Miss Idaho Will Wear Her Insulin Pump During Miss America Competition

Miss Idaho Sierra Sandison never expected to become a diabetes advocate. The 20-year-old had been diagnosed two years earlier with Type 1 Diabetes, and uses an insulin pump to control her blood sugar levels.

However, a chance meeting with Miss Idaho’s Outstanding Preteen, 12-year-old McCall Salinas at the Miss Idaho competition changed all that.  When Sandison stepped out of her dressing room, Salinas asked “Oh my gosh, is that an insulin pump?”

Sierra’s first thought was “Oh no, people are going to notice, I was hoping that it was little enough that no one would notice.” But when she learned that McCall also had Type 1 diabetes and did not use a pump because she was afraid of what her friends would think, Sierra knew she what she had to do:

“I have to do this for McCall. It was really scary (to walk out on stage) but thinking about McCall gave me a whole new confidence.”

Sandison went on to win the Miss Idaho title.  Besides winning the crown, she won an outpouring of support, as pictures of her in a bikini with insulin hit social media.  She told People magazine, “I’ve gotten personal messages from people in over 35 different countries!”

Tonight Sandison will compete in the Miss America pageant, and her trusty insulin pump will be literally right there at her side as she takes to the runway.

“I try to show other diabetics it’s possible to live a normal lifestyle. And now I’ve been able to take advocacy to a whole new level.”

Good luck tonight Sierra, we’ll be rooting for you!

What is Type 1 Diabetes?

Type 1 diabetes Diabetes, generally speaking, is a condition in which the body’s cells do not receive adequate supply of sugar, in particular, a sugar called glucose. When our food is digested,  glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. But glucose cannot enter our cells without insulin. It is insulin which enables our cells to take in glucose. Without insulin, the sugar levels in the bloodstream rise.

Type 1 may more accurately be termed “insulin-dependent” diabetes. This is because people with the condition require daily, subcutaneous injections of insulin for the rest of their lives. In type 1, the body’s immune system attacks cells in the pancreas that make insulin.

Type 2 diabetes occurs when the pancreas does not make enough insulin, suffers from “insulin resistance”, or both.  Insulin resistance means that the cells no longer respond properly to the insulin present.  An unhealthy weight is a major risk factor.

Despite the differences between type 1 and 2, the complications are often the same. The higher the blood sugars over an extended period of time, the greater the risk for complications such as blindness, stroke, nerve damage,  limb amputation, kidney failure, and premature death.

How is Insulin given to those with Type 1 Diabetes?

NeedleMany people with diabetes must take insulin to manage their disease. Most people who take insulin use a needle and syringe to inject insulin just under the skin. Several other devices for taking insulin are available and new approaches are under development. No matter which approach a person uses for taking insulin, consistent monitoring of blood glucose levels is important. Good blood glucose control can prevent complications of diabetes.

What alternative devices for taking insulin are available?

Insulin_PensInsulin pens provide a convenient, easy-to-use way of injecting insulin and may be less painful than a standard needle and syringe. An insulin pen looks like a pen with a cartridge. Some of these devices use replaceable cartridges of insulin. Other pens are prefilled with insulin and are totally disposable after the insulin is injected. Insulin pen users screw a short, fine, disposable needle on the tip of the pen before an injection. Then users turn a dial to select the desired dose of insulin, inject the needle, and press a plunger on the end to deliver the insulin just under the skin. Insulin pens are less widely used in the United States than in many other countries.

Insulin_PumpExternal insulin pumps are typically about the size of a deck of cards or cell phone, weigh about 3 ounces, and can be worn on a belt or carried in a pocket. Most pumps use a disposable plastic cartridge as an insulin reservoir. A needle and plunger are temporarily attached to the cartridge to allow the user to fill the cartridge with insulin from a vial. The user then removes the needle and plunger and loads the filled cartridge into the pump.

Disposable infusion sets are used with insulin pumps to deliver insulin to an infusion site on the body, such as the abdomen. Infusion sets include a cannula—a needle or a small, soft tube—that the user inserts into the tissue beneath the skin. Devices are available to help insert the cannula. Narrow, flexible plastic tubing carries insulin from the pump to the infusion site. On the skin’s surface, an adhesive patch or dressing holds the infusion set in place until the user replaces it after a few days.

Users set the pumps to give a steady trickle or “basal” amount of insulin continuously throughout the day. Pumps can also give “bolus” doses—one-time larger doses—of insulin at meals and at times when blood glucose is too high based on the programming set by the user. Frequent blood glucose monitoring is essential to determine insulin dosages and to ensure that insulin is delivered.

