Etiquette for People Without Diabetes

Dr. Polonsky, PhD, CDE, founder and president of the Behavioral Diabetes Institute (BDI) in San Diego, California.

| Dec 7, 2009

Dr. Bill Polonsky, PhD, CDE, knows diabetes. Among other things, he has served as Chairman of the National Certification Board for Diabetes Educators, as a Senior Psychologist at the Joslin Diabetes Center in Boston, and as an Instructor in Psychiatry at Harvard Medical School. He is the founder and president of the Behavioral Diabetes Institute (BDI) in San Diego, California, and a member of Diabetes Health's Advisory Board.

A few years ago, Dr. Polonsky addressed the frustration experienced by people with diabetes when it comes to other people's reactions to their health. He developed a very popular Diabetes Etiquette Card that helps express those feelings. It's not necessarily meant to be handed to another person, however. Instead, it is more an acknowledgment that we have all felt this way at one time or another and that it's all okay. Dr. Polonsky says that it might be time for you to try talking to the family members who "only open their mouth to change feet" when it comes to your diabetes. They usually mean well, but they probably just don't understand how it is for you and how they can help you. You can let them know what's it's like for you gently and with empathy.

Here are Dr. Polonsky's 10 etiquette tips for people without diabetes, written from the perspective of someone with diabetes:

  • 1 - DON'T offer unsolicited advice about my eating or other aspects of diabetes. You may mean well, but giving advice about someone's personal habits, especially when it is not requested, isn't very nice. Besides, many of the popularly held beliefs about diabetes ("you should just stop eating sugar") are out of date or just plain wrong.
  • 2 - DO realize and appreciate that diabetes is hard work. Diabetes management is a full-time job that I didn't apply for, didn't want, and can't quit. It involves thinking about what, when, and how much I eat, while also factoring in exercise, medication, stress, blood sugar monitoring, and so much more - each and every day.
  • 3 - DON'T tell me horror stories about your grandmother or other people with diabetes you have heard about. Diabetes is scary enough, and stories like these are not reassuring! Besides, we now know that with good management, odds are good you can live a long, healthy, and happy life with diabetes.
  • 4 - DO offer to join me in making healthy lifestyle changes. Not having to be alone with efforts to change, like starting an exercise program, is one of the most powerful ways that you can be helpful. After all, healthy lifestyle changes can benefit everyone!
  • 5 - DON'T look so horrified when I check my blood sugars or give myself an injection. It is not a lot of fun for me either. Checking blood sugars and taking medications are things I must do to manage diabetes well. If I have to hide while I do so, it makes it much harder for me.
  • 6 - DO ask how you might be helpful. If you want to be supportive, there may be lots of little things I would probably appreciate your help with. However, what I really need may be very different than what you think I need, so please ask first.
  • 7 - DON'T offer thoughtless reassurances. When you first learn about my diabetes, you may want to reassure me by saying things like, "Hey, it could be worse; you could have cancer!" This won't make me feel better. And the implicit message seems to be that diabetes is no big deal. However, diabetes (like cancer) IS a big deal.
  • 8 - DO be supportive of my efforts for self-care. Help me set up an environment for success by supporting healthy food choices. Please honor my decision to decline a particular food, even when you really want me to try it. You are most helpful when you are not being a source of unnecessary temptation.
  • 9 - DON'T peek at or comment on my blood glucose numbers without asking me first. These numbers are private unless I choose to share them. It is normal to have numbers that are sometimes too low or too high. Your unsolicited comments about these numbers can add to the disappointment, frustration, and anger I already feel.
  • 10 - DO offer your love and encouragement. As I work hard to manage diabetes successfully, sometimes just knowing that you care can be very helpful and motivating.

The Diabetes Etiquette Card is free. Here's three ways that you can get a copy of the card:

1. Download a PDF copy from the Diabetes Behavioral Institute's website.

2. Get a hard copy of the accordion-style card at no cost by contacting your local Accu-Chek representative. Roche Diabetes Care has licensed and printed the card and distributes them to healthcare professionals and to people with diabetes and their loved ones.

3. Order it directly from BDI. To cover costs, they charge $1.00 per card plus shipping, and they only sell and ship orders of 50 cards or more.  You can call them at 858-336-8693 or email them at

Read Rachel Garlinghouse's recent article, "Dear Medical Professional" on how frustrating it can be for a person with diabetes to deal with their doctor.

Please post your comment below (be civil, now!) on other things you wish other people would understand about you and your diabetes.

* * *

Source: Behavioral Diabetes Institute

Click Here To View Or Post Comments

Categories: Blood Glucose, Blood Sugar, Diabetes, Diabetes, Food, Psychology, Type 1 Issues, Type 2 Issues

Take the Diabetes Health Pump Survey
See What's Inside
Read this FREE issue now
For healthcare professionals only

You can view the current or previous issues of Diabetes Health online, in their entirety, anytime you want.
Click Here To View

See if you qualify for our free healthcare professional magazines. Click here to start your application for Pre-Diabetes Health, Diabetes Health Pharmacist and Diabetes Health Professional.

