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Powerpoint Handout 4/28/2020 Diabetes & Eating Disorders: A Complicated Relationship Quinn Nystrom, M.S. Speaker, Author & Diabetes Advocate National Diabetes Ambassador – Center for Change 1 4/28/2020 AGE 13 -Blood glucose meter -Blood glucose test strips -Ketone strips -Lancing device -Lancets -Continuous Glucose Monitor & Sensor -Alcohol swabs -Syringes -Insulin pump supplies -Batteries -Glucose tablets -Glucagon kit -Waterproof tape -Adhesive remover -Frio cooling wallet -Snacks 2 4/28/2020 6 3 4/28/2020 Camp Needlepoint Other reality… 4 4/28/2020 5 4/28/2020 6 4/28/2020 • The dual diagnosis of an eating disorder and type 1 diabetes is often referred to as “diabulimia,” however this is not a medically recognized term and it is not an accurate description. What is • “Among some academics, the nomenclature eating disorders in ED-DMT1? diabetes mellitus type 1 (ED-DMT1) is used to denote the spectrum of disturbed eating behavior found within this specific demographic.” –Jacqueline Allen, Birkbeck University 7 4/28/2020 75% of American women are dissatisfied with their appearance. Prevalence 50% of 9 year old girls and of Eating 80% of 10 year old girls Disorders have dieted. At least 4% of teenage girls and college-age women become anorexic or bulimic. Steinhausen HC: The outcome of Anorexia Nervosa in the 20th century. Am J Psychiatry 159:1284-1293,2002. Anorexia Nervosa and Bulimia Nervosa- Diagnosis & Treatment Guide for Professionals. • ED behaviors seen in 8% of T1DM vs 1% of peers without DM. • Increased risk of disturbed eating behavior in girls with T1DM as young as 9. • 32.4% of females with type 1 diabetes have Eating some form of disordered eating or weight control behavior. Disorders + • 36% reported intentional omission of insulin. Diabetes • Strong association between type 2 diabetes and clinically significant binge eating. Colton P et al, Eating disorders in girls and women with type 1 diabetes: A longitudinal study of prevalence, onset, remission and recurrence. Diabetes Care 38:1212-1217,July 2015 Peveler RC. Type 1 Diabetes & Eating Disorders, Diabetes Care 2005 Colton P. et al, Disturbed eating behavior and eating disorders in preteen and early teenage girls with type 1 diabetes; a case-controlled study Diabetes Care 27:1654-1659, 2004 Udo et al. Menopause and metabolic syndrome in obese individuals with binge eating disorder. Eat Behav 2014;15 8 4/28/2020 Feels betrayed by Emphasis on food body with diagnosis and dietary restraint. of diabetes. Diabetes Society setting “food management focuses rules” for people with on numbers. diabetes. •Patient judges self being "good" or "bad" based on eating patterns or blood Why glucose level. Weight gain/higher Belief that you “ate BMI, result from your way into intensive insulin higher diabetes”. therapy. risk? Temptation factor Effect of diabetes on •Easy availability of self-concept, body deliberate insulin omission image, and family to control weight. interactions. Family dynamics involving autonomy and independence concerning diabetes self-management. Diabetes Spectrum volume 22, Number 3,138-141,160, 2009. Mitchell, J. Medical comorbidity and medical complications associated with Binge- eating disorder. Int J Eat Dis 49:3. ED Screening Tools for Diabetes Patients Diabetes and Eating Problem SCOFF Survey – Revised (DEPS-R) 9 4/28/2020 DEPS-R 16 questions 0-5 Likert scale, can complete in <10 min Some examples of questions specifically related to diabetes: Other people tell me * ADD the total score I feel fat when I take After I overeat, I skip to take better care of = greater than 20 is all of my insulin. my next insulin dose. my diabetes. clinically significant. Markowitz, J., Butler, D.,Volkening, L., Antisdel, J., Anderson, B., Laffel, L., Brief screening tool for disordered eating in diabetes. Diabetes Care,vol. 33, number 3, March 2010. Do you make yourself Sick because you feel uncomfortably full? Do you worry you have lost Control over how much you eat? Have you recently lost more than One stone (7.7 kg, about 15 lbs) in a 3 month period? SCOFF Do you believe yourself to be Fat when others say you are too thin? Would you say that Food dominates your life? *One point for every “yes;” a score of ≥2 indicates a likely case of anorexia nervosa or bulimia 10 4/28/2020 11 4/28/2020 12 4/28/2020 Eating Disorder Diagnosis Diagnosis ED-DMT1 Treatment 13 4/28/2020 Treatment and Recovery: it’s a process MULTIDISCIPLINARY DIABETES INFORMED STANDARD ED PERFECTIONISM – TEAM TREATMENT COMBINED TREATMENT ATTAINABLE GLUCOSE WITH TECHNIQUES/THERAPIES TARGET GOALS Ann Goebel-Fabbri (2017) Injecting Hope: Prevention and recovery from eating disorders in diabetes. Social Media Resource 14 4/28/2020 15 4/28/2020 16 4/28/2020 Women with an Eating disorder Most Helpful Communication Practice & Least Helpful Communication Practice by a Healthcare Professional 17 4/28/2020 AADE, ADA, 2018. 18 4/28/2020 For Mental Health Providers Practical Applications Gather Adapt Comfort Gather diabetes Adapt your standard Comfort level - history approach to eating burnout • Diagnosis, family’s disorders response, relationship with • Diabetes specific concerns providers need to be integrated into • Expectations, targets for treatment glucose and approach to • Perfectionism : diabetes food. management , food, weight • Create a nonjudgmental treatment relationship. • Language: • Management vs. control • check/value vs. test (glucose or A1c) • Like a compass not a report card • High/low or in target vs. good/bad Diabetes • Avoid labeling food as good or bad • Avoid suggestions or comments that Providers diminish the complexity and difficulty of Practical having both DM and ED • “just eat” Applications • “Just take your insulin” • Avoid labels “non-compliant” Ann Goebel-Fabbri 2017 Injecting Hope Prevention and Recovery from Eating Disorders in Type 1 Diabetes 19 4/28/2020 Take the fear of weight gain seriously Help cope with edema Diabetes Providers Teach symptoms of DKA Practical Applications Gradual decreases in A1c Focus on when the patient feels ready Ann Goebel-Fabbri 2017 Injecting Hope Prevention and Recovery from Eating Disorders in Type 1 Diabetes For Family and Friends Practical Applications KNOW WARNING REFRAIN FROM FEAR END “BODY TALK” ENCOURAGE SIGNS OF ED AND TACTICS OR FLEXIBLE EATING SYMPTOMS OF DKA SHAMING Ann Goebel-Fabbri. (2017). Injecting Hope. Prevention and recovery from eating disorders in diabetes. 20 4/28/2020 Contact me: www.QuinnNystrom.com [email protected] Follow me @QuinnNystrom: 21.
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