Title: Diabetes and Eating Disorders
1Diabetes and Eating Disorders
- Ami Marsh, MS, MFT, LCADC
2Diabetes and Eating Disorders
- Having diabetes is the easiest way to have an
eating disorder. I can go out to eat with my
friends, eat anything I want, and purge during
the meal without anyone knowing - I am doing it.
3The Basics
- What is diabetes?
- Association between diabetes and eating disorders
- Treatment
- Other considerations
4What is diabetes?
- Autoimmune disorder where insulin producing cells
in the pancreas are destroyed. - Insulin is the hormone that allows glucose to
enter the cells, causing absorption of glucose
into the body which equals calorie absorption - Two types of Diabetes
- -Type 1, Insulin Dependent
- -Type 2, Insulin Resistant
5Diabulimia
- Not recognized in DSM-5 as a diagnosis.
- Diabulimia describes an eating disorder behavior
associated primarily with Type 1 diabetes. - Insulin dependent diabetics deliberately skip or
reduce insulin dose for the purpose of losing
weight or preventing weight gain. - Extremely dangerous combination of eating
disorder and diabetes mismanagement.
6Diabulimia
- Insulin is the hormone that allows glucose to
enter the cells, causing absorption of glucose
into the body which equals calorie absorption - If one restricts glucose, it is eventually lost
from the body in the urine it is not absorbed,
and neither are the calories from the glucose - Some patients with diabetes call insulin The Fat
Hormone. To them, insulin equals weight gain. - Physical consequences nerve damage, blindness,
kidney failure, death
7Diabulimia
- Other eating disorder behaviors are often present
(restriction, bingeing, purging, over-exercising,
judging self-worth by weight/body size, etc.). - In some cases, these other symptoms may be
subclinical. - Diabulimic patients suffer the consequences of
not taking care of a potentially life-threatening
medical condition in addition to the risks
associated with traditional eating disorders.
8Development of Eating Disorders in Patients with
Diabetes
- Patients may already have an eating disorder or
disordered eating prior to diabetes diagnosis. - Patients may also develop an eating disorder
after diabetes diagnosis. - Diabetes may trigger an eating disorder in
someone who is already susceptible.
9Potential Warning Signs for Traditional Eating
Disorders
- Weight loss (often despite increased or no change
in food intake). - Weight fluctuations.
- Hunger denial, secretive eating, or bingeing.
- Restricting or eliminating certain foods or food
groups (safe and forbidden food lists). - Inappropriate use of diet pills, diuretics,
laxatives, enemas, ipecac, caffeine, hot or cold
beverages, sugar-free gum, etc.
10Warning Signs for Traditional Eating Disorders
- Fatigue, weakness, lethargy.
- Excessive exercise.
- Preoccupation/obsession with weight, body-image
and/or food intake. - Being overly critical of appearance.
- Amenorrhea
- Removed from the DSM-5 but still important if
present. - Anxiety/depression/extreme mood changes.
- Severe self-criticism.
11Warning Signs for Diabetes Related Eating
Disorders
- All of the above, plus
- Poor metabolic control (hyperglycemia and/or
elevated HbA1c) despite reported compliance. - Weight loss or weight maintenance despite
unchanged or increased food intake. - Recurrent DKA.
- Classic symptoms of unmanaged diabetes excessive
urination, excessive thirst, excessive hunger.
12(No Transcript)
13Eating Disorders and Diabetes
- Women with Type I DM are 2.5 times more likely to
develop an eating disorder than women without
diabetes. - Up to 40 of women with DM-T1 report engaging in
eating disordered behaviors. - Up to 90 of teens living with diabetes report
having modified insulin doses to lose weight. - Among those with Type 1 DM, bulimia is the most
common eating disorder reported. - Binge Eating Disorder is more commonly reported
among women with Type 2 DM.
14Why might diabetic patients be at increased risk
for developing eating disorders?
- Onset of diabetes is often associated with weight
loss that diabetic does not want to give up. - Insulin treatment often leads to increased hunger
and weight gain, increasing likelihood of poor
body image. - Routine focus on weight at every doctor visit.
- Restrictive element of diabetic diet.
- Classification of foods as allowed,
forbidden, good or bad. - Shame about food choices.
15Why are diabetic patients at increased risk for
eating disorders?
- Contraindication of high carbohydrate foods when
blood glucose levels are elevated. - Focus on numbers.
- Necessity of reading food labels.
