Let's look at this, shall we?
Q: "I would love for you to talk about navigating transitioning while fat! I've had some struggles with medical fatphobia"
Juliana: "I have not pursued surgical transition of any kind so I only have experience with getting testosterone...."
Juliana hasn't pursued any sort of surgical transition because she knows nobody will do it due to her fatness.
"...Getting hormones requires meeting with a doctor regularly and getting your blood drawn every few months to check your stats and make sure your liver is chill. I find those spaces to often include having to navigate scales and weighing, blood pressure cuffs that don't fit, and the occasional remark about checking my a1c for diabetes 'just in case.'..."
Notice how she dismisses suggestions to check her HbA1c as mere fatphobia.
Juliana is massively obese, and has been since childhood. She has a clear visual marker for potential diabetes (acanthosis nigricans), on top of her obesity. Diabetes is nothing to fuck with; it's enormously destructive to the human body, and left untreated will kill her in any of a number of terrible ways. So it's absolutely appropriate for health care providers to recommend checking her HbA1c when she's in for bloodwork; they would be remiss in not asking her.
But no, it's just annoying fatphobia, and totally irrelevant to the reason she's there—to keep getting the testosterone she wants—so she refuses every time.
"...Which are frustrating, don't get me wrong, but theyre pretty typical for any doctors appointment. I decline the weight check or look away if necessary, remind them to check my BP on my forearm instead, and awkwardly laugh off the diabetes remarks...."
Yeah, keep laughing off those diabetes remarks, Juliana. Keep dismissing the people who obviously care about your health more than you do. Let's see how well that will work for you.
"...It's not perfect, but i do what i gotta do to get what i need."
No, Juliana; you do what you gotta do to get what you
want, which is for health care providers to serve your delusions on demand, while remaining in stubborn denial of your true state of health.
If Juliana knew she had type 2 diabetes, she might have to do something about it, and she already knows she doesn't want to do it. She doesn't want to see a dietitian and comply with their recommendations, she doesn't want to lose weight, she doesn't want to have to monitor her BG and inject insulin; she doesn't want to think about how everything she mindlessly shoves in her mouth affects her; and she doesn't want a reason to have to see health care providers any more frequently than she does right now.
Granted, Corissa already treats her own diabetes as nothing more than a nuisance she has to take medication for, while continuing to eat exactly as she pleases; she treats her IBS in the same manner. So it's not as if Juliana will have a partner who loves her enough to help her make any changes; behind all of her narcissistic self-adoration, Corissa's got the same self-loathing death wish Juliana does, and it extends to Juliana as well as herself. She genuinely does not care whether Juliana lives or not.
If Juliana remains stubbornly in denial, and refuses to get diagnosed, then she doesn't have diabetes, and doesn't have to think about it, or what it means, or how she got there. It'll never be an issue she'll have to account for at future medical appointments. Every last hater who has predicted Lord Beetus's imminent arrival is still wrong. And Juliana can keep weebling along through life, claiming that her fatness totally isn't killing her.
Denial is one hell of a drug, and both of these women are insane food addicts using it to keep justifying their insane addict behavior.
