Morality in sugar talk: Presenting blood glucose levels in routine diabetes medical visits

Diabetes is a chronic illness with individual, social, and structural-level factors that contribute to its successful management. This paper utilizes conversation analysis to analyze a corpus of 60 audiotaped adult doctor-patient interactions. We examine how patients with diabetes and their physicians discuss blood glucose level management, including how physicians present patients with their test results and how patients respond to these presentations given the possible moral orientation around these activities. We show that physicians are more likely to present “good” blood sugar levels using assessments that explicitly evaluate the patients' condition. Contrastingly, physicians present “bad” glucose levels using report formats of numerical values alone. Interactionally, this requires that patients respond to these numbers by making sense of or accounting for their glucose level. The different practices of discussing blood glucose levels suggests that physicians approach this topic cautiously. This sensitivity balances epistemic asymmetry and may help physicians avoid direct moral characterizations of their patients. Our analysis connects interactional practices to the continuous negotiation of both medical epistemic responsibility and morality between physicians and patients with diabetes as well as the implications this may have in the medical management of this illness.