What Netflix’s Purple Hearts Got Right (And Sort of Wrong) About Type 1 Diabetes

Purple Hearts. (L to R) Sofia Carson as Cassie, Nicholas Galitzine as Luke in Purple Hearts. Cr. Courtesy of Netflix © 2022.

By Julie De Vos

August 15th, 2022

I just finished watching Netflix’s smash hit film Purple Hearts. If you’re not familiar with it yet, it’s a romance centered on Cassie, a young woman who’s six months into her type 1 diabetes diagnosis. While at its core this film is a love story, Cassie’s diabetes and her incredible struggle with healthcare in America is the main plot of the film. 

People in the diabetes community are saying it’s one of the best representations of diabetes in Hollywood history. So, did it live up to the hype?

If you plan on watching it, be forewarned, SPOILERS are coming up! 

WHAT THE FILM GOT RIGHT

For diabetes accuracy, this movie excels! It describes what life is really like for Americans with type 1 diabetes right now, particularly for lower-income individuals or those with part-time or freelance jobs. These were the highlights:

The state of healthcare in America. This is probably the most important aspect of the film. 

• The movie shows what too many of us already know: that the cost of insulin in America is astronomically high. Cassie needs to pay $300 for long-acting and $220 for short-acting insulins without insurance. $500-plus per month is typical in the United States, if not lower than average.
• Because she can’t pay for all of the insulin she needs, Cassie ends up rationing insulin, a potentially deadly strategy that is all too common in the U.S.
• The pharmacy couldn’t refill her prescription early unless she paid out of pocket, as the cashier stated her “insurance wasn’t renewed.” While this term isn’t something I’ve personally heard before, the frustration and exasperation with an impossible-to-understand system is very accurate.
• Cassie is living with huge medical debt and being forced to choose between paying rent and buying insulin. The stress from her medical debt keeps her up at night — so much so that she’s willing to break the law to get better healthcare to afford insulin. 

What life with type 1 diabetes is really like. Finally, a film gets this mostly right!

• This is the best Hollywood depiction of type 1 diabetes that I ever remember seeing. It sounds simple, but Cassie checks her blood glucose with a finger poke, squeezes out the blood to put on a test strip, and gives herself insulin — exactly what we really do! So many movies get this fundamental stuff completely wrong.
• While some of the scenes seemed overacted and exaggerated, it’s done to make sense for those not living with diabetes watching the film. In general, Cassie’s high and low symptoms are accurate. She’s tired with blurry vision when she realizes she needs a correction. She’s wobbly and disoriented when her blood sugar is dropping. 
• She sets an annoying alarm to make sure she remembers to administer insulin. We know what it’s like when you forget! 
• The movie also gets a ton of tiny details right. The way Cassie turns the insulin vial upside down and flicks the bubbles out of the needle. How she bends her leg and rests her arm on her knee to get the “meat” in her tricep to make it easier to inject into her arm. I learned that trick when I was a kid and have used it SO many times in my life! If you’ve done this before, you know exactly what I’m talking about. 
• She keeps all of her diabetes stuff in her purse. If you looked in my purse right now, you’d find a loose syringe and a backup bottle of insulin with maybe 20 units left in it. Oh, and a juice box, fruit snacks, and a VERY old granola bar that I’m sure have been there for three years. If you know, you know. 
• How excited she is to go on an insulin pump and continuous glucose monitor (CGM) after struggling for so long without the best tools! Many of us remember how exciting it was to finally win approval from insurance for these expensive but vital devices. Her happy dance says it all!
• Keeping her pump in her back pocket and giving a quick correction bolus like we’ve all done a hundred times.
• Going low in the middle of the night after unexpected activity, and also seeing zero units of insulin on board (IOB) on her pump screen when she couldn’t remember the last time she ate. They definitely got this one right! 

The technology.

• Her Medtronic pump and Guardian CGM are the newest versions on the market, the MiniMed™ 770G with SmartGuard™ Auto Mode. The film shows realistic insertions of both the infusion and sensor sites.
• You hear Cassie’s CGM alarm and you see the reading: 68 mg/dL with a triple down arrow. I think I can safely say that we’ve all had this experience, where your glucose just drops so quickly that your CGM can’t even keep up. You’re fine one moment and then all of a sudden you feel SUPER low and are stumbling around. This representation is 100 percent authentic.

