Jennifer Dyer, MD, is an endocrinologist and Assistant Professor of Pediatrics in the Division of Endocrinology at the Ohio State University College of Medicine. In addition to all her hard work as a doctor, she also is passionate about consumer health communications and health media to improve health literacy. She also happens to be one of the few endos you can find using social media on a regular basis; you can follow her on Twitter at @EndoGoddess. Today, Jennifer shares her thoughts on one of the leading causes of diabetes misconceptions: Hollywood…
A Guest Post by Jennifer Dyer, MD
As a pediatric endocrinologist, I meet many young patients and their families when they first hear the news that they have type 1 diabetes. Fear is a common reaction, and understandably so. The fear in their eyes is often preceded by thoughts of the challenges of the characters with diabetes in the movies. Many families and patients do not know about the daily life of a person with diabetes. Thus, their only experience with diabetes is through the movies. I always try to point out that diabetes in the movies is often NOT an accurate portrayal of what life with diabetes is like.
I remember the first time that I saw Steel Magnolias. I didn’t know anyone with diabetes at the time, and I would have thought that frequent hypoglycemic seizures and kidney failure following childbirth were the norm for those living with diabetes — if I hadn’t learned otherwise in medical school. In the movie, Julia Robert’s character (Shelby) has a dramatic hypoglycemic reaction while getting her hair done at the salon owned by Dolly Parton’s character (Trudy). The dramatic seizure scene follows her mother’s accusations regarding Shelby’s poor diabetes self care due to the stress of her wedding planning. Shelby begins convulsing due to hypoglycemia we assume is related to her own neglect. Then her low blood sugar is treated quickly by her mother giving her orange juice. The mood in the salon quickly turns to one of fear over Shelby’s diabetes.
Shelby later becomes pregnant, suffers resultant kidney failure requiring a kidney transplant from her mother, and subsequently dies from complications of kidney failure. The movie implies that Shelby’s diabetes condition would not have progressed if she had not decided to have a child.
Not only is this misleading, but it’s absolutely out-of-date. A few important points regarding this movie and the facts of diabetes today in 2009 (versus 1989 when the film came out):
• Improved overall diabetes care: The improved accuracy and portability of glucose meters we use today have allowed diabetes care to also be much more accurate and portable. Shelby didn’t have the benefit of knowing her most precise glucose levels because these meters were not available to her in the 1980s. If the script writers even had a clue, they were probably implying that Shelby missed opportunities to modify her insulin doses to improve her glucose levels. In addition, new insulins such as Humalog/Novolog and Lantus/Levimir were introduced within the past 5-10 years. These newer insulins have resulted in much more accurate glucose control than the older NPH/regular insulin shots that Shelby was probably taking. Furthermore, insulin pumps are now available which make diabetes care more convenient. Perhaps if Shelby had had an insulin pump, she would not have neglected her diabetes care while planning her wedding. However, insulin pumps were not available in the 1980s.
• Hypoglycemia: Shelby must have been very hypoglycemic unaware. As you know, low sugar levels can be treated before a seizure occurs in most cases because they can be caught be checking the glucose level on a meter. Also, continuous glucose meter systems (CGMS) are now available which check glucos levels every 5 minutes and can help warn about oncoming lows.
• Diabetic pregnancy is considered safe with strict glucose control and close glucose monitoring! Women with diabetes have healthy pregnancies and health babies every day. Strict adherence to insulin shots and glucose checks is required, however — just as they are when not pregnant in order to maintain health. If Shelby had poor overall diabetes care throughout her entire life, it’s likely that she would still have had kidney failure, regardless of the pregnancy.
It goes without saying that Hollywood over-dramatizes (or sometimes even twists) the medical facts.
This goes for most all medical conditions. Over-dramatizing is common practice, as it drives home a point within the story arc. Take The Godfather Part 1: did Michael Corleone (Al Pacino) really have a bruise on his cheek for the entire year while in exile in Sicily? No, the point was to foreshadow that he was running away from danger after shooting Sollozzo and McCluskey, yet danger was still following him…
Shelby’s hypoglycemic seizure and early death are used as an allegory for the fragility of life and the strength of female friendships. Too bad the general public generally takes Steel Magnolias at face value as a lesson in what life with diabetes is really like.
So, all you PWDs can go forth with confidence that your daily diabetes life and Hollywood are usually not on the same page. Better yet, make sure you tell everyone around how misleading these Hollywood images can be. Or one better: try writing the next Oscar-winning dramatic movie screenplay with a story line touching on life with diabetes in a much more accurate way… Isn’t it dramatic enough already?
Good points, Jennifer. We do hope the screenwriters’ guild hires you as their next expert consultant!
Ah Hollywood. Even when it’s portraying reality, it’s through a lens clouded by fantasy and the need to be dramatic. I do hope they’d check with real people who live with diabetes, but I’m not holding my breath.