Learn More About the Professional Subscription

Free Diabetes Health e-Newsletter

Top Rated
Print | Email | Share | Comments (19)

You May Also Be Interested In...


Posted by the poor diabetic on 7 December 2009

Nice article but most of the dos and donts can be avoided by just educating those around you on what diabetes is and what the diabetic life entails to debunk all the myths and prejudices

Posted by melenis on 7 December 2009

Excelent text, I will print the card to give it as a christmas present to all my relatives Thanks!

Posted by jcobbe on 11 December 2009

I agree with the first comment; but I would add that the most awkward interactions with those close to one are those surrounding hypoglycemic (or near-hypo) episodes, where the anxiety those close to one feels (remember, they've had to deal with you and you may not even remember in detail what condition you were in or your behavior) clouds their judgment about the 'best' behavior, and the hypo affects one's own behavior and judgment. A psychologist could probably give useful advice about that, but it is not just an etiquette issue.

Posted by Anonymous on 12 December 2009

I agree! With both points. Being a person born & raised in the south, a lot of family get togethers do seem to revolve around food, getting together to eat and socialize. And although I have never understood why people care about what I put on my plate & whether or not I eat all of it for some reason with a Mother & Grandmother they always seem to comment on, be distressed over why I didn't try... or why I didn't finish, eat all of______. "Was it not good"? Sometimes I know they do mean well... but other times it is frustrating or trying. It is a tough battle! Between the "Try this, a little bit won't hurt" and the "Should you be eating that" sometimes it does seem like it's just loose, loose with people that don't understand. While I do think we should try & do whatever we can to educate people, it also doesn't hurt to just let people know how we feel & things that they can to that really help. But that is not always so easily done. A lot of the things on the "Do or Don't" List I could really relate to. And while I do think family members often mean well they really just don't understand. Sometimes these are hard issues to talk about to people in a way that they will understand & not get upset or take personally. I don't really need the "I was just trying to help" thing either. It is enough sometimes just to deal with diabetes itself. There is enough guilt already associated with self care, "I shouldn't have eaten that" or "Why are my number up, what did I do wrong"? To have to worry about making the people around me that "are just trying to help because they care" make me feel even more guilty about hurting their feelings. A list that might offer some insight to how it feels and things that might help... Is definitely welcome. It is not a personal affront from me, but just some general tips. I'm thinking that it can only be a good thing, it can't hurt. I see this article as part of the way, another little tool to help me educate those around me. Thank You very much Kristen & Dr. Polonsky!

Posted by Anonymous on 12 December 2009

Thank you, Doctor. I especially liked the part about not hiding to check bg or take a shot. I don't flaunt these behaviors, i try to be quick and discrete when riding the bus or in church or running errands. But delaying shots or tests till I can find a public bathroom with an available stall can have serious consequences. At the least it can be very, very inconvenient.

Posted by Anonymous on 12 December 2009

The first comment is correct in many situations, but I've been educating folks about my diabetes for nearly 50 years and I see situations where this etiquette card could be useful. Most people are just trying to show their support and concern, but old habits die slowly. Having a well-written list from a professiona is a good backup plan for those who must repeatedly remind a family member or friend what support looks like. I've printed one for a friend whose teenage son was just diagnosed. I think it will help them work things out.

Posted by Anonymous on 12 December 2009

Dr. Polonsky may have a PhD in psychology, but he failed to graduate from elementary school when it comes to etiquette. TELLING adults how to behave is extremely rude; handing them an INSTRUCTIONAL CARD is worse. By doing so, one has stooped to at least as low a level as the ill-mannered diabetic comment. So, doc, stick with psychiatry and leave etiquette to Miss Manners.

Posted by cjensen61 on 12 December 2009

Having lived with diabetes for almost 40 years now, I would say that I can echo the 10 things written in the etiquette almost exactly! Some bother me a LOT more that others: like when people try to be the food police!! But I am learning that when a rude comment is made, I just try to maintain my cool while helping to educate another person who hasn't the faintest clue about what diabetes really is! There are thousands out there who haven't even the slightest idea of what diabetes really entails, so why don't we all start helping them? Getting angry can only go so far and I think educating and more ducating is the only key to solving some of these annoying rules of diabetes etiquette. Let all those with diabetes jump on the bandwagon and let's help make the non-diabetes community more enlightened!!

