Being Queer With Diabetes
By Shawn Laib
People with diabetes who are also a part of the LGBTQ community face unique challenges when it comes to healthcare, dealing with stigma and body image issues. Shawn Laib describes his personal experiences while speaking to other LGBTQ people about how they manage being at the intersection of both of these identities.
I’ve known that I wasn’t straight since I was about eight or nine years old, but I was in denial about my sexuality until my early 20s. It seems silly to believe in retrospect that I couldn’t accept my attraction to men. There’s nothing wrong with being gay, or bisexual, or transgender, but sometimes it’s challenging to overcome the conditioning of how we were raised and the culture we live in.
I was diagnosed with type 2 diabetes about a year and a half ago, at age 24. I was probably undiagnosed for several months or perhaps longer. I was in denial about my medical condition in a similar way that I was about my sexuality.
Having diabetes and being gay means that I have experienced stigma from others (and myself) – though what this stigma looks like for each of these identities is different.
On one hand, I feel as though I place a lot of judgment on myself for having diabetes. It is hard knowing that the lifestyle choices I make every day can have a serious effect on my health and lead to major complications down the road. And the hardest part is knowing that this struggle is almost entirely my own – it can be a very isolating experience.
On the other hand, being gay means that I am opening myself up to being judged by others. Homophobia is still a very real issue, especially in the hyper-masculine environments that I often find myself in, such as when I work out or play sports. I have to be really aware of who I disclose my sexuality to, and I often find that it is much easier to talk about having diabetes than being gay.
At 26 years old, I am just starting to explore the unique intersectionality between these two things. And the way that my diabetes and my sexuality interact with each other may not be how they interact in others. When dissecting my identity and reflecting on how much I have overcome and learned, I realize how blessed I am to see the world through a couple of different lenses – a burden to some, but a badge of honor and distinction for me and so many others.
I wanted to understand how this duality of being LGBTQ and having diabetes influences how others in my community receive care from healthcare professionals, as well as how the world outside this sphere perceives our struggles and our uniqueness.
Do LGBTQ people with diabetes have a harder time managing their diabetes or accepting their sexual identity because of the other identifier? They seem unrelated, but can one stressor impact the other in a negative, or even a positive, way?
Researchers at the National LGBTQIA+ Health Education Center, part of the Boston-based Fenway Institute, have searched for answers to these questions, and the evidence is startling. Their work shows that many of the risk factors for developing type 2 diabetes are exacerbated by the anxiety and depression that many people in the LGBTQ community face.
Alcohol consumption, cigarette addiction, and unhealthy eating habits are all higher than average in the queer community, often because they are coping mechanisms for self-esteem issues and homophobia from the outside world. These risk factors can then contribute both to the onset of type 2 diabetes as well as an increase in cardiovascular risk.
As I discovered personally, once a queer person is diagnosed with diabetes, any pre-existing mental toll can be compounded. Both parts of your identity can snowball together if not addressed by professionals who understand the unique burdens of LGBTQ folks with diabetes.
To understand more, I reached out to Dr. Lauren Beach, a researcher in LGBTQ studies and chronic illness at Northwestern University. I had the privilege of talking with her about the struggles some LGBTQ people face when receiving healthcare for their diabetes.
“The barriers that LGBTQ people face to access care for diabetes are multilevel,” Beach told me. “On the structural level, barriers to access for diabetes care mirror those for other health conditions.”
Her list of hightened access barriers for LGBTQ people included:
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Poverty
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Lack of health insurance (especially for sexual minority women, LGBTQ people of color, and transgender people)
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Lack of ability to pay for care even with insurance due to deductibles, copays and coinsurance (in terms of diabetes, this concern can be exacerbated because of the high costs of insulin)
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Stigma
“Barriers include stigma and discrimination in healthcare settings, avoidance of care due to stigma, and lack of culturally responsive care [such as when healthcare providers assume partners are ‘friends,’ or providers assume that all their patients are heterosexual and cisgender],” Beach said.
