PRINCETON CENTER FOR EATING DISORDERS

ED-DMT1 (Diabulimia) Warning Signs Adults, teens, and even children can be affected by eating disorders and mellitus type 1, also called ED-DMT1 or diabulimia.

CLUES SOLUTION If your patient has diabetes type 1 and has If you feel like your patient may be • Unexplained high A1c • Frequent canceled appointments struggling with an , • Episodes of DKA • Claims of being unable to upload tracked blood call an eating disorder specialist for an evaluation. New Jersey • Hypoglycemia glucose information onto data sharing software has outstanding eating disorders • More test strips, lancets, or other supplies for • Reports of excessive exercise, discomfort with specialists and a nationally and checking blood glucose than expected eating or taking in front of friends and internationally known inpatient family, and hoarding food program that specializes in severe and enduring eating disorders.

INVESTIGATION Princeton Center for Eating Disorders Patients may manipulate their diabetes To learn more from your patient at Penn Medicine Princeton Medical care in several ways when they also Individuals with eating disorders often suffer from depression Center offers inpatient care for suffer from an eating disorder. and anxiety, and therefore benefit from a gentle approach to children (age 8+), adolescents, and diagnostic questioning. adults with acute anorexia, bulimia • Anorexia: Patient will limit or and other eating disorders. Patients, reduce food intake and/or avoid • Ask Questions. Ask as many as possible, but kindly and patients, and families benefit from taking insulin. curiously, without giving off an air of suspicion by asking our ability to address eating disorders • Bulimia: Patient will binge with too many. Examples: “What are you worried about?”; “How in those with additional medical compensatory behavior such as can I support you?”; “What is your understanding so far of complications, and to treat individuals insulin omission, over exercising, the nutrition needs of your condition?”; and “How has your who have extremely low body weight. vomiting, and diuretic or laxative eating changed since your diagnosis?” Princeton Center for Eating Disorders abuse. This is the most common • Avoid stigmatizing language. Ask whether a person has welcomes patients of all genders. eating disorder in . “checked,” not “tested,” his or her blood glucose. (“Test” COVID-19 Notice: All patients are • Binge eating disorder: Patient will implies pass/fail.) The terms “control,” “compliance,” and “adherence” are other words that may be seen as judgmental. tested for COVID-19 upon admission. overdose insulin to “justify” a binge. Princeton Center for Eating Disorders • Purging disorder: Patient will • Don’t use scare tactics. In the vein of language to avoid, try is a separate, secure unit within a consume food normally with not to use scare tactics, such as telling patients the worst larger hospital. Patients remain on compensatory behaviors involved possible complications. Scare tactics are harmful for any the unit, and staff must have special in bulimia. patient—those with type 1 diabetes, eating disorders, and clearance to enter. Private rooms, beyond—but they’re especially damaging to patients who restricted visitation policies, and already suffer from depression or anxiety, which are common vigilant monitoring help keep our among people with eating disorders. community safe.

REFERENCE: For a copy of Turner, H, Diabetes: Eating Disorders in Type 1 Diabetes, Today’s Dietitian, 2020.02, Vol 22, No. 2 p 14, contact Cassie Carlino (609) 423-3171. [email protected]

princetonhcs.org/EDdiabetes Equitable Care for All At Penn Medicine Princeton Health, all patients, 609.853.7575 without exception, have the right to high-quality, unbiased, patient-centered health care, regardless of One Plainsboro Road, Plainsboro, NJ sexual orientation or gender identity or expression.