From a Source of Life to a Weapon: Insulin Representation in Drama 

By Ali Hisham

“Why are you injecting me with this dangerous substance for all these years? It kills!” the young girl asked, moving her eyes between the needle and her mother’s eyes, wiggling her feet, and shaking. Unable to provide an answer, the mother turned off the television, vowing never to watch that series again. In this series, insulin injections were not represented as the life-saving substances they are; instead, they were portrayed as harmful tools used for violence and killing others.

“My daughter was diagnosed with type one diabetes when she was 2 years old and has been insulin-dependent ever since. Without insulin, we would lose her. She frequently asks why she is suffering from this chronic disease. Now a teen, she is experiencing several mental health issues because of diabetes, which sometimes lead her to self-neglect through skipping medication doses or refusing to take them,” her mother says, commenting on the shocking scenes they watched in the “Baba El-Magal” TV series.

Representing disabilities in drama has always been a sensitive and controversial topic, especially regarding hidden physical disabilities, such as diabetes, or psychological conditions, such as depression. These portrayals influence public perceptions and attitudes towards these conditions, and sometimes perpetuate stereotypes. Diabetes, and insulin specifically, are frequently presented in Egyptian drama as aspects of life to which many people can relate. In a country where over 15% of the population is diabetic, according to the International Diabetes Federation (IDF) in 2020, these portrayals are significant.

During Ramadan in March 2023, insulin was portrayed three times in two Egyptian TV series. “Al-Sundooq” series represented a doctor who is practicing mercy killing for cancer patients by injecting them with insulin overdoses. While this story could be criticised for highlighting the potential abuse of medication, the mention was brief (in 2 seconds) and went unnoticed. However, the World Health Organisation (WHO) put out guidelines for filmmakers to avoid depicting this method of violence, which could have been avoided in this case.

Worse, and more crudely breaching to all WHO guidelines, “Baba El-Magal” series, performed by the Egyptian star Mustafa Shaaban, depicted insulin twice as a harmful tool used in violence and ending lives. In episode 10 of “Baba El-Magal”, a villain kidnaps a child with type one diabetes to use as leverage against the child’s father, threatening to end the child’s life by injecting an overdose of insulin. Beyond the cruelty of the scene, in which the diabetic child was screaming while looking at the needle, the scene provides a detailed description of the action. The villain inquires about the number of insulin units the child needs with meals, then threatens to inject a lethal dose of insulin, mentioning a specific number of units that leads to death. WHO guidelines sternly warn against detailing violent acts, especially providing technical details that could assist in committing such harmful acts towards self or others. The episode did not include any disclaimers, helplines, or advisory messages as recommended by the WHO guidelines.

In episode 25, insulin is once again associated with violence as a character commits a crime, leading to death by an insulin overdose. The villainous character showed off with the “smart” and silent method of violence, even making jokes about insulin overdose. Without any dramatic context, this portrayal continues to suggest harmful uses for insulin, diverting from its purpose as a life-saving medication that tens of millions of people of all ages use daily. Furthermore, labeling a violent action as ‘smart’ is unacceptable, as guidelines recommend the use of appropriate language in this context, and obviously not to promote to such actions.

The World Health Organization’s guidelines for filmmakers on Preventing Suicide highlight the concerning issue of The Copycat effect, wherein audiences get significantly influenced and driven to imitate what they witness in news and media.

Such incidents reignite the ongoing debate between artistic liberty and social responsibility. While there’s always room for discussion on this matter, the line is drawn when human safety is at stake. Inaccurate portrayals could inadvertently encourage self-harm or harm to others, intensify misconceptions, and further stigmatise diabetes. These portrayals dangerously blur the line between life-saving medication and abuse, potentially sparking suicidal thoughts or aggressive actions among those dependent on insulin for their survival. This could even establish a new stereotype, instilling fear about these insulin dependent diabetics, a scenario likely to unfold in schools. Research already shows that adolescent diabetics find it challenging to inject insulin in public. Imagine how these portrayals could exacerbate the situation.

The intersection of drama and public health in these cases highlights the critical need for following safety guidelines. The repercussions go beyond the television screen, exacerbating existing distress and adding new risks beyond those already present.

Diabetes and Mental Health

Type one diabetes is a chronic condition in which the pancreas is damaged, impairing its ability to produce insulin, a crucial hormone necessary for living. Diabetes can be diagnosed in infancy, as early as a few months old, or later in life. Type one diabetes requires following a strict lifestyle, which includes taking multiple insulin injections daily and continuously monitoring their blood sugar levels. Insulin dependent diabetics no matter their age, could be in school or retirement homes, must be responsible for giving insulin injections to themselves whenever they eat, making them dependent on these injections for managing their condition.

According to a study by Stanford University, individuals with diabetes make an average of 180 more daily decisions than non-diabetics. This constant pressure puts them at two to three times greater risk of developing mental health illnesses, or at least experiencing diabetes burnout. Suicide and self-harm have been linked to this condition; type one diabetics are 61% more likely to feel suicidal, according to the American Diabetes Association. Misusing insulin has been reported as one of the most common tools for self-harm among both diabetics and non-diabetics. A study conducted on 160 insulin overdoses leading to severe hypoglycemia revealed that 90% were suicidal or parasuicidal, while only 5% were accidental. Given its significance, advocacy groups have been created for this cause, such as RESCUE (Reducing Suicide rates amongst individuals with diabetes).

The objective extends beyond addressing the damaging portrayal of insulin and diabetes in Egyptian dramas and correcting misrepresentations in the media. It is a crucial appeal for awareness regarding the multifaceted impact of chronic conditions on individuals’ mental well-being. The mental health of diabetics, often overshadowed by the substantial emphasis on physical health, deserves equal attention and concern. The media’s misrepresentation aggravates the psychological burden, reinforcing stigma and enhancing fears. It is essential to recognize and address these intertwined aspects of living with diabetes or any chronic condition. By shedding light on this, we can collectively work towards a more informed, compassionate, and inclusive society where individuals’ mental and physical health are treated with equal care and respect.