Diabetes in society The good, the bad and the ugly – treatment of diabetes in the cinema

Miguel Abad Vila

Diabetes has a leading role in the current global epidemic of non-communicable diseases. But it has a rather ambiguous relationship with the ‘seventh art’. On the one hand, diabetes has made a number of high-profile appearances in blockbuster movies – which has helped to raise its profile among the general public. On the other, it remains underrepresented – only around a dozen films have dealt with the condition in the past 25 years – and is often distorted by the time it reaches the screen. Miguel Abad Vila reviews the portrayal of diabetes by various filmmakers and discusses the film industry’s duty to present diabetes accurately and responsibly.

48 DiabetesVoice October 2010 • Volume 55 • Issue 2 Diabetes in society

highly emotive diabetes-related issues into a story about a close-knit circle of friends whose lives come together at a The good, the bad and the ugly – beauty salon in a small town in the south- ern USA. Diabetes provides plenty of drama. In one scene, Shelby, played by Julia Roberts, is seen feverish and diso- treatment of diabetes in the cinema rientated during a severe hypoglycaemic episode, fighting an offer of orange juice from her mother, M’Lynn (Sally Field). Later, M’Lynn is upset at the news that her daughter is pregnant, despite her doc- tor's advice. While Shelby’s insistence that women with diabetes have babies ‘all the time’, her mother disagrees, insisting that ‘There are limits to what you can do’. At the end of the film, Roberts’ character dies due to diabetes-related kidney failure.

The Godfather Argentinean director, Ernesto Parysow’s and Company, Life for a Child was made In a personal favourite of mine, 1998 drama, Punto de Equilibrio (Balance specifically to raise awareness of the dev- Coppola’s The Godfather III, the leader Point), is an example of ‘good practice’ astating impact of diabetes and increase of a mafia family has type 2 diabetes. in the on-screen depiction of diabetes. support for the IDF Life for a Child Michael Corleone (Al Pacino) suf- Indeed, it stands out in the history of initiative. It won critical acclaim in the fers a hypoglycaemic episode during a particularly stressful time in his life. the condition’s relationship with film- Tribeca Film Festival (2008), Vienna "When I'm under stress, sometimes makers. A well-crafted film that leads (2008), Heartland (2008) and Festival du this happens," Michael Corleone tells a the audience through the multiplicity of Nouveau Cinéma de Montréal (2009). cardinal (Ralf Vallone) while drinking challenges facing people with diabetes, orange juice and eating snacks to raise Punto de Equilibrio is as emotionally The latest in IDF’s Life for a Child series, his blood glucose. The cardinal’s reply engaging as it is educational. Complex Lifeblood, which highlights the struggle is disarmingly accurate, given what we and difficult diabetes-related issues are of children with type 1 diabetes in the know about the associations between brought to life accurately and thought- Democratic Republic of the Congo, was stress and diabetes: "Your mind suffers fully through the experiences of a number premiered recently in Stockholm. and the body cries out!" of characters who are affected in different ways – from early symptoms of type 1 But what of the broader film industry’s As his diabetes develops, Michael re- diabetes, through social stigma and guilt, efforts with diabetes? A few works from quires insulin therapy. Finally, type 2 to life-threatening complications. the past 25 years or so stand out for their diabetes-related vascular damage is the treatment of diabetes and, because of probable cause of his death – as it was Edward Lachman’s 2008 documentary, their enormous box-office success, their for his father before him, and indeed Life for a Child, also comes highly rec- potential impact on the knowledge and for the author of the original Godfather ommended. This stirring film follows attitudes of the general cinema-going novels, Mario Puzo. the journeys of children with type 1 and DVD-watching public. diabetes through the streets and moun- Nothing in Common tains of Nepal, one of the world’s poorest Steel Magnolias In Nothing in Common (Garry countries. Produced by the International Steel Magnolias (Herbert Ross, 1989) is Marshall, 1986), Max Basner, played Diabetes Federation (IDF) and Eli Lilly a bittersweet comedy that weaves some by Jackie Gleason, struggles with his

