Language Used for Insulin Management Impacts Patients’ Diabetes Outcomes

The therapeutic relationship between a pharmacist and a patient managing diabetes often begins at the counter, but new research suggests that the most critical exchange may not be the insulin itself but the language used during the encounter.¹

“Diabetes management is unique to each individual and embedded in every aspect of life, physically, psychologically, and socially,” the study authors said.¹ “A negative psychological relationship with diabetes can contribute to distress, burnout, depression, anxiety, and non-adherence.”

According to a 2026 study published in Global Qualitative Nursing Research and colleagues, language serves as a vehicle for individuals to express and defend their desired identity while navigating the complexities of chronic illness. For pharmacists, who frequently monitor medication-taking behaviors, understanding these subtle linguistic patterns is essential for fostering the trust required for effective insulin management.¹

The study, which explored the experiences of adults using insulin pumps, found that patients often use specific language practices to build a bridge of communication with their health care providers. When this bridge is strong, patients use rhetorical questions, similes, and metaphors to invite the listener into their daily reality, such as comparing the routine of insulin administration to the simple act of brushing one’s teeth.¹

However, when patients feel judged or misunderstood, this bridge erodes, leading to a loss of trust and a decreased willingness to discuss the actual challenges of their journey. For a pharmacist, identifying these invitations to understand can be the difference between a patient who is honest about their insulin usage and one who feels the need to hide their struggles.¹

Despite the clear importance of supportive communication, a secondary analysis of health care provider interviews revealed that stigmatizing language remains deeply embedded in clinical practice. Researchers found that providers frequently use labeling language such as "diabetic" or "noncompliant," as well as terms with negative connotations like "control" and "testing.”²

In one instance, a pharmacist interviewed in a rural setting noted that although they recognized "noncompliant" was an inappropriate term, it was still used by nearly every provider they worked with. This disconnect is significant because words like "compliance" and "adherence" imply an authoritarian power dynamic where the patient is expected to simply take orders rather than make active, informed choices in their own self-management.^2,3,4

The impact of this language is not merely psychological, as it has direct clinical consequences. When patients feel stigmatized or blamed for their blood glucose levels, they may experience higher levels of psychological distress and depressive symptoms, which are associated with fewer self-care behaviors and higher A_1C values. Research has even shown that hearing negative or pain-related words can activate brain networks similar to those triggered by unpleasant physical stimulation, potentially increasing the perceived burden of daily injections or site changes.^2,4

Furthermore, the label of "noncompliant" can become a self-fulfilling prophecy. Providers who perceive a patient as "unwilling" or "uncontrolled" may be more likely to delay necessary escalations in therapy, such as the initiation of insulin.²

The investigators of the current study found that patients use distinct strategies to defend their self-esteem and sense of efficacy when they feel their identity is threatened. For example, patients might "whisper" when recounting behaviors they perceive as "deviant" from medical recommendations, or they might offer extensive justifications for why they chose to individualize their treatment plan.¹

They also discussed that patients often personify their technology, with 1 participant describing how their insulin pump "hiccups" when they eat pizza. These anthropomorphic descriptions allow patients to frame the challenges of diabetes as an interaction with an external actor, mitigating the personal blame often associated with fluctuating glucose levels.¹

To counter the negative effects of stigma, international diabetes organizations now advocate for a language movement centered on person-first, strengths-based communication. This approach involves using neutral, fact-based terms—such as "medication taking" instead of "compliance" and "blood glucose targets" instead of “control.” By focusing on what a person is doing well rather than what they are failing to do, pharmacists can help build the self-efficacy necessary for long-term health.^2,4

Ultimately, the way a pharmacist listens is as important as what they say. Attending to language practices gives insight into a patient’s identity and potential threats to that identity in a way that direct questioning cannot. When a patient uses distancing language, referring to their condition as "the thing" or "it" rather than "my diabetes," it may signal a lack of ownership or a threat to their sense of competency.¹

Conversely, the use of possessive terms often reflects a high degree of comfort and confidence in their management. By hearing these unexpressed needs and adapting their own language to be respectful and inclusive, pharmacists can strengthen the therapeutic relationship and provide the tailored support essential for successful life with diabetes.¹

“HCPs [health care providers] must pay attention to indirect verbal cues and recognize language practices that protect diabetes identity. This understanding aids in comprehending a person’s self-management journey, needs, and challenges,” the study authors said.¹ “Developing the skill to hear unexpressed needs strengthens relationships and enables tailored professional support for self-management.”

READ MORE: Insulin Management Resource Center

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REFERENCES

1. Gonzalez J, Crossman R, Spiers J. "Do You Understand What I Am Saying?": Exploring Language Practices in Describing Life With Diabetes. Glob Qual Nurs Res. 2026;13:23333936261426775. Published 2026 Mar 2. doi:10.1177/23333936261426775

2. Beverly EA, Hughes AS, Saunders A. Examination of Health Care Providers' Use of Language in Diabetes Care: A Secondary Qualitative Data Analysis. Clin Diabetes. 2022;40(4):434-441. doi:10.2337/cd21-0108

3. CDC. Speak the language of diabetes: language guidance for diabetes-related research, education and publication. 2021. Accessed March 6, 2026. https://www.cdc.gov/diabetes-toolkit/media/pdfs/speaking-the-language-guidance.pdf

4. Dickinson JK, Guzman SJ, Maryniuk MD, et al. The Use of Language in Diabetes Care and Education. Diabetes Care. 2017;40(12):1790-1799. doi:10.2337/dci17-0041