A healthy relationship with sex starts with self-love. I had to accept being diabetic as a part of my physical and emotional identity.


Editor’s Note: This Sexual Health and Awareness month, we will be exploring related issues at BYP, and we are interested in publishing works that address these topics. What does sexual health look like outside of cishetero norms? Where does the #MeToo movement go from here? What can we do to better support survivors, including survivors of childhood sexual violence?

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By Kui Mwai

Mike and I laid on his queen size bed, legs-tangled in a boyish blue colored blanket obviously picked out by his mother from Target’s back-to-school section years ago. We were scrolling through Netflix, engaging in a tense debate over whether we should watch Dear White People or Black Panther.

After our playful banter ran its course, I surrendered. As the opening starry night scene of the Marvel movie graced his TV, we continued to chit chat about our days and giggled telling each other anecdotes about our wacky coworkers. The sexy concoction of our chemistry blooming with a film that is a pinnacle of Black excellence eloquently playing in the background led to a passionate kiss.

Then things started to escalate. Blankets and clothes were thrown. Bra hooks were hunted for, and as Mike was fiddling with them like someone trying to crack open a safe, I stopped him. This would have been our first-time having sex, and I knew, before we gave in, I had to have an important conversation with him. 

I sat up and started nervously going through a speech I’ve carefully curated over the last 3 years. It starts with confirmation of my excitement, something in the realm of “I’m so excited to get closer to you in this way,” or a blunter “I can’t wait to have sex with you.” Then a drop the “but” bomb. But I’m not on birth control. Most men try and shield their disappointment. Their attempts are appreciated as being painfully transparent. This transparency manifested in Mike in the form of a brief furrowed brow. Then the conversation gets interesting. Twelve times out of ten, my gentlemen callers question why I’m not on birth control, which then launches the conversation into a 150-characters-or-less description of my medical history.

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With a disease playfully (and problematically) coined “the sugah” in the Black community, I am one of 1.25 million Americans living with type 1 diabetes (T1D). T1D is a disease that affects the body in nuanced, viscous ways. But diabetes generally has a very specific perception. Most people envision the grandparent archetype: older, slightly overweight, a lover and best-maker of all things sweet. But that is only a tiny sliver of the pie. 

Both this stereotype and disease are unfortunately prevalent in the Black community. African Americans are twice as likely to be diagnosed with diabetes and more likely to suffer from complications from diabetes, like end-stage renal disease and lower-extremity amputations, than white people. Despite its prevalence, when I talk about my diabetes, how it affects me or how it’s inspired certain choices in my life, many times my suitors don’t hear me. They only understand diabetes by way of their aunties yelling at their grandma to put down the sweet potato pie. But my disease isn’t a comical scene from family cookouts. It’s me. 

Unfortunately, Mike responded to my speech as expected. He was nice enough, but I saw his rejection of my truth as his eye glazed over and he begrudgingly offered his “understanding.” Things cooled off, our passion muted, and we went back to watching Killmonger challenge T’Challa to battle. 

Because diabetes is caused by a lack of insulin, a hormone, diabetic women have to approach birth control cautiously. Introducing new hormones like estrogen and progesterone can compromise a diabetic body. The estrogen used in most birth control pills can raise blood sugar levels, affecting insulin resistance and requiring a change in medication. Some doctors refrain from prescribing hormone-based birth control for diabetic women. 

So what’s a diabetic woman to do? Our options are bleak at best. IUDs are a major “no” because most of us are prone to pelvic infections. Any kind of foreign object inserted in our vaginas would be asking for trouble. A significant number of women reported that they needed double the insulin when on the pill. Injections? They have been linked to weight gain which can also inspire insulin resistance.

The ring appears to be a safe option for diabetic women. The way in which the ring distributes hormones into the body avoids certain blood sugar malfunctions. But the makers of the ring advise women who already have any complications from diabetes should not use the ring. Diaphragms and barrier devices like condoms are the safest option, but are not rid of risk. The spermicide used in some barrier devices can increase the risk of urinary tract infections (UTIs) and birth control of this kind only has around 70% effectiveness compared to the 99% effectiveness of the pill or the ring.

Risking the effects of birth control is not an option for most of those with diabetic complications. My decision to choose the easy-going path of being a 20-something woman not on birth control was inspired by my battle with diabetic ketoacidosis (DKA). DKA is a diabetic complication that occurs when the body produces excess blood acids. Those excess blood acids make your body shut down. It was a horrifying experience. I was in and out of the hospital for months, as my team of doctors struggled to find the right medications to heal the various ways DKA had suppressed my health. I was in a never-ending state of fatigue and lost more than half my body weight in a span of months.

As a Black woman, losing my body was losing my identity. The maternal figures in my life instilled a sense of strength and pride in my figure. My body was carved by my ancestors in the shape of our likeness, our stories, our personality as a group of people. I absorbed that idea early in my life and learned to love my body for the power it gave me. In time, the world caught up to the way I saw myself. The age of body positivity started gaining momentum, right as I was losing my body, and my positivity. I felt disconnected from myself and my Black identity. 

My experience having DKA traumatized me and has instilled a personal aversion to hormone-based birth control. I’m terrified of introducing new hormones into my body, potentially catapulting right back into a DKA-state. 

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That fear is ringing in my ears when I have the birth control conversation with my partners. I’m afraid of not only how having safe sex can affect my diabetes, but how to explain my health experiences and choices in a way that isn’t overwhelming or rejection-worthy.

A healthy relationship with sex, whether you’re diabetic or not, starts with self-love. I had to accept being diabetic as a part of my physical and emotional identity. I had to get rid of the shame I had about having the body that I do, and the disbelief I had that I could be diabetic, pursue my desires and be desirable. Achieving self-love eases communication about intimacy, which makes the experience enjoyable. 

I’m still trying to figure out what a healthy diabetic sex life looks like for me. I’m still scared to talk to my sexual partners about my choice to not be on birth control. I’m afraid to be rejected and judged for having a disease that isn’t generally assigned to my demographic. I’m scared of how the physical and emotional vulnerability could compromise my body and my mind.  

Mike’s response and those of all the other men I’ve talked to about my diabetes was disappointing. For a moment, it made me question the validity of my struggle and the desirability of my insulin-deficient body. But in a leap towards a healthier sex life, I’ve learned to embrace self-love, and am glad I spoke up. I’ve learned to accept and love my diabetes, because it makes me who I am. I’ve learned to be proud of my choices, because they are made out of my commitment to my health and to protect the most important relationship in my life: my relationship with myself. 

Kui Mwai is a freelance writer based out of DC. Her passion is using the written word to offer authenticity, humor and truth to the issues that face the communities she is apart of- the black community, the international community, the feminist community. She prides myself on using my third culture perspective to offer compelling and fresh commentary on a myriad of social topics, from women’s issues in sub-Saharan African to black culture in America.