Evaluation of Diabetes Representation in Middle Grade and Young Adult Fiction


Books and other forms of media have the ability to shape how society perceives certain conditions and disabilities, such as type 1 diabetes. As someone who is knowledgeable about diabetes, I set out to create a list of novels that feature type 1 diabetes in a positive and empowering way. Unfortunately, there is an overall lack of novels that feature diabetic characters and offer readers an accurate portrayal of the condition in middle grade and young adult literature. In the future, I hope to see authors embrace diabetes and create stories those with diabetes can see themselves in.

Below I have ranked a variety of middle grade and young adult novels for their portrayal of diabetes to help create awareness of the need for more diabetes representation in these genres and provide praise where it is due.

Middle Grade Reads

96 Miles by J. L. Esplin

“What I’m questioning is his willingness to do anything hard—or in this case, anything revolting—in order to save himself.”

96 Miles is truly a story of determination. After a Western Interconnection Power Grid failure leaves the western United States in a detrimental blackout, the Lockwood brothers are forced to
take drastic steps for survival, including walking ninety-six miles in the Nevada desert to Brighton Ranch for desperately needed supplies. The book features many interesting flashbacks to the first days of the blackout and their journey, and loyalties are put to the test during the disaster. The brothers’ journey is grueling, but they form meaningful relationships along the way. However, I found the main character John to be completely unlikeable. In addition, the reveal of Stewart’s type 1 diabetes is used as the climax of the story, which I did not enjoy. Using diabetes as the hidden main source of drama felt insensitive to me. I appreciated John’s admiration for those with diabetes, but I think it would be difficult for readers with diabetes to relate to the representation. If you like survival and adventure, give 96 Miles a try, but do not expect normalized or continuous diabetes representation.

Sal and Gabi Break the Universe by Carlos Hernandez

“I was the one who could feel the fabric of the cosmos like a stage curtain in a pitch-black theater. I could feel it, and I could do things to it. Like open it.”

Sal and Gabi Break the Universe is a cosmos-wide adventure that keeps readers at the edge of their seats! Thirteen-year-old Sal is not like other middle schoolers. For one thing, he has type 1 diabetes, but he also is an aspiring magician with the ability to tap into other universes. After a serious mistake involving Sal’s deceased Mami, Sal and his family relocate to Miami, where Sal starts at the Culeco Academy of the Arts. There, he meets whip-smart student body president Gabi who quickly catches on to his secret ability. Hernandez utilizes an engaging writing style, captivating descriptions, and humorous inner monologue readers can easily relate to. The diabetes representation is perfectly balanced throughout the plot—Sal is shown checking his blood sugar levels and being mindful of his condition while also addressing common stereotypes surrounding being denied equal access to school activities. Diabetes is a part of Sal, but it is not his whole identity. In addition to spot-on diabetes representation and an exciting plot, the novel thoughtfully touches on important themes such as abuse, bullying, toxic masculinity, stigmatization, grief, and death. I also found the Spanish dialogue to be the most effective of any book I have read, offering easy-to-interpret meanings and applicable uses of slang. Sal and Gabi Break the Universe is an exquisite read you do not want to miss! It has a little something for everyone and features realistic diabetes representation.

The Truth About Stacey: A Graphic Novel, Adapted and Illustrated by Raina Telgemeier, based on the novel by Ann M. Martin

“What Stacey needs is some stability.”

The Truth About Stacey: A Graphic Novel incorporates positive diabetes representation with the trademark Baby-Sitters Club flare. Stacey had to overcome many obstacles in the past year, such as moving from New York to Stoneybrook to learning how to manage her type 1 diabetes. But the entire Baby-Sitters club is at risk when a new rival club, The Baby-Sitters Agency—which features older sitters who can stay out later—threatens to put the club out of business. How can the Baby-Sitters Club prove they are the better sitters? I appreciate how the novel emphasizes that Stacy lives a normal life by carefully balancing her diet and insulin injections. The story also touches on overprotective parents and how others may not understand or behave strangely around those with diabetes, which could be very relatable and applicable to readers. However, I would have liked to see a few more specifics about diabetes, including how diabetics can eat sweets if they appropriately compensate with insulin. Overall, The Truth About Stacey: A Graphic Novel is a solid middle grade read that will not disappoint and help introduce readers to the topic of diabetes.