- Need for ongoing close monitoring of diet,
exercise, blood glucose levels and insulin
dosages leads to obsessive thinking and unhealthy
preoccupation with food and weight. - Fear of bad experiences going low eat to
prevent or correct, then feel guilt about eating
and fear that eating will lead to weight gain.
16Why are diabetic patients at increased risk for
eating disorders?
- Role of parents or others (diabetes police) in
managing diabetes (control). - Misconceptions/judgments of others You cant
eat that, youre diabetic! (lack of
understanding/education). - Need for control (controlling food and/or weight
when one cant control emotions or external
situations). - Use as a coping mechanism (emotional
disassociation). - Focus on exercise.
17Why are diabetic patients at increased risk for
eating disorders?
- Psychological issues associated with diagnosis
and management of long-term illness (anger at
diabetes). - Diabetes diagnosis can contribute to triggering
factors that often lead to eating disorders low
self-esteem, depression, anxiety and loneliness.
18Increased Risks for Diabetic Patients with Eating
Disorders
- If manipulating insulin
- Hyperglycemia
- DKA
- Elevated HbA1c levels
- Earlier onset of degenerative complications of
diabetes - Retinopathy (blindness)
- Kidney disease
- Heart disease
- Nerve damage
- Circulation problems
- Higher early mortality rate than in diabetics
without eating disorders
19Increased Risks for Diabetic Patients with Eating
Disorders
- If bingeing and/or purging
- Episodes of both hyperglycemia and hypoglycemia.
- Difficult to gauge appropriate insulin dose
following a binge and/or purge episode. - Earlier onset of degenerative complications of
diabetes. - All complications (physiological and
psychological) associated with bulimia.
20Treatment
- Evidence based research suggests
multi-disciplinary approach to be most effective
form of treatment - At minimum, this is primary care provider,
endocrinologist, dietitian and therapist all
working together to provide integrative,
full-circle care. - At higher levels of care, team also includes
nursing, psychiatrist, direct line staff,
continuing care.
21Treatment Methods Behavior Management
- Individual, family, and group therapy sessions
- Body image, body appreciation, CBT, DBT, process
group, emotion acceptance, anxiety management,
yoga, meditation, equine therapy, reiki, massage,
self-empowerment, recovery maintenance, creative
expressions, relapse prevention, problem solving,
goal development, lunch out - Psychotropic medication aindicated
- Antidepressant, mood stabilizer, anxiolytic,
sleep aid, etc.
22Treatment MethodsMedical Management
- 24 hour nursing
- Nursing support before, during and after meals
and snacks to monitor blood glucose and determine
insulin dose - Daily monitoring of blood glucose logs
- Weekly meetings with endocrinologist
- Weekly meetings with primary care doctor
- Weekly meetings with diabetes educator
- Weekly or bi-weekly labs
23Treatment Methods Psychological Complexities
- Challenging core beliefs, Something is wrong
with me. - Increase sense of self-as-context- acceptance
of diabetes - Change the conditioned response link dosing to
feeling better - Addressing the system diabulimia education,
patterns of interactions - Body image and shame dealing with an insulin
pump or injections
24Intuitive Eating Diabetes
- Eat when hungry and stop when full.
- There are no good or bad foods.
- We teach our clients to dose for
- what they want to eat.
- Patients participate in carb counting
- from the first day of treatment
- -Key piece of diabetes education
- -Must be carefully navigated to
- avoid triggering the ED
- Patients are allowed to read labels
- for carb counting when appropriate.
- More to come on this next month!
25Education for Recovery
- Education
- Emphasis on intuitive food choices
- Teaching carbohydrate counting
- Modern educationless emphasis on restrictive
diabetic diet - Life is centered around diabetes care a
lifestyle choice to care for your diabetes - Incorporating mindful exercise
26It takes a village
- Endocrinologist
- RD experienced in diabetes and eating disorders
- Therapists experienced in chronic disease and
eating disorders - 24-hour nursing care
- Resident Advisors
- Diabetes Group- talk about current
issues, questions related to diabetes
27Case Study
- Jane, 26 year old female.
- Jill, 45 year old female.
28Conclusions
- Due to high comorbidity rate, assessment for
eating disorders among those with T1-DM is
crucial. - Eating disorders are often tightly woven around
diabetes issueshunger cues, eating disorder
urges, weight gain, depression and psych issues. - Integrated care provided by a communicative
treatment team is critical. - Blood sugar stability is crucial to the patients
recovery from psychological aspect of their
eating disorder.
29Questions?
- www.centerforhopeofthesierras.com
- 877.828.4949