October 2010 • Volume 55 • Issue 2 DiabetesVoice 49 Diabetes in society

diagnosis of diabetes and finally under- goes the amputation of some toes and part of a foot – a cruel outcome of the microvascular and neuropathic com- plications of poorly managed diabetes. The storyline was based on the personal experiences of the film’s scriptwriter Rick Podell, who had cared for his own late father, who had diabetes. viewers very probably will have left the ers have a degree of responsibility for cinema with the impression that this girl accuracy and sensitivity. Panic Room suffering hypoglycaemia was saved by a Cinematographic illustrations of people shot of insulin. Steel Magnolias, a success at the box- with diabetes often are used to satisfy office and well received by critics, de- the filmmaker’s need for high drama. Con Air picted the dramatic impact that diabetes In Panic Room (David Fincher, 2002), Another thriller in which the film-mak- has on people's lives and the tragedy that the two main characters, played by ers seem to be confused about the dif- this sometimes involves. The hypo scene Jodie Foster and Kristen Stewart, are ference between hypo- and hyper-gly- was realistic up to a point but it could a mother and her insulin-dependent caemia is Con Air (Jerry Bruckheimer, be argued that it was overdramatized daughter, who are being hunted by a 1997), where difficulties treating an – an extreme example of what could group of criminal intruders. They be- inmate with diabetes trigger a mutiny happen. The on-screen response to hy- come trapped in an armour-protected onboard an aeroplane transporting dan- poglycaemia in Panic Room is not only safe room in the basement of their home. gerous prisoners. The depiction of dia- inaccurate, it sends out a potentially Rather predictably, they have no access to betes here is unrealistic and exaggerated dangerous message: insulin, of course, the daughter’s life-saving medication. But to the point of absurdity. At one point, lowers blood glucose. For a person with dramatic licence is so stretched in this the character with diabetes warns that hypoglycaemia, an insulin injection ad- thriller that it becomes a feast for spot- if he does not “get my shot in the next ministered by well-meaning but clueless ting diabetes-related goofs and errors. couple of hours, somebody's gonna be friend really could be The End. sending flowers to my mother”. Near For example, although the girl is seen eat- the end of the film, the man appears to It is unfortunately the case that many ing high-carbohydrate pizza and drinking be exhibiting signs of low blood glu- people encounter ‘diabetes education’ high-sugar (regular) Coca Cola at the cose, despite the lack of insulin – which only through the storyline of a film or beginning of the film, she develops low should have resulted in high glucose. television programme; many people re- blood glucose later the same evening. ‘I'm dead in two hours,’ he says. After ally do believe what they see. How many The mother begs the criminals to be al- the plane lands, he is given an insulin diabetes-unaware people, having seen lowed access to her daughter’s insulin; it injection, after which he immediately Steel Magnolias, still believe that women is made clear that the girl will die from regains strength and stamina. with diabetes should not have a baby? We hypoglycaemia if she does not receive should welcome films that bring to the an injection! At the climax of the action, Research and responsibility public’s attention the potentially terrible the girl finally receives her long-awaited It could be argued that a film is made nature of diabetes but writers and direc- injection and quickly makes a full re- to entertain rather than to educate – to tors must do the proper research if they covery – which is puzzling. Watching allow an audience to escape from reality are to avoid spreading the epidemic of this sequence closely (for a second time, rather than to dwell upon its complex, confusion already surrounding diabetes. perhaps), we see that the life-saving sy- ugly or painful aspects. Moreover, it is ringe actually contains glucagon (which true that the film-watching public has Miguel Abad Vila causes the liver to release glucose, rapidly a degree of responsibility in choosing Miguel Abad Vila is a General Practitioner at the Centro de Saúde Novoa Santos in raising blood glucose) rather than insu- whether or not to accept what happens Ourense, Spain ([email protected]). lin. The problem here is that this was in a film as fantastic or verisimilar. But He is the author of the blog Medycine (http://medicinaycine.blogspot.com/). not made clear to the audience. Many with regard to medical issues, filmmak-

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