Physical and mental health conditions affect many people and there is still a lot of stigma and misunderstanding around different problems people have.  Tackling that stigma and misunderstanding is difficult, but as a society we’d like to think that we are more open and understanding than ever before.  However, how can we honestly be understanding of medical conditions if television dramas depicting them get their facts so wrong?

On Saturday evening, a television shows called Casualty aired on BBC One in the UK.  The show, which has been running on UK screens for decades, is a medical drama series showing what happens in the emergency department of a typical UK NHS hospital.  As with any medical drama, there are a range of different physical and mental health conditions that patients present with, alongside accidental emergencies.  One of these medical conditions shown in saturday’s show was of a diabetic teenager messing with her insulin intake in order to lose weight.  The drama of the show was good and having had type 1 diabetes since the age of ten myself, I’m always keen to watch any depiction of this in film and television.  However, it soon became clear that something was wrong and the script writers clearly hadn’t done the most basic of research.

What happened in the show

The girl at the heart of the story was a teenager who was being moved from foster carer to foster carer, never really having a settled long-term home.  She was first seen running erratically through a park before running straight into a bus, causing herself accident with cuts and bruising to her face.  She fell unconscious after hitting the bus and was taken into the hospital siffering from a hypoglycemic attack (or a hypo) where her blood sugar levels were dangerously low.

After being fed a drip of glucose to stabilise her, she later removed the glucose drip and locked herself in a toilet ccubicle, suffering from another hypo attack.  As the story came to its conclusion we found out that she didn’t want the glucose drip or any kind of glucose fed to her because she was afraid of the calorie content of it, she didn’t want to put on any weight.  The nurse speaking to her explained the dangers of messing with her insulin in order to lose weight and she eventually, reluctantly sought help.  This story was clearly meant to be showing a severe eating disorder that type 1 diabetics can suffer from called diabulimia.  However the term diabulimia was never mentioned and the basic facts of diabetes were incredibly messed up!


Diabulimia is an eating disorder (and therefore mental health condition) where type 1 diabetics restrict their insulin intake in order to lose weight.  Although the term sounds like bulimia it has nothing to do with the condition and is more like anorexia as diabetics get thinner and thinner at a rather alarming speed.

The human body converts all carbohydrates we eat into glucose which moves around in the blood stream so it can get to all the body’s cells.  The cells need glucose to use as energy, but insulin is needed to move that glucose into the cells of your body.  It’s a normal process that happens to everyone everday, but type 1 diabetics don’t produce any insulin at all in their bodies and so without them injecting insulin they will continue to have the glucose in the blood stream and there is no way for it to move into the cells.  The cells of your body need the glucose for energy and to function, so the body instead resorts to burning up it’s own fat reserves in order to get entergy from somewhere.

You may have heard the term ketosis in dieting, this is the process of eating few carbohydrates in your diet and therefore burning up fat rather than carbohydrates/glucose, but with ketosis people’s bodies will always have regulated blood sugar levels and you still end up eating a healthy diet and maybe a small portion of carbs.  But diabetic ketoacidosis (DKA) is a much more severe condition, where diabetics also have very high blood sugar levels and the term ketoacidosis is so called because the blood stream literally turns acidic making it hard for the whole body to function normally.  It can leave people feeling very nauseous and in pain as well as cause severe complications including at the exteme end, things like blindness.

So the condition (DKA) is a serious one and it’s good that it is depicted on television.  But the problem with the girl in the show was that she was suffereing from hypos, a reaction of having too much insulin in the body, not too little.

TV confusion

The story of diabulimia, if shown correctly, would have shown the girl having hyperglycemia and suffereing from DKA (diabetic ketoacidosis) which is the result of too little insulin in the body for a long time.  The girl wouldn’t have been hypoing as shown in the drama, instead she would have been suffering the syptoms of DKA which include tiredness, pain in the abdomen and other areas (I’ve had severe muscle cramps in my legs from this condition in the past), rapid breathing and other symptoms of high sugar which include needing to urinate and drink a lot.

The symptoms of low blood sugars and hypos are very different and it would be very hard for the girl hypoing to not feel hungry as hypos tend to make diabetics ravenous and if we don’t control ourselves it’s easy to eat half the fridge in a few minutes (not joking, you literally feel starving!)

The girl was also shown running through the park in the first scene which is almost impossible to do while having a hypo as diabetic muscles literally feel drained of energy and you’re more likely to collapse than successfully run.  While the television drama did a good job of showing the various symptoms of very low blood sugar including fitting when having extreme hypos, giving glucose to this girl would have been useless if she had been really suffering from DKA.  Without insulin in her system that glucose would just continue to move around her blood stream, never getting into the cells where it was needed.  Instead a DKA sufferer needs to be given insulin.

Tackling stigma/misunderstanding

There is a lot of stigma still attached to eating disorders which are really mental health conditions with vrery physical symptoms.  While we’ve come a long way in trying to understand mental health more, there is still a lot of misunderstanding in the world today around the different medical problems, chronic, physical and mental, which people can suffer from.  And while there is misunderstanding there will be stigma attached to them.  Misunderstanding can also lead to well-meaning people doing the wrong thing in an emergency.  They might see someone collapse from high blood sugar and try to give them glucose and the opposite can be true to, some may try to inject a diabetic’s insulin into them when they are fitting from a hypo.  Both scenarios can lead to very dangerous complications and even death!

Casualty isn’t the first drama to get its facts wrong about diabetes, I’ve seen the same thing happen for years in various shows.  For example, well over ten years ago a story in a daytime medical soap called Doctors (also on BBC One) showed a diabtic woman going into a hypo and getting confused (which are the symptoms of hypos) but instead of eating something she decided to get out of her car and collapse outside it.  Within minutes she was dead when a doctor appeared on the scene, she didn’t fit, she didn’t fall into a diabetic coma, she just died right after being awake.  This isn’t quite how diabetic hypos work, people like in a coma for a long time before dying (often brain damaged) and the whole storyline depicted a woman who had diabetes for years but not the first clue on how to treat it.  Some scriptwriters and television producers get it right while others don’t seem to do the most basic of fact-checking online before taking a script and filming it.

Television shows, particularly medical ones like this, are obviously here for our entertainment but I believe they also have a responsibility to get their facts right before showing the truth of the complications of medical conditions like type 1 diabetes.  People can and do approach me sometimes commenting on medical conditions I’ve had thinking they know the right treatment for me after watching a television show.  They believe that because they saw something in the show, they must be right and I (who have lived with the conditions) must be wrong. 🙄

Final statement

Television and film need to do a better job of researching their content before producing it.  Books with such ridiculous factual errors would do very badly if published and there are some editors who are there purely to check facts in books before having them printed.  It’s not just the case that there are a few silly errors like a coffee cup left in the middle of a fantasy drama scene, these are medical facts which people will take back into the real world and treat as facts.

If this is the quality the television script writers and producers are willing to put into todays dramas, especially BBC dramas, then I have to question where on earth do they get their scriptwriters from?  And to be honest it also makes me question the price of the TV licence in this country too!

Did you watch this episode of Casualty?  Have you seen television of film shoing wrong facts of misinterpretations of medical conditions?  Let me know what you think in the comments below 🙂