The Diabetes online community (DOC) went wild over a teaser trailer for Pixar’s latest film Turning Red, back in the summer of 2021.

At forty years of age, I too got excited when I saw that teaser trailer. Then I scoured the internet for answers. It appeared at least one of the characters was wearing a diabetes device.

Fingers took to keyboards and message boards became flooded: is it a continuous glucose monitor? Are those infusion sites? Is it an Omnipod Pod?

However, what it was would remain unknown until just before the movie released in February 2022.

I approached the film with hesitation. Most times when a character with diabetes appears on screen it leaves me disappointed because most of the time, they get it wrong, or the character ends up the butt of a joke. Or dead.

Diabetes is hard to glamourize (though model Lila Moss is certainly making a go of it!), and that is why it is never in a starring role and often portrayed in an overly simplified way.

This may be the initiatory diabetes appearance in a Pixar film, but it is not the first appearance diabetes has made on screen, and that prompted me to dive a little deeper into the portrayal of Type 1 Diabetes in media, specifically television and film.

HOW MUCH REPRESENTATION IS ENOUGH?

The narrative and characters in Turning Red never formally address diabetes, but we did learn from Susan Fong (formally of Pixar) that the characters are in fact wearing infusion sites from the early 2000s.

So, diabetes receives a subtle reference in the form of minute details in the film. Though, by not addressing diabetes in the film, there are several things that happen.

Initially there is the creation of confusion because the types of devices and diabetes are not clearly defined. And it makes me wonder if this is intentional.

Especially by not specifying the type of diabetes.

Was this an effort to bring the community together through the fostering of inclusivity and the denial of othering?

One of the biggest problems in the DOC and beyond, extending even to health care professionals, is the employment of defensive othering. This is a stigma management tactic that only reinforces stereotypes, even though the attempt is often to eliminate them.

Stacy Frick is a recurring character in the film. Many times, we see the infusion site on her upper arm and her pump on her waistband. The artists did an excellent job of recreating technology true to the time of the film.

While insulin pump wearing children and adults alike will see themselves represented in the film, I cannot help but think there still is a missed opportunity to further normalize diabetes.

SPOLIER ALERT: We see Stacy in gym class and at a high-energy concert. What if we saw her sitting on the bleachers drinking a juice box? A subtle suggestion of a hypo. Or she tinkers with her insulin pump at the concert? A low-key nod to adjusting basal rates.

And what about the other moments in the lives of people with diabetes? All those in between quick stabs or pokes? Certainly, showing a moment like that would create even more inclusivity and offer a connection for those living with diabetes but not employing an insulin pump.

Sometimes representation without explanation can lead to misunderstanding. Such a quick reference can make things appear too simplified, fostering the public’s notion that managing is easy.

But I wonder if the lack of explanation is to avoid getting diabetes wrong.

SOMETIMES IT’S RIGHT, SOMETIMES IT’S (REALLY) WRONG

My first memory of a film depiction of diabetes is Steel Magnolias. And I know I am not alone, the very mention of the film often garners the response, “with Julia Roberts as a diabetic, right?”

I remember watching the character Shelby experiencing a hypo (but not knowing exactly what was going on) and needing to drink juice.

When I watched it again after my diagnosis, I was traumatized by the scene of her unconscious on the floor next to her screaming child. In fact, that portrayal loomed over my entire pregnancy, even though the movie character’s troubles, and eventual death, were from kidney complications aggravated by her pregnancy and not her diabetes.

While the scenes are technically accurate for some, I find them to be overly dramatized and a bit focused on the negative.

South Park has a character living with diabetes, Scott Malkinson, who warns his father not to stress him out because it will negatively impact his blood sugars. This character also highlights the notion that people with the same diagnosis are a) all the same, and b) destined to get along. This is exemplified when Scott meets a girl living with diabetes and assumes she will want to be his girlfriend because of their shared situation.

His alter-ego Captain Diabetes is set to appear in a South Park video game and has toys and figures available complete with a glucometer, syringes, and vials of insulin.

In Memento a character’s wife lives with Type 1 Diabetes. She begins to question her husband’s amnesia and tests it by continuously dosing her insulin, which results in a hypoglycemic coma. But the injections are intravenously administered opposed to subcutaneously. In this film, diabetes is subtly (and somewhat factually) portrayed.

