Films portraying diabetes mellitus need to get their facts right
We’ve all shouted from the sofa, “Why would you go down to the basement? At least take a weapon with you.” You don’t need any medical knowledge to know not to go into the basement when there’s a killer loose. “That’s not how hypoglycaemia works,” however, is a comment less often heard on film night, unless you’re a frustrated healthcare professional wondering how the film industry got diabetes so wrong.
I was enjoying the re-enactment of Zimbardo’s famous prison experiment in Paul Scheuring’s film, The Experiment, until one of the prisoners fell ill. He had type 1 diabetes mellitus. Apparently, because he had not had his insulin, he was hypoglycaemic. To treat him, another prisoner correctly gave him a piece of white bread to increase his blood sugar level, but the prisoner also, incorrectly, waited for his insulin injection, which would have the opposite effect and bring his sugar back down. This film, like several others, perpetuates inaccuracies about a condition that affects one in every 430-530 people under the age of 19 in the United Kingdom.
In the 2013 film Hansel and Gretel: Witch Hunters, Hansel had a deadly disease (“the sugar sickness”) caused by eating too many sweets as a child. He had to inject himself every few hours. When he missed his injection, his symptoms were similar to the prisoner from The Experiment; both became weak, breathless, and sweaty. These symptoms resolved immediately once Hansel injected himself—in the thigh, through his clothes (see box 1).
Box 1 Which type of diabetes does Hansel have?
If Hansel has got “the sugar sickness” from eating too many sweets, he is likely to have developed type 2 diabetes. The beta cells of his pancreas and the cells of his body have insulin. However, his body’s cells have become resistant to insulin over time, and sugar still stays in his bloodstream without getting into the cells. Type 2 diabetes is not treated with insulin. Instead, diet control to reduce sugar is used, sometimes along with drugs that help sensitise the body to its own insulin.
In Panic Room, a mum and daughter get locked in their “safety room” while three men rob the house. The daughter has insulin dependent diabetes. She starts feeling dizzy and hungry with no food or insulin injections available. Her apparent hypoglycaemic condition deteriorates quickly into a seizure and near comatose state. In the end, one of the robbers gives her an injection of insulin, rousing her immediately, but resulting in a confusing portrayal of insulin dependent diabetes for the viewer. Insulin would, in fact, drop her blood sugar further, risking death.
My frustration with these film portrayals of the recognition and management of type 1 diabetes took me online. I came across many film review sites with educated viewers slating films for not getting their facts right about diabetes. Additionally, in forums for people living with diabetes users express disappointment with the portrayal of people with the disease (see box 2).
Box 2 Commonly misconstrued facts about diabetes
- Missing an insulin injection will not lead to hypoglycaemia but may result in hyperglycaemia, and, potentially, diabetic ketoacidosis
- Having an insulin injection does not treat hypoglycaemia; conversely, it lowers the blood sugar further
- An injection of glucagon can treat hypoglycaemia by raising the blood sugar level.
- Excessive activity and injection of too much insulin for the amount of food consumed can lead to hypoglycaemia.
Type 1 diabetes is an autoimmune phenomenon. Beta cells in the pancreas that normally produce insulin no longer function. As a result, people with type 1 diabetes cannot produce insulin, which acts to regulate blood sugar levels by enabling sugar to leave the bloodstream and enter into cells to be used for energy. If too much insulin is injected for the amount of sugar consumed, the sugar leaves the bloodstream and goes into the cells, resulting in hypoglycaemia. The reverse is also true—lack of insulin can result in high blood sugar levels; hyperglycaemia, which can result in harmful short term effects, such as diabetic ketoacidosis, and long term effects, such as kidney, nerve, and ocular damage.
The characters in the films I have described exhibited symptoms of hypoglycaemia, including hunger, confusion, and, in severe cases, seizures. The films portray these symptoms well. However, a fundamental misunderstanding—that lack of insulin causes hypoglycaemia—lets these films down. So what would happen to these characters in real life?
Hansel is going about his day, eating and drinking normally. He’s not doing anything unusual when his “hypoglycaemia” strikes. In reality, without insulin his blood sugar would be above the normal range, but there would likely be no acute consequences, certainly none like the ones shown on screen.
With The Experiment’s prisoner and Panic Room’s locked up daughter, both characters are in stressful situations and lack food. The films rightly portray that the environment could cause them to enter a hypoglycaemic state. Sugar is the answer, and the white bread that the prisoner’s inmate smuggles him is the correct treatment. Similarly, the mum is right to look for food in the Panic Room. Both films get it wrong though by claiming that insulin is what people with diabetes need to save them from death caused by hypoglycaemia.
We know that lack of insulin could lead to diabetic ketoacidosis, the most common and serious acute complication of diabetes, representing 7.6% of admissions to an intensive care unit. Although far-fetched, it is possible that the prisoner and the daughter could have been experiencing diabetic ketoacidosis because of their lack of insulin. However, they would have been likely to exhibit nausea, dry mouth, extreme thirst, abdominal pain, and loss of appetite rather than the dizziness, sweating, and seizures seen in the films. And in the Panic Room, the daughter’s immediate recovery after an insulin injection is nothing like the complex insulin treatment that would have been required to treat diabetic ketoacidosis.
What was most disturbing was that my fellow, non-medical, viewers did not understand what was wrong with the portrayal and management of the characters who had diabetes. What if someone on the street was having a hypoglycaemic episode and someone thought it correct to give them an insulin injection?
For people who aren’t healthcare professionals, something they have seen in a film may be the only information they are exposed to about a medical condition. Perhaps medically qualified individuals or patients should review all medical content in films, whether that be on an individual level for each condition or by a group panel. Films should get their facts right when they show characters with medical conditions, especially when that portrayal might mean the difference between life and death.Stephanie Hill, final year medical student
1University of Nottingham
Correspondence to: firstname.lastname@example.org
Competing interests: None declared.
Provenance and peer review: Not commissioned; externally peer reviewed.
- Diabetes UK. Diabetes: facts and stats [patient leaflet]. Diabetes UK, 2014.
- NHS Choices. Hypoglycaemia—symptoms. www.nhs.uk/Conditions/Hypoglycaemia/Pages/Symptoms.aspx.
- Freire A, Umpierrez G, Afessa B, et al. Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis. J Crit Care 2002;17:207-11.
- NHS Choices. Diabetic ketoacidosis—symptoms. www.nhs.uk/Conditions/diabeticketoacidosis/Pages/Symptoms.aspx.
- Hardern R, Quinn N. Emergency management of diabetic ketoacidosis in adults. Emerg Med J 2003;20:210-3.
Cite this as: Student BMJ 2015;23:h3291