Posted by Rick on 13 December 2009

this all comes down to what is right and wrong. these ignorant clods are the type of people who would stare at someone with a disfiguring birth defect. i've had diabetes for 43 years and the only totally ignorant comment i ever received was shortly after i was diagnosed when a coworker said, "you better start having fun, you're not going to live long." i would advise anyone dealing with such insensitivety to say, "living with diabetes is hard enough, i could do without the ignorant statements!!" and people who are bothered at the sight of someone testing or injecting? sometimes healthy people are just a pain in the a*&!! healthy people are a huge majority in the U.S. someday i would like to see anyone with any chronic illness all form some kind of, for lack of a better word, a union. and fight for our rights!!

Posted by Anonymous on 14 December 2009

I am a diabetes educator. When I mention that people always ask for my advice about how to handle their diabetes or their husbands diabetes. Sadly, many still do not know about carbs. I do not think it is wrong to offer advice on managing diabetes as many people need it. Sadly, most insurance companies don't pay for education and people on pills only often have no education at all.

Posted by Anonymous on 15 December 2009

Very well written. I plan to share it with the important people in my life.

Posted by jbarnes on 16 December 2009

Great article, thanks Dr.! I also would like for people to realize that I also have days that I just don't feel well and want to be able to say, "I want to rest"and not have to explain why. I know everyone has days like this but, I think we diabetics have these a little more often. It is sometimes hard to explain this to my family or friends.
I belong to a Diabetes Education Task Force and plan to share this article with them. Thanks again, for the great article!

Posted by Anonymous on 21 December 2009

I heard Dr. Polonsky speak to a group at the Mall of America in MN, where he shared these cards. At the time, and still today, I think they are a great idea! Yes, it may be awkward to address adults in this manner, but for me, it's alot better than internalizing my frustration! Thank you, Dr. Polonsky!

Posted by Anonymous on 21 December 2009

I forwarded this on to many friends and relatives. THANKS for writing this article!

Posted by Anonymous on 23 December 2009

My son has type 1 and I would like to add please don't compare you handling your dogs diabetes with my son and his diabetes.

Posted by Anonymous on 27 December 2009

As a T1, I would say that I greatly appreciate any effort from any person to clarify the personal boundaries of T1 people. I would like to suggest that the whole "making healthy lifestyle choices" and "offer to help" as well as the "make a safe place for diabetics" suggestions may be well-intentioned, but they do, in fact still suggest that a non T1 person make decisions on behalf of a T1 diabetic. I wish that I could show this to me lifelong friend who is so very thoughtless and compulsive in her "advice" and controlling behavior, but because it also enables people to opine, if covertly, she'd use it to justify her rudeness. Please curtail the whole "help the D person by 'suggesting' joining in some healthy decision." It doesn't help. Leave the health decision part to another brochure on how non T1 people can actively interfere in the existence of a T1. This pamphlet should curtail all boundary violations instead of encouraging them in places. I know you didn't mean to do it, but you have.

Posted by Anonymous on 29 December 2009

Having a child with diabetes (type 1) it breaks my heart when some of the insensitive comments are made to him. I just wish some people would think before they speak.

Posted by Anonymous on 4 February 2010

Dr. Polonsky, do you have either T1 or T2 diabetes? Why do you use the word "choices"? T1 is not a choice. I have a suggestion for an ettiquette card. I would have one sentence, in all caps. Feel free to sign it with your MDiety title, Doctor. "MIND YOUR OWN BUSINESS."

Posted by Anonymous on 10 October 2014

I have had type I diabetes for 42 years. Dr. Polonsky's article was comprehensive, and unique, because it addressed people who do not have diabetes- there are few articles on etiquette in this area. Sadly, though, many people, at least, in my experience, have a hard time hearing these dos and don'ts for their behavior. I have tried to explain it to people very tactfully, yet, somehow, they get mad at me anyway. It is so frustrating. My reaction, has been, and I can't say it's the most healthy, is to keep my diabetes Very Private, and walk away from people who make rude comments. That's the best I can do at this time. However, kudos to Dr. P, for writing this article, and I hope that it helps people come closer to an understanding of what people with diabetes live with every day. Thank youl.

Add your comments about this article below. You can add comments as a registered user or anonymously. If you choose to post anonymously your comments will be sent to our moderator for approval before they appear on this page. If you choose to post as a registered user your comments will appear instantly.

When voicing your views via the comment feature, please respect the Diabetes Health community by refraining from comments that could be considered offensive to other people. Diabetes Health reserves the right to remove comments when necessary to maintain the cordial voice of the diabetes community.

For your privacy and protection, we ask that you do not include personal details such as address or telephone number in any comments posted.

Don't have your Diabetes Health Username? Register now and add your comments to all our content.

Have Your Say...

Username: Password:
©1991-2014 Diabetes Health | Home | Privacy | Press | Advertising | Help | Contact Us | Donate | Sitemap

Diabetes Health Medical Disclaimer

The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained on or available through this website is for general information purposes only. Opinions expressed here are the opinions of writers, contributors, and commentators, and are not necessarily those of Diabetes Health. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website.