Fabulous post.
I have never seen Steel Magnolias. But after my son’s type 1 diagnosis, I’ve been curious about it– though not enough to violate my strict cover-the-ears-and-eyes-when-someone-is-talking-about-a movie-I-might-see policy. I only heard that it was a good movie and that Julia Roberts played someone with type 1 in it. Figured I would get around to renting it sometime…
Well, I just violated my policy by reading this post and am so very glad I did– thank you for saving me a good deal of pain.
The folks in Hollywood are either clueless, careless or both.
I’m so glad to hear someone point all of this out.
I remember my friends crying when they saw Steel Magnolias and telling me I’d die if I ever got pregnant. Mind you, I was in the 5th grade at the time. I tried to tell them that that wasn’t what diabetes was really like, but those negative perceptions persist today, twenty years later.
I was diagnosed around the time that the movie was released and was told even then that the depiction was completely off the mark and that I would lead a healthy life and have healthy pregnancies in my future. Thank goodness for a supportive medical team!
But boy do I hate that movie…
Hi, Your article is interesting – must watch that film to check it out. Now I don’t want to be negative but as the Mum of child with type 1, can I say that it is easy for medical people to say that diabetes is manageable etc but it is no walk in the park for kids who have it or indeed their parents. Medical people get to go off-duty but we are “on-call” 24/7. And my child is young… I hear that the teenage years can be particularly difficult because of the impact of hormones on the condition. Yes some hypos can be picked up quickly but not always. And I have seen a bad hypo so I know what I am talking about. Frightening experience.
In 1990, upon my own diagnosis, the movie ticked me off. Then someone told me it’s based on a play set in the 1960′s (maybe 50′s). That doesn’t help diminish the spread of misinformation about current treatments or living with the bigD now, but I am less angry at the movie because it’s historical fiction.
Wow. That movie, as much as I love Roberts and Fields, still gets under my skin.
I was diagnosed in ’85. I know all too well what “control” was way back when: crap.
I am blessed to be living with T1 now. I am blessed to know what I know.
Do people still “believe” that movie? Unfortunately, yes.
Yet another opportunity to advocate and educate.
The problem is that, for some people, Hollywood is their only frame of reference is they don’t know anyone with Diabetes.
I love Steel Magnolias for the story it tells. It’s one of my favorite movies. Dramatic, inaccurate, and over-the-top portrayals of illness are standard fare in films and books. What is more damaging to the general public’s understanding of diabetes is a celebrity like Halle Berry claiming that she switched from being a type 1 to a type 2 diabetic.
I never saw the film, but I had a diabetic cat whose diabetes was better controlled than Julia Robert’s character.
Steel Magnolias was based on real life This has been widely reported and the playwright has discussed it in multiple interviews.
After the death of his sister, Robert Harling locked himself in a room and 10 days later came out with this play which 3 years later became a movie. The movie was even filmed in the town that where everything happened and the nurse and doctors who cared for his sister Susan played themselves in the movie.
http://en.wikipedia.org/wiki/Steel_Magnolias
Jennifer:
Thanks for the well written comments on Steel Magnolias. However, I do want to take a small exception to one of your conclusions. You said: “Perhaps if Shelby had had an insulin pump, she would not have neglected her diabetes care while planning her wedding. However, insulin pumps were not available in the 1980s.”
For the sake of accuracy, Insulin pumps were “available” in 1980 and on. I know because I started using one in September of 1980. Albeit a tab big and inconvenient compared to today’s miniaturized models, it did work and it did help get the “movement” started.
Jennifer,
Are you married?
Patients with diabetes have too much sugar in their blood. In this problems are caused by diabetes. Endocrinologists treat diabetes with diet and medications, including insulin. They also work closely with patients to control blood sugar and monitor them so they can prevent health problems.
Thanks for your good work and good informations.
Lara, I would be interested to find out how much of “Shelby’s” story is what actually happened to the author’s sister. There is such a thing as artistic license. Do you have links to these interviews? I did not find much in the Wikipedia entry reflecting the reality vs. the story.
I’ve always hated this movie; I can’t think of any other depictions of diabetes besides this one though.
its really good if HollyWood is Show the realy things with facts,
oh my, did i hate this movie (it lost me during the hair salon scene).
i was diagnosed in 1984 at 11 years old, and today am a tired but healthy mom to two kiddos — with fabulously managed pregnancies (if any of you out there are in the seattle area, dr. zane brown at the UW is *the man*, and dr. kerry mcmahon is also fabulous).
Steel Magnolias still annoys me…
However, I do want to take a small exception to one of your conclusions. You said: “Perhaps if Shelby had had an insulin pump, she would not have neglected her diabetes care while planning her wedding.
They also work closely with patients to control blood sugar and monitor them so they can prevent health problems.