The diabetes lingo. So many other movies and TV shows get this so incredibly wrong. Cassie spoke like a real person with diabetes. 

• “Reserve,” the backup insulin vial that has a little bit left just in case
• “Short-acting” and “long-acting” insulins
• “Go, Big Pharma,” said in a sarcastic tone

The relationships. Cassie is surrounded by well-meaning people who try to be supportive but don’t really understand what she’s going through. Many people with type 1 know exactly what this is like.

• Cassie’s mother is supportive and understands how serious the condition is. She asks Cassie to move back home so she can help shoulder the burden. However, she doesn’t understand just HOW expensive Cassie’s insulin is — at one point she gives her daughter $80, not realizing that it’s not even close to what she needs. Even though Mom has the best of intentions, she doesn’t completely understand what it’s like for her daughter.
• The pharmacy cashier doesn’t really seem to understand that if Cassie can’t get insulin, she could die. She doesn’t assist or provide any resources for Cassie to get the insulin she needs. This is a common story we hear in the community often. There are resources for people that cannot afford their insulin.
• Cassie’s friends and husband give her space to do diabetes things, but don’t really understand or know how to help.
• I love that as the romance progresses, Luke begins to understand Cassie’s diabetes better. When he hears her alarms, he runs to grab the glucose gel and quickly learns that T1D can be scary. It’s an accurate relationship scenario. 

WHAT WASN’T SO ACCURATE 

As realistic as the film’s depiction of diabetes was, it’s still a movie, and there were moments that felt over the top. I have a brother who is a director and editor (he also has type 1!), so I can appreciate that movies need to exaggerate to get the point across and to heighten the drama. A mild low blood sugar that you fix with a few glucose tabs isn’t exactly exciting. One example: The filmmakers had Cassie use a massive syringe, with a needle that was MUCH larger than any needle I’ve ever seen used for insulin. 

More importantly, Cassie’s symptoms (or lack thereof) felt exaggerated to me. She’s rationing her insulin so we know she’s going to be high. But the intensity of her symptoms — labored breathing, stumbling, sweating, and exhaustion – make it seem like she’s experiencing diabetic ketoacidosis (DKA). She injects some insulin, and the next day she seems healthy again. That’s just not how that works.

She also rebounded very quickly from that 68 mg/dL triple down arrow to make out with her husband. I think she’s about to find out that physical activity after hypoglycemia usually brings more lows. 😉 

MISSED DIABETES OPPORTUNITIES

As good as the movie’s depiction of diabetes was, I felt it could have done an even better job. Here’s what I wish Purple Hearts had shown:

• I wanted to see more of those little management moments highlighting how exhausting and all-encompassing T1D is. We are always looking, checking, and adjusting: briefly checking your CGM graph, mindlessly touching your pump or sensor site, or slightly adjusting your pump on your waistband when you sit down. (My brother disagreed. He was glad that the film focused more on character development and their relationships.)
• Cassie was never shown bolusing for food or managing her blood sugar around meals. This might have been done on purpose, to avoid the stigma around food and diabetes. But I think it was a missed opportunity to show the reality of how central food is to our condition, and how stressful diabetes makes every meal.
• Cassie’s insulin pump is almost never visible. While I often try to hide my insulin pump, you can still see the outline under my clothes, and when I’m around close friends or family, I don’t bother tucking the tubing away. There aren’t many of these moments in the film, and with some of the wardrobe choices, it would have been tough to hide her pump. I feel this doesn’t accurately represent how intrusive and omnipresent a tubed pump is.
• The film features a conversation about Cassie and Luke having children. They are sitting around the table in the backyard and Luke’s sister says how great he’d be with kids. There is an awkward pause, and Cassie says nothing. This would have been a nice moment to say something about type 1 diabetes and pregnancy. Again, another lost moment. 

I think Purple Hearts did a great job portraying life with type 1 diabetes, both for people from the diabetes community and for viewers just learning about the condition. I hope this movie helps the world better understand what many Americans are facing each and every day.