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.


  1. Elizabeth Godfrey

    September 23, 2014 at 9:13 am

    Why Miss Idaho’s Insulin Pump Has Inspired Viewers Worldwide
    In Monday’s Miss America pageant, one contestant walked the runway wearing not just a sleek bikini or an evening gown, but a pager-sized medical device, out for all to see. The medical device? An insulin pump for the treatment of Type I insulin-dependent diabetes. The contestant? Miss Idaho, Sierra Sandison, who first wore the pump onstage in the Miss Idaho pageant. Since then, her story and her image in swimsuit and pump have circulated the web before landing on CelebrityDiagnosis. It even started a viral campaign on social media called #showmeyourpump encouraging Type I diabetics to share pictures of themselves with their pumps.
    So why are images like this picture of Sierra Sandison so powerful? How has it gained such traction in the public eye? It has become a temporarily iconic image in current events, appearing briefly everywhere and inciting public action. Three reasons for the impact of Sandison’s image are its accessibility through social media; its representation of our ideals; and its resonance with personal emotions of viewers.
    The impact of Sandison’s picture is not just because of novelty: Sandison is not the Miss America contestant to wear an insulin pump. Nicole Johnson, Miss America 1999, also wore her insulin pump when she competed. But while novelty isn’t a reason, media accessibility is. 1999 was before the age of Instagram, Tumblr, Twitter, and Facebook—before any mainstream social media—and while people saw pictures of Johnson on television, they didn’t have the platform to reproduce and disseminate it. But Sandison’s “coming-out” as a diabetic comes when web communication is fast-paced and rife with instantaneous external validation (or criticism), so once it emerged into public knowledge, it was able to spread and grip the public psyche almost immediately.
    Another reason Sandison’s image has achieved a degree of iconic status is her physical idealism. Sandison, a pageant winner, embodies beauty and physical perfection. She, and by extension her image, represent an ideal. Historically iconic images do this—da Vinci’s Vitruvian Man is his representation of a perfect human, and it has been reproduced and shared with billions throughout history. Similarly, Sandison’s picture is something that people want to remember and share, fuelling its travels around web media, because it is an aesthetically pleasing representation of humanity.
    The final factor behind the impact of Sandison’s image is its emotional resonance. By releasing a picture of herself with her insulin pump, Sandison has allowed herself to be classified as “diabetic”, quite literally in the public’s mind’s eye. Many individuals would be uncomfortable doing such a thing; they fear a visual announcement would define them by their physical condition, be it a disorder like diabetes or just difference from the norm. But Sandison puts herself on display anyway to ultimately become an advocate for youth with diabetes. This engenders a perception of bravery and selflessness in those who view her image. Viewers admire Sandison’s choice, so they share it, remember it, and act to encourage more like it through social media campaigns like #showmeyourpump.

  2. Lauren Bockhorn

    September 23, 2014 at 9:14 am

    Visual representation is the most powerful form of devotion and defiance.

    To see is to believe. For Ms. Idaho to demonstrate her dedication to Diabetes awareness and acceptance, she had to allow her medical device to be seen. Only visually displaying her insulin pump held the power to demonstrate her courage and investment in standing up for those with Diabetes 1, such as herself. Speaking out for others with her voice, or advocating by talking to women in hospitals and schools would not have drawn the attention her photograph did. “Visibility” to the public, for celebrities or an issue, requires just that—visibility. Though actions speak louder than words, visual demonstration seems to speak the loudest.

    Her photograph not only attests to her devotion, but also defies the most prevalent social expectation: to appear perfect. Our ideals of beauty are based on appearance. Images must fit a socially constructed prototype of the average of all beautiful women or the most ideal beautiful woman. The media sees anything lying outside of this narrowly defined image as a flaw. In a culture permeated by visual images, images that produce, reinforce, and reimagine body image are particularly important for young women. Our consumer culture portrays images of beauty and glamour perhaps more than any other type of image, and the wearing of her insulin pump clearly go against the grain of the ideological constructions of beauty.

    Given the most beauty standards concern only appearance, it is clear that vision proves very important to us. Visual beauty rises above any other perception, such as how attractive someone’s smell, laugh, or intelligence is. In a blog post about her decision to wear the pump and in many interviews, Ms. Idaho asserts that others do not need to buy into the media’s lies that any deviation in appearance from perfect is a flaw. This reassurance reinforces the notion that it is not the disease, or the presumed lifestyle of a diabetic, or anything other than visual appearance that concerns the public. This reveals the power of visual sense over other observations.

