Background
Arranged marriages are the cultural norm of the subcontinent, Pakistan being one of them, where the elders take care of the match-making business. Critically, judgements are done in various forms for both genders, males and females, whether it be age, education, profession, height, colour, wealth and health which includes acute or chronic diseases and syndromes. Specially, when marriage seeking individuals or parties question the capability of a person with diabetes to grow into a family and take part in social affairs. Diabetes Mellitus is considered as one of the conditions which requires a challenging lifestyle however, it is yet not commonly acclaimed to be given the status as a normal healthy condition. Particularly, Type 1 Diabetes which is a much more challenging and demanding condition.

Aims
The objective of this case study was to assess and compare through personal experiences of people with T1Ds specifically, how much people in general are aware of T1D and its management; what is the level of social acceptance in Pakistan of people with T1D where marriage and relationships are concerned; and analyse how married couples identify their status in society as a healthy functional unit.

Method
A Qualitative analysis was done by conducting in-depth interviews and integrative approach was taken to analyse indicative answers from different participants deriving a conclusion. A mixed group of 13 married couples living in different cities of Pakistan having at least one member with T1D were interviewed individually. Ages, livelihoods and years in marriage were taken into consideration. Their experiences before and after marriage regarding education and awareness on diabetes, social pressure and peer support, dealing with a medical emergency and their role in society was discussed. Responses were recorded and likely answers were grouped into clusters. Relevance and authentic information was given the priority to screen into logical grouping.

Results
Males and females, both faced social stigma related to T1D. They are wrongly assumed to be terminally ill, inadequate for marriage, always dependent and unable to perform essentially at home or outdoors. Most of them avoid to disclose about their condition, including to prospective proposals, as they struggle more than a normal person to prove themselves as healthy and useful part of the society. Some medical professionals are also not aware how to deal with a T1D patient. Education and awareness is very less which has caused creating more myths about the condition.

Discussion
Emotional distress is quite common with people with T1D, especially when it comes to marriage which makes it more psychologically stressing. Society in majority does not accept people with T1D to perform as normal beings do. On the contrary, some people are open to accept the person with T1D and associate themselves to become part of their lives and help in diabetes management. Spouses play a very important role in supporting their partner with T1D. Some of them do face stigma but apparently as couples they support each other and keep engaging with communities. Education and Awareness is still to be disseminated to masses.

Type 1 diabetes, marriage and social stigma: a case study of Pakistan