Insulin & Hunger:
Main factors that affect blood sugar…
1 Dehydration
2 Medications
3 Carbohydrates
4 Stress
5 Physical activity
6 Lack of sleep
Lack of insulin à Loss of amylin, leptin, dopamine turnover; Increased ghrelin Ã
1 Uninhibited hunger
2 Decreased control/satiety
3 Loss of reward while eating
Pre-requisite to Eating Disorder?
1 Hyper-focus of NUMBERS in DM management: – glucose, carbohydrate counting, insulin dosing & timing
2 Dangerous peri-diagnostic phases: initial weight loss à Initial insulin treatment = fluid retention, body mass gain
3 Medical identity- constant medical visits
4 Dietary Regimen (food preoccupation)
5 Hunger/Satiety Disruption (hypoglycemia à binge-like behaviors)
Oh, and don’t forget
1 Perfectionism
2 Obsessional thinking/behaviors
3 Timing in life (young, image focused)
4 Rigidity
Remember… DM1 is a CHRONIC disease (the client has this forever)
These factors lead to a negative effect…
1 Dietary restraint
2 Obsessive compulsive thinking
3 Body image dissatisfaction
This can lead to … Disordered Eating Behavior (DEB)
Old thinking: Does not need to be bulimia + Diabetes Type 1 (DM1)
1 Intentional omission of insulin (or decreased dose) to induce hyperglycemia as a means to control weight
2 Lack of insulin à starvation/weight loss, dehydration from glucosuria, ketosis (fat for fuel)
New thinking: Any eating disorder + DM1
1 Drive to manipulate insulin is not always for weight loss (financial, lack of education)
2 Anorexia Nervosa, Bulimia Nervosa, ARFID, BED, OSFED in the DM1 client
How do we care for these clients?
1 Individualized management
2 Educate (client, loved ones, other health care professionals)
3 Stop validating perfectionism; instead remind clients how serious an ED is and even more so an ED + DM1
4 Forward thinking (prevention)
5 Allow for food flexibility
6 Therapy = ACT, Motivational Interviewing
7 Separate ED vs DM thoughts/behaviors
There is so much more to be said on this topic so please use this as a basic resource.