I did watch Steel Magnolias and thought it was ludicris. There are twos other movies where there was a diabetic scenario. Panic Room with Jodie Foster and Memento with Guy Pierce (the injections were given into a vein). Also, glucose testing was definitely available in the 80′s as I had a glucometer in 1981.
I remember being outraged after watching an episode of CSI: Las Vegas when a diabetic (type 1) woman ended up in hospital in a coma because she drank ONE SHOT of spirits… pfffff. I love CSI, but really…
I am entering my junior year of undergrad and picked up this blog while I was browsing a for information related medics. I m pretty set on going to med school but of course have my doubts which some of them is answered here..
I have directed this play twice. My wife is a diabetic and has been so for approximately 20 years. I am well aware of the problems with both the play and the film. There is a difference. I do try to post disclaimers each time that the play is done but please remember the differences between 1985 and 2009. There have been vast changes in our treatment of this disease and I would not throw the baby out with the bathwater. The play is a moving reminder of the seriousness of diabetes. Also please keep in mind that many diabetics die because they do not take it seriously until it is too late. I would hope that anyone viewing the movie or seeing the play would trust their own doctor’s advice first and remember this is a play or movie. If it were written and happened today events would be different, I am sure. However, I would not stop the film and insert a footnote saying I hate this line because we now have insulin pumps that are small. The bonding of these ladies and life moving on is what the play is about. Please do not forget this in spite of its weakness.
My best,
Michael
On the accuracy of Steel Magnolias…
I was diagnosed in the early 80′s and although for a while I was only doing home urine testing, I quickly got introduced through my state’s research hospital to home bg testing.
While Steel Magnolias is a late-80′s movie, it represents what happened to the moviewriter’s sister at least a decade before, when there was no (or almost no) home bg testing.
And even with home bg testing, bad hypos can happen. I’ve been in the ER twice for them over the past 30 years. It’d be nice to say that with the new technology that just never happens, but I don’t think that’s true.
I first saw Steel Magnolias as a young child, and was always so confused as to why Shelby started convulsing at the salon, and why she died after having a child. Now as a graduate nutrition student, I understand how T1DM affects the body. Obviously Hollywood exaggerates health conditions in movies, but it may serve a purpose besides adding drama. A person who is unfamiliar with the disease may watch the film and begin to pick up on some of the basics: 1- Hypoglycemia needs quick source of sugar to raise blood glucose (orange juice in the film) 2 – Poor control can lead to kidney problems.
For the most part, Shelby’s diabetes isn’t the major focus of the movie. It is mostly a light-hearted drama about funny southern women who find strength in eachother.
To be fair to this movie, it must be remembered (as several comments have poined out) that the author based his story on his sister’s real-life experiences, and with the grief of her loss still very much on his heart.
Although the movie came out in 1989, the play was written still earlier and the real-life experiences much earlier than that. I have no doubt that the experience of the woman on whom the character of Shelby is based were as emotionally wrenching as portrayed.
The woman on whom “Shelby” is based undoubtedly did not have the kind of care that is standard now; much of it simply didn’t exist back then. Still, even with monitoring, hypoglycemic episodes and insulin shock are a constant possibility (my mom’s SO has had several such incidents, some requiring hospitalization, in spite of twice-daily meaurements).
This article’s last line says it all. This is a comedy-drama about six friends, one of who _happens_ to have type-1 diabetes, and not a documentary about diabetes and how to treat it.
This is an article I found about the author’s sister. http://www.cpmag.org/article.php?articleid=157&cmonth=9&cyear=2007
It mentions that she did, in fact, die after a kidney transplant but it also says that some aspects of her story were “exaggerated” in the play/movie.
Sorry, but I thought this article was poorly written. I was eager to track down someone who could explain exactly why her diabetes was so unmanageable or why pregnancy may possibly cause complications more so than other times. Neither question was answered, and your points make no sense. You say it’s misleading and out-of-date, but being out of date does not make it less true for the time. Also, I am unconvinced it is misleading since you said “Women with diabetes have healthy pregnancies and health babies every day.” This was mentioned in the film with the lines “Diabetics have healthy babies all the time” and “But you are special, Shelby. There are limits to what you can do.” That implies that she has some complications/condition more serious. I would like to have heard some possible conjecture as to what that is. And, diabetics do die from the condition. Just because it’s not a nice fact, it’s true. For people posting to say they hate this movie because of its portrayal of diabetics does not change the true seriousness of your disease.
i second the wish to have heard a doctors thoughts on what made this particular woman’s illness and complications so different from a typical type 1 diabetic, and how they may have lead to her irreversible coma and death…it is clearly out of of date, as many people commented, but that does not mean it was an impossibility at one point
To read the comments, is to realise how much the author did write, but also how much the author needed to write, about the diabetes, and the portrayal within in film.
