Diabetes is one of the most well-known and most prevalent chronic diseases in the world. In 2021, it was estimated that 38.4 million Americans, or about 11.6 percent of the population, had the disease, according to the American Diabetes Association. The World Health Organization estimates about 830 million people have diabetes worldwide. So it’s practically expected that diabetes would be well represented in fiction too.
When creating a character with diabetes, asking specific questions will help you create a well-rounded and realistic portrayal of the chronic illness and help you avoid harmful misconceptions. Like any illness or disability, diabetes shouldn’t be used as a plot device alone, but when used correctly, incorporating it in your writing can not only help shape a more authentic, layered character; it can create a more immersive story for your readers too.
Medical and Practical Aspects
First, determine what kind of diabetes your character has: type 1, type 2, or gestational diabetes, the kind some people develop during pregnancy. Let’s talk about the two main kinds, type 1 and type 2. Type 1 diabetes is often called “juvenile diabetes,” and occurs when the pancreas stops producing insulin, which allows the body to break down and absorb sugars. Those with type 2 diabetes still produce insulin, but their body can no longer use it properly. Neither is caused by simply eating too much sugar, but both types can cause long-term health effects if left untreated.
The type of diabetes your character has will determine things like the medications they use, how they manage it throughout their day-to-day life, and how long they’ve likely had the diagnosis. This can affect their confidence, routines, and habits around diabetes management, and how visible their diabetes is to other characters around them, such as whether they wear an insulin pump or a medical ID bracelet.
Diabetes requires people to work to regulate their blood sugar with food and medication so it stays at a normal level throughout the day. If your character’s blood glucose becomes too high—called hyperglycemia—they might experience intense thirst, frequent urination, fatigue, blurred vision, headaches, or irritability. If left untreated, hyperglycemia symptoms can worsen, making it crucial for them to check their blood sugar, adjust their insulin or medication, and rest while drinking water.
A character’s blood sugar dropping too low—called hypoglycemia—is more immediately dangerous. As their blood sugar drops, they might experience shakiness, sweating, dizziness, confusion and foggy thinking, hunger, and irritability. If their blood sugar doesn’t rise, these symptoms could worsen, leading to weakness or even unconsciousness. To counteract the low, a character may need a quick, carbohydrate-filled snack or a juice to provide their body with more sugar.
Diabetes care is far from one-size-fits-all; do your research to figure out how your character is likely to manage their condition. Consider what medication your character might be on, if they’re taking medication at all. If they have insulin, how do they manage it? Do they use an insulin pump, take injections, or rely on a combination of both? Do they use a continuous glucose monitor (CGM)? This is a sensor attached to the body that sends regular readings to a cell phone. CGMs can offer more insight and control but might come with alarms and social implications. How do they handle highs and lows? Are they careful and cautious, or do they sometimes take risks?
If your character has not managed their diabetes well, they may also have diabetes-related complications, like neuropathy or vision loss. Diabetes can even lead to amputations, and according to the Amputee Coalition, is the leading cause of amputations in the US. Details like this can add a realistic layer to your character and affect how they navigate their world.
Lifestyle and Personal Life
No matter the type, diabetes requires people to make several lifestyle changes in order to manage the diagnosis. As you write, consider how your character’s diabetes affects their daily routine. What adjustments do they make for meals, exercise, or stress management? Do they need to take breaks to check blood sugar? Once you know your character’s daily routine, consider also how your story has caused this to shift. If you write Thrillers, how does your character’s diabetes come into play while they’re on the run from the antagonist? How about if they’re in a post-apocalypse world and food is scarce?
As you build out your character and your world, here are a few more questions you can consider:
- How does your character feel about their diabetes? Do they resent it, accept it, or try to ignore it?
- Do they talk about their condition openly or try to keep it private?
- How does diabetes affect their eating habits? Are they particularly conscious of carbs and sugars, or do they have a more relaxed approach? Do they ever experience food guilt or discomfort when eating around others?
- What is their relationship with exercise? Since physical activity affects blood sugar, do they enjoy exercise, or is it a challenge for them to manage their levels during and after workouts?
Further Research
If you’re looking for further information or have specific questions, try diabetes.org or diabetes.org.uk. More personal, anecdotal information might be found in the relevant Reddit groups. Finally, reach out to sensitivity readers, who can help ensure your portrayal of your character’s condition is accurate and respectful, without falling into stereotypes.
Diabetes is a complex condition, and like any medical diagnosis, it affects everyone differently. However, pay attention to the details as you’re writing, and it will add an element of realism and representation to your novel that’s too sweet to pass up.
Elaine Bateman