The Truth According to Blue by Eve Yohalem

“Diabetes is something I have to live with, not something I have to be.”

Get ready to set sail! Thirteen-year-old Blue plans to spend her summer treasure hunting for an ancient ship’s lost gold that her Pop Pop claimed is connected to her ancestors. However, things quickly change when Blue’s mom signs her up to be the face of a fundraiser to cure type 1 diabetes where she meets famous actor Ed Buttersby’s daughter Jules. The girls are polar opposites and come from completely different backgrounds, but both have something to prove: they are more than just a girl with diabetes and Ed Buttersby’s daughter. I enjoyed the treasure-hunting theme and the fun antics that go along with it. Blue’s type 1 diabetes is realistically represented throughout, with Blue shown regularly testing her blood sugar. My favorite part of the book is Blue’s diabetic-alert dog, Otis. I did not know anything about medical alert dogs and was fascinated by Otis’ ability to smell low versus high blood sugar and alert Blue. The novel also touches on the financial stress of diabetes, along with body image issues, false type 1 diabetes misconceptions, and the importance of continued research to find a cure for diabetes. While I do not think many readers will be able to relate to Jules’ struggles with having a famous dad, they can relate to the journey of finding one’s personal identity and potentially to the realistic diabetes representation. The Truth According to Blue is a fun adventure you do not want to miss!

Young Adult Reads

Let Me List the Ways by Sarah White


“Being Nolan’s friend had been easy. Falling for him had been effortless. Maybe that kind of attention would be fleeting, but as I sat there with him at my side, I knew that loving him was eternal.”

Let Me List the Ways scores on the diabetes representation but left me unrealistically fulfilled plot-wise. Mackenzie is in for a surprise when she realizes she is in love with her supportive and perfect best friend, Nolan. He understands the ins and outs of Zie’s diabetes and is always standing by with Hershey’s Kisses when her blood sugar drops. With their remaining time together before college ticking down, the best friends embark on a senior year redo bucket list, finding each other along the way. Zie’s diabetes is always portrayed realistically, with her going through the steps to check her blood sugar before every meal and describing how it feels to have high versus low blood sugar. I particularly appreciated addressing diabetic stereotypes and stigma throughout and witnessing Nolan’s support when Zie feels self-conscious about her insulin pump. The diabetes representation is encouraging and is portrayed in a way readers can relate to. My only struggle with this book was the unrealistic friendship and romance portrayal between Zie and Nolan, but if you enjoy cheesy banter, best-friends-to-lovers storylines, and realistic diabetes representation, this is the read for you!

Lucky Few by Kathryn Ormsbee


“Maybe it was the fact that the morbidity was so unexpected that made it so unacceptable.”

Lucky Few is a meaningful young adult read with subtle type 1 diabetes representation. Homeschooled sixteen-year-old Stevie just wants to focus on saving the Barton Springs Watershed; it was a major component of her childhood, and she cannot imagine no longer spending sunny days swimming there. But things change when she finds a body covered in blood in her backyard, especially once she realizes the body belongs to her new neighbor and is still breathing and covered in corn syrup. Max recently moved in next door with his grandpa after a woodshop accident that cost him two fingers and inspired him to create a list of twenty-three ways to fake his death without dying. He enlists Stevie and her best friend Sanger to help him on his quest, and sparks quickly start flying between the neighbors. I adored Lucky Few. It is a very poignant and realistic coming-of-age story that addresses labels, stereotypes, insecurity, mortality, and mental health. Stevie always stands up for what she believes in and is a very interesting and relatable character. I only wish that Stevie’s type 1 diabetes was introduced sooner in the novel. There are subtle references to insulin and glucose tablets, but it is not until page 130 that it is confirmed that Stevie has diabetes. While I appreciated that this was not added to “shock” the reader, I would have appreciated more comprehensive representation sooner. However, as the novel continues, Stevie’s diabetes is better represented and touches on the idea of diabetes fatigue. Lucky Few may primarily be a story about growing up with diabetes second, but the novel thoughtfully touches on many important themes and is a story that readers will continue to think about long after they turn the last page.