I one of a long line of diabetics, who has seen grandmother in and out of the hospital at a time before there was the measurements and controls there are now; as well as watching my mother destroy her ability to make insulin because of the early drugs that caused that destruction, to watching her, receive no treatment at the hands of a callous doctor, his beliefs that old people don’t matter, and turning her treatment around because I am bull-headed and know more can be done. Still, that was not enough.
I can relate just how horrible a hypoglycaemic episode is as I have some dramatic and terrible times where I thought I could manage, but for those seemingly unending 15 minutes to half hour, I was not sure I would ever stop shaking, and feel normal again. I do make some of my insulin, and have an insulin pump–which is a revelation in caring for myself. Still I have glaucoma and neuropathy, and, like most diabetics, face the real possibility that it will be kidney failure that will eventually get me. All that damage to the nerves takes its toll.
A quick search on the internet for gestational diabetes will reveal much about the temporary condition that can come to some mothers. I would think, but do not know, keeping one’s blood sugar at fairly steady levels, when some part of your body is working against you, can’t be easy. (When I have muscle pain, for example, my blood sugar levels run much higher than ordinary, so those episodes require more monitoring. Even banging your toe, or almost anything, can set the body into attempting to compensate, so that just adds more burden to the system; I have crashed from some events, but was near my desired normal, so there was little leeway for error; or the liver has decided to dump sugar into the system).)
I will say that the film does present a simplistic view of diabetes and its dimensions and its complications.
Even the author of the article leaves much “in fill” explanations fall far short of presenting a reasonable “why” for the film’s shortcoming in presenting the true nature of Shelby’s condition, so it could be understood by an audience.
Yes, one does get a hint that something is changing when one begins to crash. One can also get a sense when the blood glucose it rising. I think it would have been helpful to have mentioned neuropathy, at least….
Drama or not, I have found that reality is often much more dramatic than theatrical drama.
I have to side with Hollywood on this one. As the author of this article clearly points out, monitoring tools were limited or non-existent in the 80s, yet she criticizes the movie for not promoting tools that didn’t exist yet. That’s ridiculous. The movie was also based on true events. While Hollywood will always err on the side of drama, I’m sure the movie did more good than bad in educating viewers about the seriousness of diabetes.
My first exposure to diabetes was the character Stacey in The BabySitters Club books. I was so intrigued that I did a report on diabetes in sixth grade. (Ironically enough, the same year the movie came out.) I still find it fascinating for some reason, and over the years, I’ve kept an eye on advances and news concerning diabetes.
When I saw Steel Magnolias over ten years later, I realized that Shelby’s case must be very unusual and hard to manage. What she experiences is not typical for many, and adds to the drama and pain. The most ridiculous part that I found wasn’t the depiction of diabetes, but the fact that Shelby and her husband were not allowed to adopt -at all- because of her medical history. They weren’t even given a chance. (There is a reason so many people go overseas to adopt. The regulations in this country are just absurd.)
Dr. Dyer, I greatly appreciate your efforts to educate the public as to diabetes.
Yes, there’s a ‘but’.
I would kindly suggest that, before posting or submitting an article, you have someone you trust review it. Someone who is willing to criticize, explain, and help. Many of the previous comments about your article do highlight weaknesses in the article structure and the details it covers.
Thank you for listening.
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I am not diabetic but was waiting for a liver transplant when I first saw this movie. I was 12/13 years old then. It did scare me a little about her having a transplant and dying but I didn’t dwell on it because I knew without the transplant I would die.
But, people have the same misconceptions about transplants too.
Thank you for writing this and educating people out there
I actually chose NOT to have children because of my Type 1 diabetes, but not because I saw this movie or believe that the portrayal of Type 1 diabetes in it is an accurate assessment of what one can expect with it. Type 1 diabetes runs in my family; my father inadvertently passed down the illness to me (though not to my sister) and I did not want to do the same thing to another generation. In addition, by the time I finally found Mr. Right (at age 35), I was already on enough medications to try to prevent some of the long term complications that arise with it. I’d already had retinopathy and some reduced kidney function, despite having a HA1c of 6.2. Some of the meds I’m on clearly state that pregnant women should not take them. So when a third issue came up, something that almost all of the women in my famiy have to deal with by their early 40′s (massive fibroid tumors and 4-month-long periods), I knew what had to be done. After the hysterectomy, I at least have the peace of mind knowing that the Type 1 diabetes in our family will die with me. We’ve had my nieces in for screening – neither of them have the genetic markers for the illness that I do. I suppose that those commenters who have had successful pregnancies might accuse me of playing God, choosing not to take ANY chance of passing those markers on to an unsuspecting kid. But I just can’t see going forward with a pregnancy, given my age and my level of complications, and with a family history of an incurable illness that renders a sufferer a second-class citizen with regard to insurance eligibility and with employment, at least in the U.S.