial about the permeability of her body. She bickers constantly with her mother about having children, a choice her alluded-to doctors warn against. But this is melodrama, so Shelby ultimately pursues pregnancy. This choice, which structures the last third of the film, eventually kills her. Of course, reading Steel Magnolias through a clinical lens of management leads to a pretty transparent conclusion: Diabetes killed Shelby. However, if we take a page from the tudiabetes.com blogger above and shift our perspective for assessing the narrative, a queer heuristic for exploring management exposes what is perhaps most unsettling about the film: heterosexuality. Throughout the movie Shelby insists that her body is a productive one, vigorously defending the possibility that her diabetes can be overcome. Shelby’s compulsive desire for children seems as essential as her need for insulin. Indeed, in a film that champions the queerness of kinship, Shelby’s heterosexuality is every bit as volatile and precarious as her diabetes. It is not simply that diabetes could have been managed, it’s that Shelby consciously chose to ignore the constraints of her body and insist that she is “normal.” Reproductive heterosexuality appears to have killed Shelby every bit as much as her irregular blood sugar did. Historically queer and disabled characters have met unfortunate, if not punitive, ends in Hollywood cinema, and Shelby’s non-normative being, regardless of her girl-next-door persona, conclusively defeated her. Articulating management to notions of heterosexuality, in this particular case, alters how illness might be deciphered.
A production like Steel Magnolias highlights one of the many ways people might come to process diabetes—their own or others, rightly or wrongly—outside of proscriptive medical appraisals. People formulate interpretations of disease in assorted ways not reducible to the patient-doctor relationship or clinical data. Diabetes is no exception, with the word “management” itself denoting degrees of flexibility and contingency, if not hazard and risk. As I was writing this book I repeatedly encountered accounts of diabetes that were fascinating, surprising, and disturbing. At least two children died when their parents elected prayer as treatment over medicine. A school district prohibited a boy with diabetes from playing baseball, fearing no adults were qualified to address the hypoglycemia he might experience. They also clearly violated the Americans with Disabilities Act when they refused to hire a nurse to accommodate him. On that note, sometimes diabetes is framed as a disability and sometimes not. Public figures such as Mary Tyler Moore, Jay Cutler, Halle Berry, Sonia Sotomayor, and Bret Michaels spring to mind when thinking about diabetes. Their biographies tend to accentuate discipline, transcendence, and redemption over structural barriers and economic hardship. Many young people know what they do about diabetes because of Nick Jonas, who frequently poses shirtless to show off his muscular physique and visually demonstrate that the siphon is being defeated. Others will immediately think of Wilfred Brimley and his slightly divergent pronunciation of the disease. Controversies, both individual and institutional, abounded during this book’s production. Media outlets became fascinated with so-called diabulimics, young women who withhold insulin to lose weight and control their sugars. Their narratives of excessive self-control provided a cautionary tale about restraint, allegorizing the ways management can haunt those it is meant to help most. On the other end of the spectrum, as part of a health campaign the New York City Department of Health and Mental Hygiene (DOHMH) circulated a photoshopped image of an African American man who they erroneously posited had lost a leg to diabetes. The image, scrutinized in chapter 5, called into question the ethics of public health and its incessant desire to reach citizens. New drugs, new insulin pump technologies, and the promise of an artificial pancreas came across my screen consistently as I wrote. None of these anecdotes are meant to evacuate the important medical realities of management, only to say that a variety of affects, logics, and emotions come into play when assessing the vivacious character of diabetes and its management. Managing Diabetes focuses on a series of case studies in order to ruminate on the divergent ways management is realized in public culture. In what follows, I submit an extended example to conclude this chapter and exemplify how a move away from a clinical perspective might divine insight into the paradoxes and dislocations of diabetes on a level that is cultural every bit as much as it is medical.
The Art of Care
Jen Jacobs is an artist and schoolteacher in New York City living with type 1 diabetes. In her senior year of college, Jacobs began using art as a medium for dealing with chronic disease in ways that were not reducible to medical parlance. Her paintings take as their object of study varying aspects of diabetes management, ranging from the pseudo-realism of insulin vials to the ephemeral, though deeply alarming, effects of hypoglycemia. Each painting portrays some aspect of daily life for those who are insulin-dependent, concentrating on the temptation of sweets, the intrusive questions asked by acquaintances, and affective bodily responses that lie outside the trappings of language. Taken together, her compositions are collectively generative, pointing to contradictions and incongruities that lurk in the pursuit of personal well-being.
Figure 1.2. Jen Jacobs, “Routine.” Used by permission of Jen Jacobs (diabetesart.com).
The contrast between her paintings “Routine” and “Good Morning” challenge the oft-assumed assertions that self-care is transparently plotted. The work depicts a large blackboard (not a surprising choice given Jacobs’s occupation) with the word “Routine” written repeatedly over ten lines. The word is recurrently broken up when space runs out at the end of the chalkboard. The reiteration of the word “routine” boldly and appropriately mimics the management regimen it is meant to index. However, due to lack of space on the board, routine is also discrepant in its composition, unsettling the very idea of a direct approach to controlling blood sugar. Despite the lack of coherence suggested in the piece, the entirety of the word “routine” is centered in the middle of the blackboard four lines down. Periodically, it would seem, routine comes together. The creation’s purpose appears to convey that to have diabetes is both to perform routine and be caught in its accusational gaze. Management looms large even as one mulls over its simultaneous discontinuities and monotony.
Figure 1.3. Jen Jacobs, “Good Morning.” Used by permission of Jen Jacobs (diabetesart.com).
Conversely, her works “Good Morning” and “Every Time I Eat” present the dilemmas of management when the fantasy of habitual technique is disrupted. While “Routine” presents viewers with the idea of persistent, almost dreadful repetition, “Good Morning” probes the intricacies of diabetes management, framing it as a math problem with a preponderance of variables that must be analyzed before eating. Like “Routine,” this painting is conceptualized on a chalkboard that insinuates education, critical thinking, and calculation. The problem reads:
Starting the Day
Diana Betes wakes up at 6:30 a.m. with a Blood glucose (BG) of 60 ml/dl. She plans to have a cup of coffee with 4 oz. of milk on her ½ mile walk to work.
A) How many glucose tablets does Diana need to correct her BG level?
B) How many units of insulin does Diana need?
Alongside these words is a segmented table labeled, “Givens,” which includes information about her blood sugar targets, the number of carbs in milk and glucose tablets, and the amount of insulin needed to metabolize them. In contrast to “Routine,” which is circular despite its periodic breaks, “Good Morning” offers a range of contingencies, some of which will be familiar to observers and others of which may not. The concept of the “Dawn Phenomenon,” for example, will likely seem mysterious to many. The dawn effect, as it is also called, is a surge of glucose made naturally by the body in the early morning hours to provide energy for the day ahead. Below the extended math problem are two formulas for calculating how much insulin Diana must administer to herself.
The use of the blackboard in each of these implies a public that is