Swamp Thing: Twin Branches by Maggie Stiefvater and illustrated by Morgan Beem


“Maybe the biggest difference between humans and plants isn’t whether plants think…But what they think about.”

Unfortunately, Swamp Thing: Twin Branches is not a graphic novel I can recommend. Twins Walker and Alec visit their cousins for the summer after they find their dad cheating on their mom. Alec hopes to continue his botany research, which involves proving that consciousness exists outside the body. Alec has recently been diagnosed with type 1 diabetes, and his family has a very negative and insensitive perception of diabetes that is never addressed. The timeline is confusing, and the plot is chaotic and hard to follow. The amount of unchecked bullying and disrespect throughout is truly astonishing. The sole redeeming aspect was the mending of the twin’s relationship. The plot may have been too abstract for my liking, but the negative themes and disrespectful diabetes representation are serious causes for concern. Hopefully, in the future, we will see young adult graphic novels that effectively and positively represent diabetes.

Sweetblood by Pete Hautman


“You are more powerful than you know. The world that surrounds you is what you make it.”

Looking for a short, angsty young adult read? Sweetblood offers readers a bite of an angry teenage narrator who is mad at the world and authority figures. Sixteen-year-old Lucy has type 1 diabetes and is convinced that vampire lore originated from the symptoms of untreated diabetes during the Middle Ages. She quickly gets swooped up into late-night parties and is increasingly obsessed with learning who the mysterious Draco is from her online vampire chatroom. I did not know what to expect and was left wanting a richer story or coming-of-age storyline. The most interesting aspect of the novel was Lucy’s management of her blood sugar. I appreciate that the difficulty of managing diabetes and staying within optimal range was not overshadowed. I also admire the touch on mental health and the process of trying to find yourself. Lucy is a flawed character, unlike many other protagonists in diabetes reads. The only downside was Lucy does not always stress the seriousness of type 1 diabetes which could be a negative example for younger readers, although the consequences of this decision are shown. Sweetblood is flawed and angry but offers a unique take on diabetes some readers may be able to relate to.

Sugar Scars by Travis Norwood


“Everything about the virus was fast. There was plenty of speculation about what had caused something so deadly, but that was irrelevant now. All that mattered was that we were immune.”

I devoured Sugar Scars and could not put it down! After almost everyone in the world had died from a fast-acting infectious disease simply referred to as “the Virus,” life looks different for 19-year-old Sugar. She may not be a people-person after being bounced around foster homes, but Sugar is not used to the new strange empty world. While all of the other immunes are left with seemingly endless supplies of food, houses, and cars, Sugar also needs daily insulin to manage her type 1 diabetes. What happens when she realizes that all remaining insulin has an approaching expiration date? Sugar Scars is an upper young adult novel that features some intense material due to the apocalyptic nature of the story. However, the diabetes representation is unparalleled. Sugar shows a realistic portrayal of what life is like managing diabetes, from the daily preparation before each meal to how insulin injections occur to the careful balancing act. Readers learn about how insulin is produced and the historical advances in diabetes treatment that need more celebration in society. Nothing in Sugar Scars is sugar-coated, and I feel it is an effective post-apocalyptic read with realistic diabetes representation that will make readers sit back and reflect.

Winter Road by Kristin Butcher


“Maybe I want my mother to hurt as much as I do. Maybe I’m so desperate to connect with her, even a fight would feel good.”

Unfortunately, Winter Road misses the mark on realistic type 1 diabetes representation. Sixteen-year-old Kat has been having a difficult time since her dad passed away eight months ago. Kat no longer sees her mom as often since she has taken up trucking again to support them, and Kat has recently been diagnosed with type 1 diabetes. Aching to reconnect with her mom, Kat stows away in her mom’s rig before a shipment out on the winter road. Although told in first person, Kat is almost emotionless despite her struggles. I learned a decent amount about trucking but was left unsatisfied by the diabetes representation. Kat is angry about her diagnosis and does not take managing her blood sugar seriously. She is never shown preparing before meals, injecting insulin, or checking her blood sugar! The diabetes is just a random plot point to add another layer of complexity to Kat’s changing life, but it is included in a very ineffective manner that I cannot recommend as positive diabetes representation.

PRR Writer and Editor, Emilee Ceuninck