Not a report card: the words that help and the words that hurt

What people say about diabetes — at the dinner table, at work, in the clinic — shapes how safely someone can live with it. This page explains why a number is not a grade, which sentences published guidance says to avoid, and what to say instead.

An A1C is not a report card on how hard someone tried

An A1C is the joint product of many things: biology, access to technology, insurance, food security, mental health, the quality of the education someone was given, whether their clinician's language made them want to come back — and effort. Effort is one input among many.

It is also the only one anyone ever gets blamed for. And blame makes every other input worse: people who experience stigma have higher A1C, more variable glucose, and are less likely to come back for follow-up care.

Shame is not a motivational tool that happens to fail. It is a risk factor.

If you are with a family, this is the sentence the person with diabetes most needs the others to hear.

The sentences that do damage

This list is not opinion — it comes from published guidance on diabetes language. If you recognize something you have said, you are in very large company; the point is what comes next, not blame.

Why it matters

Judgement causes concealment. People under-report readings they expect to be judged for — and hidden numbers are a safety problem, not just a feelings problem.

People with diabetes are clear about the words they prefer. Across surveys, 96% of people with diabetes reject "sufferer," and 83% reject "good" and "bad" applied to blood sugar. That is why this site talks about glucose being in or outside the target range, and uses the actual numbers.

A few swaps

• "Diabetic" as a noun → "person with diabetes" or "person with type 1"
• "Good" or "bad" numbers → "in range," "high," "low," or the number itself
• "Control" → "manage"
• "Compliant" → describing what is actually happening, without a verdict

The food version of this — "are you allowed that?" — has its own advice for hosts in For coaches, teachers and hosts.