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Update on 'Geographies of Diabetes' research

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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.

MarkL07

New Member
Relationship to Diabetes
Type 1
Hello,

Some people may remember my request for questionnaire responses some time ago for my research about living with diabetes. I apologise that it has been so long since I have been on the forum and have not updated people who contributed as well as I should. I have been sidetracked by other commitments and have only started to analyse my data recently. I do very much appreaciate the contribution of people, it has made my research so much easier! I have written and update of my research here for anyone that might be interested.

Due to the character limit on the post I have had to split my post into two. I do apologise also for such a long post.

Summary of Research

The research is funded by the Economic and Social Research Council (ESRC); is titled; ‘The Everyday Geographies of Living With Diabetes’ and explores the ways in which diabetes affects the day-to-day life of a person, for instance when at home, at work, out with friends or family, travelling on public transport and the many other situations that occur during day-to-day life.

The aim of the project is to compile these experiences and present a picture of the way that a person with diabetes, both type 1 and type 2 as well as the various other forms, accommodates the condition within their everyday lives. Hopefully this research will give many people the opportunity to talk about the day-to-day struggles, stresses, difficulties and issues that living with diabetes can cause.

Human Geography

My discipline is human geography. Human geography looks into the human experience of space and place, often focussing on political, economic, social, cultural, health, gender and sexuality issues of a specific group of people in a specific location/region and relating the findings back to broader theoretical discourses. My interest is in health geography, which investigates the individual experience of illness and disability, for instance, considering the meanings that people attach to specific spaces and places. I wish to investigate the various meanings that people with diabetes will attach to various spaces in their everyday lives.

The overarching research aim therefore is to expand the, non-medical understandings of living with diabetes by examining, routine and often unreflected everyday experiences. In order to do this I have set the following questions as a basis for my research.

? How do people accommodate diabetes into their everyday life?
? What are people’s experiences of hypoglycaemia and hyperglycaemia?
? How do people with diabetes understand the wider public perception of diabetes?
? Have people experienced instances of stigma and discrimination because of their diabetes?
? What sense of community do people with diabetes have?

Diabetes as a ‘Contested Illness’

One aspect of my research has been to examine how diabetes is understood within wider society. In order to do this I have considered Pamela Moss and Katherine Teghtsoonian’s (2008) concept of ‘contested illness’, which they argue occurs when people with various illnesses struggle to have their experiences acknowledged in various different situations. They argue that various legal and private sector authorities can control a person’s illness experience by generating truth claims about the experience. They argue ultimately that, ‘the bodily based expertise held by people who are ill has enjoyed a far less privileged status than any of these more conventionally accepted knowledges’ (p. 11). Essentially they argue that there is a neglect of actually talking to and taking seriously the points of view and experiences of people who actually have illness.

I see something similar happening with diabetes. I believe a misunderstanding of the condition often emerges from informal sources such as second hand stories about a friend or a friend of a friend who had diabetes, painting a common understanding of someone with the condition as someone who for instance must take insulin or cannot eat sugar both of which are not true as treatments and diet can vary. But also from more formal sources such as misunderstood and often limited media reports about the causes and treatments for diabetes, that stress the poor lifestyle choices such as a bad diet and limited exercise as causes, especially type 2, which again is a misrepresentation. This argument has emerged from personal experience (I was diagnosed as type 1 in 2008), a review of online discussion forums; a preliminary online questionnaire that I have conducted and a diabetes literature review, drawing from various academic disciplines.

Questionnaire Responses

For the rest of this brief report I will quickly summarise some responses received to the online questionnaire that I have conducted as part of my research in order to illustrate how people live with diabetes. I posted this questionnaire for the first time a year ago and have since received many helpful responses. I very much appreciate all these responses and I thank everyone who took the time to complete the questionnaire. In the questionnaire people were encouraged to write as detailed responses as they wished. The summary below is not complete and is based only on an initial analysis of a sample (about 50%) of the responses and so is not necessarily indicative of my final findings. It also does not represent analysis from interviews that I have also conducted with people with both type 1 and type 2 diabetes.

Diabetes at Home

For many people home was considered as safe space for carrying out diabetes management practices. People replied that they felt comfortable at home and that they feel safer experimenting with different food and insulin doses. Some people also commented on the fact that being in public spaces can cause anxiety should a hypo strike and therefore viewed home as something of a safe haven.

However the home was also be envisioned as a place of drudgery for people with diabetes. Many of the people who responded to my questionnaire noted the inconvenience of having to count carbohydrates before every meal and having to test and inject every time they ate along with restrictions on eating certain types of food, which made meal times and food bland.
 
