Dear Ann Landers... You're No Miss Manners
In November 1998, Landers published a letter from a woman whose relative with diabetes injects insulin at restaurant tables. Signing herself "Mrs. Anonymous," the woman says that the blood and the needle offend some people, urging Landers to comment, as it "would help make others who are afflicted with diabetes aware of how this sort of thing affects some of us."
Landers responded with words that still ring in the ears of people with diabetes: "A person who would inject himself or herself at the dinner table in the presence of others exhibits gross insensitivity and very poor manners."
Diabetes Health asked its email news group for reactions. Out of about 140 people who responded, about 25 percent agreed with Landers. Reasons for praising or vilifying Landers were as diverse as people with diabetes. Some even accused Landers of purposely printing inflammatory statements to stir publicity for her column.
Diabetes Health also called Landers's offices in Chicago, to see what the nationwide reaction has been. One of her employees said that no responses had come in, but asked to see those collected by Diabetes Health. Time will tell how Landers will respond.
A sample of readers' responses follows.
Many people emphasized that they test so discreetly at the table, fellow diners barely notice.
I usually agree with Ann but she really blew this one. It is not always possible to remove oneself from sight to test sugars or inject insulin. And they shouldn't have to. It can be done very discreetly. There is nothing gross about testing and injecting insulin.
Tina Fitzgerald, RN, BSN
Taking an insulin shot is a medical necessity, like placing a nitrogylcerin tablet under the tongue. Anyone offended can look away. I think Ann should try walking a mile in diabetic shoes before pronouncing judgment. Intolerance is not helpful.
I regularly test blood and take insulin shots wherever I am at the required time. I punch shots through my clothes. It's not like I'm baring some portion of my anatomy for public scrutiny. How about live and let live.
Giving insulin discreetly at the table is their preference and should be as accepted as taking pills at the table. Unfortunately, we still have many people in our society who are squeamish about needles and dislike seeing them, even when others are using them. Maybe it is time for them to deal with their own issues, rather than making people with diabetes feel out of place.
Paula Yutzy, RN, BSPA, CDE
Diabetes & Endocrine Center for Harbor Hospital
Others reminded Landers that public rest rooms are often dirty, and accused her of treating them like lepers who should be kept out of sight.
Where would Ann Landers suggest that diabetics perform our testing and insulin shots? Should it be in the rest room, which is often unsanitary? Should it be in our car before we go to the restaurant? Perhaps we should just disappear from view and stay locked up in our house. I suggest Ann Landers exhibits gross insensitivity and poor manners towards diabetics.
Howard Beach, New York
As the mother of a 16-year-old diabetic daughter who strives to make my child feel as "normal" as possible, I felt her response was akin to the Nazi mentality of isolating society's misfits.
Until you have accompanied a child to a dirty public rest room, balanced two glass insulin bottles on your lap while seated upon the toilet and attempted to draw up an accurate dosage of insulin in a dimly lit stall, you are in no position to criticize someone who administers insulin publicly.
Bala Cynwyd, Pennsylvania
I do not see how any of us doing blood testing or injections in public are infringing on the rights of anyone else. There are few alternatives: not eating out or going into an often dirty public rest room to test and inject. I think it is insensitive of her not to understand that this medical condition requires constant diligence to maintain good control and it must sometimes be done in public.
I hope she never develops this disease. She might never get to eat out again.
Crystal L. Carrier
My name is Laura Lynn. I am 8 years old and I am a diabetic. I sometimes test in the bathroom and sometimes I don't. Usually [in bathrooms] there isn't anywhere to sit my stuff and I have to just set it on the sink or the floor and they are dirty.
My mom showed me what you wrote and I wish you wouldn't say we should have to go to rest rooms. Most people are not grossed out by me.
I check my blood sugar in my class every day and none of the kids minds. They even think it is neat that I have a blue insulin pump and they ask me about it. They also think it is neat that I can take shots without crying. Most people are sorry that I have to take shots and prick my finger and are very nice to me. I wish you would change your mind because my mom says a lot of people read what you write about. I like being a diabetic since I have an insulin pump like Miss America. Insulin pumps are cool.
