dStigmatizing Holiday Meals With Diabetes

No matter which holidays you celebrate, this time of year is all about family, friendship, and tradition. But for people living with diabetes, the holidays can also bring unique challenges. 

From navigating food-centric gatherings to managing blood sugar fluctuations amid holiday stress, the season can feel overwhelming. Add to that the weight of having diabetes and its associated stigma, and the holidays may feel like anything but a joyous occasion. 

Acknowledging the stress and challenges of holiday meals

More than 42 factors impact blood sugar levels, so it's no surprise that holidays can be an extra difficult time for diabetes management. A disrupted sleep routine, travel, busy work schedules, making time for friends or family, missing time for workouts or meditation, navigating the grief and challenges of a new (or old) diagnosis, missing loved ones who aren’t present…the list goes on.

Food-centered holidays and events can amplify the pressures of daily management. Having to use guesswork for the carb counts of a meal you didn’t cook and fielding a sea of advice about the carbs you “should be avoiding” can quickly sap the joy from any meal. The ongoing narrative of what to restrict and avoid can perpetuate food fears and make holidays more difficult for those working to build a more positive relationship with food or break free from disordered eating. 

Living with comorbid conditions like celiac disease, which impacts approximately 6% of people with type 1 diabetes, or exocrine pancreatic insufficiency, which affects anywhere from 25-75% of people with diabetes, can further complicate efforts to have a stress- and stigma-free holiday. Common diabetes nutrition plans for people living with type 2 diabetes, like following a low-sodium eating pattern for heart health, or taking medication that impacts appetite can also draw increased attention and scrutiny.

Even if you reach the table feeling confident about your plate, you often hear a chorus of stigmatizing comments from well-meaning (but misguided) loved ones, such as, “Are you sure you can eat that?” or “Shouldn’t you check your sugars again?”

“When you're enjoying a gathering with friends and family, the last thing you want is to feel like diabetes is on display for criticism,” said Mila Clarke, a board-certified integrative nutrition diabetes health coach and founder of the The Hangry Woman. “It can be overwhelming to feel like you've got a handle on your management, only for others to make comments that question your capabilities.”

When diabetes becomes the center of attention at a holiday gathering can feel isolating and magnify feelings of shame and stigma. And that stigma can have very real consequences for diabetes management.

The unique impact of diabetes stigma and stress

Diabetes stigma refers to negative social judgments, stereotypes, and prejudices about diabetes, or about a person due to their diabetes. Stigma can take many different forms. 

External stigma can come from family members, loved ones, healthcare providers, or strangers. While people don’t always intend to be stigmatizing, misconceptions can lead to harmful jokes and nosy questions like the ones mentioned earlier. Research has shown that social stress and stigma can have tangible effects on diabetes outcomes by negatively impacting diabetes self-management behaviors and mental well-being. 

With so much emphasis placed on having “good” diabetes management during the holidays, it’s easy to turn that pressure inward in the form of self-stigma and shame.

“People with diabetes are harder on themselves than anyone else could be. The negative external perceptions of diabetes can weigh on us emotionally, and cause us to feel like we have to perform like "a good diabetic" and not make any perceived mistakes while everyone's watching,” said Clarke. 

Clarke said she overcomes the pressure to bend to stigma and outside expectations with self-compassion. 

“While it's important that we understand the implications of sustained, out-of-range blood sugars, we also deserve nourishment alongside food joy, and the ability to have the comfort foods we enjoy alongside the people we love,” she said. 

6 practical tips for removing diabetes stigma from the holidays

For your next holiday celebration, leave behind unnecessary stress and diabetes stigma by implementing a few practical suggestions. 

1. Work with your healthcare team to create a diabetes self-management strategy for the holidays that works for you 

Your primary care provider, endocrinologist, dietitian, or therapist may all have helpful resources for adjusting your diabetes management strategy, if needed. Adjusting your eating plan for the holidays or implementing tools like continuous glucose monitoring (CGM) can reduce the burden of stress and stigma to ensure you have a positive and joyful occasion. Meet with them early and plan ahead.

Remembering strategies that work any other day to support steady sugar levels can be helpful for the holidays. Consider asking a family member to join you for a walk to fit in some movement without feeling like you’re missing out on quality time with loved ones. Alternatively, invite them to join you for 15-30 minutes of quiet reading time to destress after an eventful day. 

2. Enlist your family and loved ones to support a stigma-free holiday 

Instead of becoming the center of attention when stigmatizing or diabetes-centered discussions arise, identify one or two loved ones who can help kindly redirect the conversation. Practice one or two scripts in advance to acknowledge helpful intentions and move forward from unhelpful interactions, such as, “It's so thoughtful of you to make sure I have what I need, but I've got this covered!”

If you are a loved one of someone living with diabetes, remember that one of the best things you can do is ask how to be helpful, don’t assume. It’s wonderful to be concerned and offer assistance, but let your loved one with diabetes steer the conversation so they don’t feel singled out or stigmatized. 

3. Lean on community support resources. 

Not everyone in your family “gets” diabetes, so leaning on communities that do can help navigate the challenges of the holiday season. Community can take many forms: a close “diabuddy” you speak with daily, a local diabetes community group, or participating in the diabetes online community. No matter what it looks like for you, sharing recipes, trading advice for navigating holiday chaos, or having an understanding ear to help you feel seen after a rough day is invaluable. 

4. Use tools like time in range to get the full picture of your diabetes management this holiday season 

Tools like time in range help us understand our unique responses to factors that impact blood sugar (including things outside of food like sleep and stress). This helps you adapt and feel confident in your management. 

Use time in range to zoom out and see the big picture instead of focusing on single moments or days of diabetes management. Seeing the full story can remind you of how well you’re doing overall and bring peace of mind that even blips during the holiday don’t mean you’re “off track.” 

5. Make informed choices about food and do your best 

The “right” choice about what to eat on a food-centric holiday is entirely up to you. Stigmatizing comments about skipping your favorite treats or watching your numbers shouldn’t dictate the menu.

To make holiday meals easier, gather as much information as you can ahead of time and participate where you feel comfortable. Ask the host for the menu or their recipes and suggest helpful ingredient swaps (like this easy spiced cranberry relish). If you enjoy cooking, offer to bring a favorite must-have dish or pack backup snacks that bring you joy.

Do what makes you most comfortable and gets you what you need to build your perfect plate, feel confident, and nourish your body and heart for the holidays.

6. Celebrate yourself and practice compassion 

We wouldn’t put this much pressure on ourselves to get any other single meal of the year perfect, so why all the pressure for holiday feasts? 

“We know that we've made it this far, and we don't become less capable of taking care of ourselves at the holiday table,” Clarke said. “Give yourself more grace than usual, and remember that you do this every day.”

If you feel the need to “get it right” or feelings of shame creeping in, take a step back and celebrate at least one thing you have done to support your physical and emotional health that day. 

The bottom line: Tomorrow is a new day

Managing diabetes is hard. And with no shortage of stressors, disruptions to routine, and sources of stigma during the holidays, it can quickly begin to feel impossible. For your next food-centric holiday celebration, keep your approach simple and give yourself grace instead of giving in to the stigma and demands to be perfect. 

You likely won’t look back and remember what your blood sugar was that day, but you will remember the moments spent with loved ones, the laughter shared, and that perfect bite of a favorite family recipe. 

Learn more about diabetes management and stigma here:

• Dealing With Shame Around Diabetes and Food
• Diabetes Stigma Basics
• Defeating Diabetes Stigma With Comedy