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Diabetes at Work

Another focus of my research is to investigate how diabetes is managed and accommodated in work environments. Many respondents to the questionnaire replied that they did not really have any problems with employers or colleagues due to their diabetes but there were some responses that did indicated problems. These responses indicated that unlike home, workspaces can be less welcoming to people with diabetes. A few people experienced discrimination and a great deal of stress simply fighting for their right to be allowed to inject insulin at their desk/workplace. They felt often that they were forced into the toilets at work because of their diabetes management practices. These stories very much highlight the ?contested? aspects of living with condition, showing how the opinions of how diabetes should be managed of employers were radically different than people with diabetes own opinions about diabetes management. Because of this difficulty in challenging the accepted knowledges of living with diabetes, some people may try to avoid acknowledging their diabetes while at work. For instance some people responded that they would try to endure a hypo if it hit them while they were in a meeting, scared of drawing attention to themselves. Some research on work environments, mainly Robyn Longhurst?s 2001 book Fluid Boundaries, has considered how workers are supposed be healthy and problem free, or at least display this image through formal dress, clean shaven, make-up, in order to be, or at least appear to be, good and effective workers. However the reality is that people are rarely ever completely problem free. For people with diabetes hypos may occur at work, which may require you to step away from a meeting for 5 minutes to have some glucose tabs or some quick acting carbohydrate. The sad reality for some people is that they feel that those 5 minutes will not be understood by colleagues who do not have hypos and the person?s productivity or commitment will be called into question.

Diabetes and Social Life

The question about social life in the questionnaire also received a number of responses telling about people?s gradual withdrawal from social situations due to their diabetes. Although many of the responses to this question were much more positive and reflected that having diabetes did not affect someone?s social life. Some people reported, however, that they avoided going out in the evenings because of the stress of everyday management of diabetes, along with the pressure to consume alcohol, which can easily disrupt a person?s blood glucose management. Indeed ?the pub? is one is one of the most common places for people to socialise and these responses show how it can be something of difficult place for people with diabetes to feel comfortable in as they may worry about standing out, and having to explain why they are not drinking. Of course having diabetes does not mean that you cannot drink alcohol but the responses did indicate that the decision to drink, and how much to drink, is complicated by having diabetes and gauging that effects that this will have on one?s blood glucose levels. The pub is not the only place in which people socialise and meet each other and hopefully through further research I can discover how diabetes creates or doesn?t create problems for people in social and places.

Diabetes and Discrimination

I am also interested in how diabetes is ?done? in space. The issues of testing blood glucose levels and injecting insulin provides an interesting route for this. The toilet emerged throughout the responses as a common place where these practices are done and there were mixed opinions about the use of this space. Some people replied that they preferred to test in toilets when at work or out and about in order to maintain some privacy. Others, however, objected to being expected to test/inject in unhygienic and dirty places.

Diabetes and Community

A key positive aspect of living with diabetes is the sense of community that exists on many of the online forums. People reflected on the importance of having other people with diabetes to talk to, especially when the help and support provided from other sources can often fall short, due to people not quite understanding exactly what it is like to have diabetes.

Why this research?


The aim of collecting and analysing responses such as these is to understand the lived experience of diabetes better. A better understanding of diabetes can help inform the treatment of diabetes by health professionals. A large part of my research involves working with providers of DAFNE courses in GGC. For those of you who don?t know, DAFNE (Dose Adjustment for Normal Eating) is a course designed to improve people with type 1 diabetes BG control and allow them to have less restrictions on what they can eat and what they can do. My research then can provide a very useful resource for organisers of DAFNE, and other similar courses. In this way I can further contribute to challenging the ?gluco-centric? view of diabetes which places importance on people with diabetes achieving good numbers, HBA1C, rather than considering the everyday lived experiences. I hope that highlighting the mundane, annoying and possibly overlooked aspects of living with diabetes; will help communicate the everyday experience of living with diabetes to health care professionals.

I also hope that my research can help raise awareness of what it is like to live with diabetes so that people with diabetes do not feel that it has to be kept quiet for instance by not talking about it out or kept hidden for instance by testing and injecting being carried out in unhygienic spaces like toilets.

Of course everybody?s experience of living with diabetes will be different and I am looking forward to doing further research, talking to people and finding out more about how different individuals live with diabetes.

I have tried to make this report short and sweet, but if you wish to know more please contact me, through private message here, and I will be happy to discuss any aspect of my research in more detail (possibly through email correspondence). My research is still ongoing and I am still trying to gather data, so if you would like to share your thoughts please get in touch with me. The questionnaire is now closed but if people would like to complete it, I will resurrect it and post it again, providing this it is permitted by the site moderators.

Please note though that I will be on holiday from the 28th June to 10th July and will not be able to respond to messages. I will respond to any messages soon after my return. I do apologise for this poor timing, but given it has been so long I decided not to delay any further.

References

Longhurst, Robyn. Fluid Boundaries, Routledge, London, 2001

Moss, Pamela; Teghtsoonian, Katherine (eds). Contesting Illness: Process and Practices, University of Toronto Press Incorporated, Toronto, 2008
 
Mark, thank you very much for posting your research findings so far, I found it very thought-provoking and interesting 🙂 I wish you success in expanding your conclusions, and hope you enjoy your holiday!
 
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