Film Review – Blood Sugar Rising


Premiere Date: April 15, 2020

Where you can watch: On the PBS website, channel or streaming service.

Directed by: David Alvarado 

Narrated by: S. Epatha Merkerson 

Produced by: WGBH


“In a broken system, it’s harder to follow the rules.” 

That’s one of the many gems in PBS documentary, Blood Sugar Rising, directed by David Alvarado. The documentary gives an overview of the diabetes and pre-diabetes epidemic in America, a disease that impacts over 100 million people and is predicted to be prevalent in half of the U.S. population by 2025. Through the stories of patients, providers, community health care workers, parents and more, Blood Sugar Rising puts human faces to those dire statistics. 

Blood Sugar Rising does a remarkable job discussing the nuances in type 2 diabetes management and what contributes to a type 2 diagnosis without placing blame on patients themselves. Discussions about type 2 diabetes usually revolve around blanket, stigmatizing statements and stereotypes like “eating too much sugar causes diabetes” or “being obese causes diabetes.” However, the documentary delves deeper into those statements by analyzing the socio-economic and environmental factors that contribute to the prevalence of diabetes, especially in communities of color. It adds to this depth through the stories of several people impacted by type 2 diabetes. 

One of those people is Monteil Lee, a 36-year-old aspiring rapper and a native of the Fillmore District in San Francisco. Lee is an African-American man who was diagnosed with type 2 diabetes at age 28 and is facing amputation of his toes due to a diabetes-related infection. At the time the audience is introduced to Lee, he has no primary care physician but finds one in Dean Schillinger, a UCSF primary care physician at San Francisco General Hospital. Schillinger orders Lee to remain off the infected foot to prevent and tend to the wound to avoid surgery. For Lee, remaining off his infected foot means no taking out the trash, no helping around the house, no pressure whatsoever. The film also does not shy away from showing the graphic nature of Lee’s infection. 

It’s mentioned in the film that Lee doesn’t fit the “stigmatized stereotype of someone with type 2 diabetes;” he’s a slender man who’s always been athletic. But due to his food-insecure, low-income environment, Lee has struggled to build and maintain healthy eating habits. He grew up eating candy, sugar sandwiches and drinking beverages high in sugar such as a Hawaiian Punch and Capri Sun. As a self-described junk food addict, Lee says it’s been a battle and struggle to improve his health. 

Anthony Hatch, Ph.D., a professor at Wesleyan Univesity and who specializes in social inequalities, notes the link between racial disparities and the incidence of diabetes. Hatch explained that our genes do not exist in a vacuum, they respond to their environment and these environments are structured to create inequality. It goes back to the quote from the beginning of this article—“in a broken system, it’s harder to follow the rules.” 

Across the country in the Bronx, New York is Karen Washington, a community activist who co-founded an urban farm called the Garden of Happiness in the late 80s. In 2010, her brother passed from diabetes complications. Washington is vocal about the “tale of two cities” such as her neighborhood and more affluent ones. Unlike richer communities, her community is riddled with fast-food restaurants and corner stores with little to no access to fresh fruits and vegetables. 

Washington, who believes it’s important to change the food system and believes healthy food access is a social justice issue, educates young children on gardening, connecting with food and making healthy eating decisions. She pushed back against the term “food desert” and said communities like hers have access to food, they just don’t have access to food options. 

But it’s not just urban communities struggling with the diabetes epidemic. Blood Sugar Rising showed how rural communities in Appalachia are impacted by it. Laura Greuser, a community health worker in Meigs County, Ohio, started living a healthy lifestyle after being diagnosed with prediabetes and decided to teach others how to do the same. Though her area had access to fruit and vegetables, Greuser stated her neighbors needed more nutrition education on how to implement healthy lifestyle changes, including carb-counting, how to read a food label and control portion sizes.  

Blood Sugar Rising also documents other issues unique to people with diabetes such as living with other diabetes-related complications, insulin access and affordability and parenting a child with type 1 diabetes. 

Nicole is a 35-year-old woman in Southern California who was diagnosed with type 1 diabetes at age 17. For years, Nicole lived in “deep-rooted” denial and carried on with life as if she didn’t have diabetes. She skipped insulin injections and ate whatever she wanted. As a result, she ended getting kidney failure and retinopathy and is shown awaiting a rare kidney-pancreas double transplant to save her life. To stay positive and support others, she started sharing her story on social media with the diabetes community. In Nicole’s segment, the documentary spotlights mental health issues associated with diabetes management, such as loneliness and sheer exhaustion of managing it 24/7. 

While Lee’s and Nicole’s respective stories show how diabetes complications can put one’s life in danger, it’s hard not to notice the access to specialists Nicole has compared to Lee, who is only to see a primary care physician for his diabetes care. It further shows how socioeconomics plays a role in the kind of health care one receives. Also, from a storytelling perspective, the documentary could’ve highlighted people with well-managed diabetes—both type 1 and type 2—who are living well with the disease. 

In regards to the issues surrounding insulin affordability, the documentary tries to tackle it without getting too deep into the weeds about the actual pricing structure of it. Instead, it focuses on the Smith-Holt family, who lost their loved one Alec, to diabetic ketoacidosis from insulin rationing. Alec had recently turned 26-years-old and aged out of his parent’s insurance. Soon after, the Smith-Holt family has been fighting for affordable and accessible insulin for all. 

Blood Sugar Rising also briefly explores the rising incidences of type 2 diabetes in children. Type 2 diabetes is more aggressive in children and according to Schillinger, they are more likely to experience complications earlier and more frequently than adults. Gretchen Carvajal, a poetry mentor for Youth Speaks in San Francisco, uses art and poetry to connect issues like food accessibility to diabetes. This is one of the lighter moments of the film, which serves as a reminder that there’s no one way to spread awareness about diabetes and the issues surrounding it. 

Overall, Blood Sugar Rising offers a refreshing, nuanced take on the impact of diabetes in the United States. General audiences will be able to learn about the differences between type 1 and type 2 diabetes, as well as the important social and environmental factors that contribute to type 2 that go beyond just “eating too much sugar” or “being overweight.” 

Diabetes is a serious disease that has life-and-death implications, but Blood Sugar Rising shines a light on how activism, education, innovation and even poetry, can help mitigate the impact of diabetes and fight against the epidemic. 

A quick note about Blood Sugar Rising: 

WRITTEN BY T'ara Smith, MS, Nutrition Education, POSTED 04/20/20, UPDATED 11/30/22

T’ara was diagnosed with Type 2 diabetes in July 2017 at the age of 25. Since her diagnosis, she focused her academic studies and career on diabetes awareness and living a full life with it. She’s excited to have joined the Beyond Type 1 team to continue her work. Two years later, T'ara discovered she'd been misdiagnosed with type 2 and actually has latent autoimmune diabetes in adults (LADA). Outside the office, T’ara enjoys going to the movies, visiting parks with her dog, listening to BTS and cooking awesome healthy meals. T’ara holds an MS in Nutrition Education from American University.