Let Ann Landers take my three shots and do my four tests a day, and let her do it in poorly lit, dirty rest rooms, then see what she has to say on the subject. Most people don't even know I've taken my shot and done my test when I do it in public.
Ann Landers needs to get with the times!
I have a 7-year-old daughter, diagnosed at age 4. She tests her blood sugar eight times a day. She takes four shots a day. In the next year she will take 1,460 shots and prick her finger 3,000 times!
In the three years she has had diabetes we have always tested her blood sugar and given injections wherever we may be when she needs them. We have never received any negative comments about our performing these tasks in restaurants, malls, amusement parks or anywhere else.
I refuse to teach her that diabetes is something that she should be ashamed of. This disease asks a lot of the people it inflicts and their families. We certainly don't need you putting additional pressure to find a place to hide while we perform these medical procedures.
Melissa's Mom and Dad, Dennis and Laurie Cardone
Salem, New Hampshire
Another popular message was the danger of hypoglycemia unless injections are timed precisely.
It is evident that she does not know how vital it is to know the amount and composition of a meal prior to injecting an insulin dose. It is evident that she has never left a restaurant table to inject insulin after ordering a meal, only to suffer a severe bout of hypoglycemia due to the fact that the service happened to be poor that evening.
El Paso, Texas
I used to inject my insulin before arriving at the restaurant. If there was a long wait, I would have a low blood sugar episode, which ruined my meal because I was unaware of what was going on around me and even what I was eating! Now, I wait until I arrive at the restaurant, determine what I'm going to eat, then inject my insulin.
San Antonio, Texas
Some people used sarcasm to get their points across.
I think Ann is being extremely gross and inconsiderate when her pancreas does that foul thing of kicking out insulin while she is sitting in the restaurant in front of God and everybody. What a disgusting thing to do. I think her pancreas should have the decency to wait 15, 30 or even 45 minutes and then go into a rest room, where everything is so clean and sterile, to secrete insulin.
God bless her; if she only had a clue.
Slippery Rock, Pennsylvania
All that whining about inadequate health insurance coverage. The annoying blood testing in public (those beeping meters are a public nuisance!) with actual blood right out where decent people can see it. Please! Not to mention all those unattractive insulin vials and syringes. Don't those people know there's a war on drugs in this country?
Well, I, for one, have had enough. I say it's high time Ms. Landers gets a clue and uses her pulpit to do some actual good by spreading the word that diabetes means something more than an irritating inconvenience to millions of people. But that would requireÃ‘God forbidÃ‘learning something about the real world.
Hoboken, New Jersey
Some called for more understanding:
Diabetes is, I believe, deeply rooted with strong emotions and insecurities. Irresponsible comments such as those made by Ann Landers could result in people's giving up on control.
Her comment is indicative, in my opinion, of a lack of understanding of the responsibilities that accompany her role as a national columnist.
Overland Park, Kansas
Today's insulin is a miracle of chemical purity and efficacy. If Ann is too squeamish for such a small concession to health, then perhaps she should spend some time assisting the aged and ill at a nursing home. Perhaps we all should do more.
On Ann's Side
The sight of blood is not appetizing to most people, so if testing involves a blood draw it should not be done at table. It should be done in a place where one is not going to be observed.
If there is some reason that testing and injecting must be done at the table, then health concerns come first; but if one can make it to a rest room or other, more private place, then it is polite to do so.
I do not agree about "gross insensitivity" but I do agree with "very poor manners." One should not force on others one's personal problems, especially in public, unless there is no alternative.
My usual way of doing testing and injecting is simply to go to the toilets and do my business there.
I'm not sure about "gross insensitivity and very poor manners," but maybe poor judgment. Depending on the time and place, testing and injecting may be in poor taste if performed at the table. I think it's a task better completed out of sight of other diners (especially in a five-star, metropolitan restaurant). I have many friends, associates and patients with diabetes and have been exposed to all circumstances. I think most folks sense their audience and act accordingly.
For those who find basic diabetes survival skills and practices to be insensitive and poor manners, perhaps it's time for them to become educated.
Elizabeth Gower, RPh, FACA
Salem, New Hampshire
Many of us talk about being treated "like anyone else" and then go ahead and make sure everyone nearby knows that we have a health condition requiring attention. As for me, I prefer some privacy.
John F. Cunningham