The movie Panic Room is another bridge between – there are moments where it is right and moments where it is wrong…

The character Sarah wears a “watch” that offers blood sugar readings. However, when the film was made a similar product GlucoWatch® Biographer™ was just entering the market, so her particular “watch” is a fabricated bit of technology. We never see the character prick her fingers, and the use of the “watch” simplifies and dismisses all that we do to monitor our blood glucose.

There are other oddities in the film, like misunderstandings about carbs and glucagon, and the portrayal of hypoglycemia. Sarah’s “watch” shows a reading of 42 mg/dl or 2.3 mmol/L prompting her mother to scour the room for something to raise her levels.

Everyone experiences hypoglycemia differently, yet Sarah appears calm and collected with dangerously low levels. I know when I am that low, I experience symptoms like confusion, sweating, and sleepiness.

In Con Air the diabetes depiction is not just confusing, it is completely inaccurate. Like the part where the character yells, “I’m diabetic, if I don’t get my shot within two hours, you can send flowers to my mother!”

Excuse me, what?

Also, this character spends a goodly part of the movie experiencing hypoglycemia as the main character searches for his insulin… HUH?

There are other instances in television and film where characters have or mention diabetes. Though most of them are brief and often inaccurate mentions.

FAKING IT

There are also times we see diabetes but through fractured light.

The television show Prison Break includes the portrayal of its main character pretending to have diabetes. It is strongly suggested that he is impersonating Type 1 Diabetes, and he must visit the nurse for daily insulin injections.

It is later explained that the character was taking a drug to keep his blood sugar levels elevated and support his apparent insulin resistance thus necessitating the daily insulin shots.

There is, however, room for the argument that these visits are merely shown for dramatic effect implicating that he visits more often throughout the day.

The issue here is without a formal explanation, the suggestion that a person living with Type 1 Diabetes simply requires a daily shot to be sustained reigns over the storyline. And so, comes an improper portrayal of T1D even while it is being faked.

There are other examples throughout film and television where someone fakes having diabetes. Recently our family watched an episode of Malcolm in the Middle where two brothers get into some trouble at a car race and are taken into custody by security when one of them exclaims, “I’m a diabetic! I need insulin!”

The movie Cliffhanger gives us another example of using diabetes as a get-out-of-jail-free card. The pilot of the criminal gang radios for emergency back up, expressing the need for insulin for a person with diabetes.

WHEN IT ISN’T THE PUNCHLINE AND HITS HOME

In (the reboot of) The Baby-Sitters Club on Netflix, we meet the character, Stacey, who lives with diabetes on screen just as she had in the book series. I only read a handful of them growing up, but I do remember the mention of diabetes. I scoured the series for the episode where she shows up to an appointment, feels her blood sugars dip, then pulls out a juice box!

This is one of those in-between moments, the scary times, that all of us living with diabetes experience. And it was quite something to see that depicted on screen.

While I was not diagnosed as a child, the excitement of seeing diabetes portrayed in a Pixar film still resonated. And it did with my child too. While he does not live with T1D, the portrayal of characters like his mom was important. And then, of course, we were excited Turning Red took place in Toronto, where we used to live.

But there were missed opportunities, for me.

We see Stacy’s empathy when Mei “goes panda” in the bathroom, perhaps, this is an unspoken nod to Stacy’s own feeling of difference. A more elaborate moment between the two girls would have been a wonderful way to clarify that comradery.

The school the girls attend and the SkyDome (now Rogers Centre) are both near U of T the place insulin began its journey beyond the mind of Dr. Banting. With the movie premiering in 2022, the year we commemorate 100 years since the first successful injection of insulin, acknowledging that location would have been some brilliant Canadian content!

But maybe I ask too much. Maybe diabetes is not meant to go mainstream.

Though it makes me ask why? Why not show someone standing in front of the fridge, at 2 am, shaking and sweating, guzzling juice and eating everything in sight? Why not show snarky high glucose attitude? Or a person checking their blood sugars and administering a correction dose?

The lack of these moments on television/film makes me ask when will it be acceptable for the reality of diabetes to take centre stage?

There IS an independent film where it does, and it does so with raw honesty. Hypo is a short film highlighting the time the star suffers a monumental hypoglycemic attack that ultimately ends his football career.

The truth is most of the time we see/hear mention of diabetes in television or film it comes in the form of a punchline or diabetes lands a role with the caveat “it isn’t about diabetes” and so the reality of life with diabetes is generally glossed over, or the facts ignored.

However, the rarity of the portrayal should place a greater emphasis on the need for accuracy. Though it appears more often to lead to creative freedom and a disregard for factual integrity.