    Why is it that using a device vital to preserve life somehow violates cultural standards? Ms. Idaho’s display of her insulin pump reveals the social constructionist view of the world, demonstrating that only in public imagination is a medical-assistance device necessarily mutually exclusive from popular standards of beauty. It is interesting to consider that we share the social assumption that someone could not and would not wear an insulin pump when competing in a beauty contest.

    In contrast to our expectations that popular media would censor non-standard images of beauty, the press advertised the fact that Ms. Idaho chose to wear her pump. Furthermore, they chose to capture images where the pump was visible. Considering the fact that images including the insulin pump involved a subjective choice by photographers, it becomes clear that there was intent to publicize her decision. In this way, Ms. Idaho was able to use social marketing for activism and empowerment of young women. This was made possible by her image.

  3. Sajani Patel

    September 23, 2014 at 9:46 am

    Type I Diabetes is not an illness that can be easily hidden due to the very visible insulin pump. While the insulin pump is an obvious image for Type I Diabetes, it may also be mistaken for Type II Diabetes. There is a negative stigma around Type II Diabetes and it is sometimes associated with obesity and poor health. Confusion regarding the pump and what it is used for could cause people to believe that those with a pump have Type II Diabetes. If this is happens then the pump-wearer may face the negative stigmas and attitudes those with Type II Diabetes may face or may even feel shame.

    I think Miss Idaho became an image for Type I Diabetics by wearing her pump in the pageant. Her pump is a medical symbol commonly associated with diabetes. She did not look unhealthy or debilitated in the pageant and thus could become an image that could change people’s perceptions of the insulin pump and diabetes. She was strong, powerful, and looked healthy – none of which are associated with illness. We know that images and how certain things are portrayed in the media affect people’s perceptions of those things. While Miss Idaho wearing her insulin pump is not a picture, photo, or other traditional image, she is still an image of medicine. In this case, Miss Idaho was an image of health and positivity despite her illness.

    This image of Miss Idaho could also help overcome stigmas associated with diabetes and be an educational tool to raise awareness about the differences between the two types of diabetes. Media influences people’s perceptions of health negatively and positively. Miss Idaho could use this opportunity to fight any stigma there is against diabetes and show people that wearing an insulin pump and being a diabetic does not make you any different. She already had this effect with Salinas but has the opportunity to do this for so many others. Many TV shows and movies already use their access to a large population as a means to educate and raise awareness. Miss Idaho should take her position in the spotlight and her position as a positive image and educate about diabetes. There are many more positives that can come from this.

  4. Hai-Uyen Nguyen

    September 23, 2014 at 5:38 pm

    This post made me think about the ways that the relationship between medicine and media is a recursive one. Popular media can often influence the way medicine operates. Models are often pictured as having “ideal” bodies. Consequently, people often extend this reasoning and believe that models are pretty much perfect in every way. Miss Idaho Sierra Sandison, by wearing her insulin pump with her bikini, is breaking this idea that models are perfect. The context of the image is extremely important. If Ms. Sandison were simply a person on the beach, nobody would take notice. By identifying herself as a diabetic during the race for the title of Miss America, Ms. Sandison is influencing the way people see models like her.
    What the insulin pump is doing to the image of models is similar to the history of atlas making; at one point in time, atlas makers strived to create the “ideal” image of an organism. Over time, however, atlases have shifted to showing figures of actual individuals, acknowledging the individual differences among us. It looks like popular media is becoming more accepting of displaying individual differences. In addition to Miss Idaho’s insulin pump, clothing companies such as Aerie have stopped airbrushing their models to show that every shape and size is beautiful.
    One other important factor in changing the way the public sees something is also the shifting ideologies of people in American culture today. The public’s reception of certain images decides what will stick and what will simply fade away. In the past, people might have rejected the idea of plus-sized models or models with insulin pumps showing. The fact that there is such a wide positive response for Miss Idaho’s advocacy for diabetics shows the public’s increasing acceptance towards individuals and their differences.
    One problem is that popular images can be taken out of context to make a point. For example, people today often use this picture of Marilyn Monroe to give power to women who have “real curves;” however, if someone were to do research on the photo, they would find out that the photo is actually from a time when Marilyn was at one of her heaviest weights. In today’s sizes, Marilyn would be a size 2-4! It is important that we, as consumers of images, understand the context of images before we make assumptions of their significance.

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