Diabetes and Eating Disorders - PowerPoint PPT Presentation

About This Presentation
Title:

Diabetes and Eating Disorders

Description:

Diabetes and Eating Disorders Ami Marsh, MS, MFT, LCADC – PowerPoint PPT presentation

Number of Views:318
Avg rating:3.0/5.0
Slides: 30
Provided by: rha142
Learn more at: https://med.unr.edu
Category:

less

Transcript and Presenter's Notes

Title: Diabetes and Eating Disorders


1
Diabetes and Eating Disorders
  • Ami Marsh, MS, MFT, LCADC

2
Diabetes 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.

3
The Basics
  • What is diabetes?
  • Association between diabetes and eating disorders
  • Treatment
  • Other considerations

4
What 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

5
Diabulimia
  • 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.

6
Diabulimia
  • 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

7
Diabulimia
  • 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.

8
Development 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.

9
Potential 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.

10
Warning 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.

11
Warning 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)
13
Eating 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.

14
Why 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.

15
Why 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.

16
Why 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.

17
Why 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.

18
Increased 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

19
Increased 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.

20
Treatment
  • 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.

21
Treatment 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.

22
Treatment 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

23
Treatment 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

24
Intuitive 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!

25
Education 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

26
It 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

27
Case Study
  • Jane, 26 year old female.
  • Jill, 45 year old female.

28
Conclusions
  • 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.

29
Questions?
  • www.centerforhopeofthesierras.com
  • 877.828.4949
Write a Comment
User Comments (0)
About PowerShow.com