On the individual level, she explained, “minority stress,” which is the chronic pressure that members of certain groups face due to stigma and discrimination, can shape individual health behaviors among people who are LGBTQ or who are part of other marginalized populations (such as being a women, or being a person of color).
“[These] health behaviors can include physical activity, or lack thereof, changes to diet and eating habits, lack of sleep, increased substance use, among others,” Beach said. “These health behaviors in turn can elicit judgment from diabetes providers who may then feel that patients are ‘non-compliant’ and who will not take into account how homophobia, biphobia, and transphobia are impacting the lives of their patients.”
This is an important reminder of the need to educate healthcare providers on the differences in how to care for people in the LGBTQ community, she said. External and internal issues arise that are specific to the queer experience that are going to shape that person’s journey with diabetes.
For example, imagine the struggle that a transgender person will undergo while grappling with their diabetes and their gender dsyphoria (or the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth) as a combined lived experience.
Researchers at the National LGBTQIA+ Health Education Center found that those who are undergoing transitional surgery and hormone replacement therapy (HRT) may see increased A1C levels. In addition, transgender women taking estrogen hormones may find that this hormone intereferes with insulin sensitivity. Transitional surgeries aim to align a person’s physical characteristics with their gender identity (such as a mastectomy, also called “top surgery,” for transgender men) while HRT involves having people take hormones and hormone blockers that match their gender identity (such as testosterone for transgender men).
Though there are many stories of transgender individuals improving their A1C after starting their transition as a result of improved mental health and self care, there is not enough research to confirm this. It is vital for healthcare professionals to understand these specific risks and closely monitor the people they are treating and discuss insulin dosing adjustments and other medication needs while transitioning.
But how do non-medical professionals view this issue? Getting proper health care is just one hurdle, but educating people is also important.
Ray Parker is a genderqueer individual (someone who does not follow strict gender norms of male and female) who has been undergoing HRT for over two years now.
Parker mentioned that health care professionals can provide better care for transgender individuals by putting genuine time and effort into researching and understanding the unique intersection with diabetes. For him, HRT helped to create a more positive mindset related to his diabetes.
However, he struggled with starting HRT because he didn’t know any other people with diabetes who had undergone the therapy.
“There was no one to talk to about undergoing a second puberty [a side effect of HRT], and I had no information directly pertaining to me or what I should expect once starting testosterone as a type 1 diabetic who is also a trans person,” Parker said. “As for top surgery, again this process was not entirely fun. While surgeries themselves come with potential complications, adding diabetes on top of that was more of a challenge – at least it was for me.”
Parker said he wished he had more support, as well as more directed resources to give his partner, who does not have diabetes, and who took care of him post-operation, to prepare both of them for the issues that they would confront.
Even beyond the healthcare people received from providers, diabetes and sexuality are intertwined in ways people may not even suspect. Another person I reached out to for a perspective was JP Qualters, a gay man who has lived with type 1 diabetes for years and has a fulfilling career as a dancer. He says that the experience of being both gay and having diabetes has been a tough, but it has made him a stronger person. He told me about the ways body image is so important in the queer community, and how diabetes can make your body shape change.
“Being a gay man, the standards of looks and having a nice body are so high, but having a Dexcom on your body and taking injections everyday has turned guys off from me because I have, to quote what they say, ‘problems,’” he said. “I also think that, regardless of being LGBTQ, so many people do not understand how many decisions [people with diabetes] make a day, on top of our regular lives and work lives. Sometimes when I’m on a date I don't want to make a decision because I’m thinking about my health.”
Qualters also talked about the intersection between body dysphoria and undergoing a diabetes diagnosis.
“I chose a career path in which I perform eight shows a week, so I think I’ve had anxiety about the way I look due to the field I chose,” he said. “I think for some time I lost confidence in myself when I started using Dexcom because it made me feel insecure about the way I looked. But now I have confidence wearing it.”
For me, hearing from these people who also have dealt with the challenges resulting from this intersection is a powerful reminder of the array of barriers facing people with diabetes who are also part of the LGBTQ community. I hope that by encouraging others to better understand the struggles of queer people and people with diabetes, true progress can be made.
