News and Updates
July 02, 2017
Diabetes and Eating Disorders: Yoga as an Adjunct
This article is contributed by Beverly Price RD, MA, E-RYT 200, CEDRD-S. Thank you, Beverly!
Individuals with Type 1 diabetes have a higher-than-normal prevalence of eating disorders. In 2013, the National Institutes of Health (NIH) reported, from a review of literature, that 12-58% of young women with type 1 diabetes overeat, while 37% omit or restrict their insulin in order to control their weight. Similarly, a study of adolescents ages 12-21 found that 10.3% of females in their sample reported skipping insulin and 7.4% reported taking less insulin to lose weight. In terms of males, a study showed males with type 1 diabetes to have a higher drive for thinness as compared to males without diabetes, which may be a risk factor for further development of disordered eating. Further, research suggests that males may be more likely to exercise than to diet for weight loss, and boys who participate in sports that emphasize weight or leanness, such as wrestling or diving, may be at higher risk for disordered eating behaviors.
Why the prevalence?
Because diabetes and eating disorders involve attention to one's body, weight management, and control of food, some individuals develop a pattern in which they use their diabetes to rationalize or mask their eating disorder.
Let's look at a snapshot in the life of an individual with diabetes:
In addition, let's look at the dichotomy ("the Yin and the Yang") of diabetes with an eating disorder:
- Frequent testing of blood sugar
- Continually staying on top of food that is consumed
- Counting carbohydrates
- Attending nutrition education programs
- Multiple doctor visits
- Learning the technology to use a blood glucose meter
- Using a needle not only to test, but to inject insulin multiple times a day
- Having people monitor records and state of health continually
- Being considered "different" by peers
- Monitoring during sports
- Special snacks during the day
- Loss of control of one's own body
- Feeling scared at times
"Control" is a central issue in both diabetes and eating disorders. Individuals with diabetics may feel guilty, anxious, or out of control if their blood sugar swings more than a few points. Individuals with eating disorders may feel the same way if their weight fluctuates. The control needed for the individual with diabetes, followed by the mixed messages that individuals with diabetes and co-occurring eating disorders receive, have the propensity for the diabetes to spin out of control when coupled with the eating disorder.
- "Maintain your weight, blood sugar, and exercise! (numbers, numbers, numbers!)"
- "Count your carbohydrates!"
- "...but eat intuitively, do not count, measure or weigh… and let go of the control."
Complications of Diabetes with an Eating Disorder include:
Treatment for individuals with Diabetes and Eating Disorders
- High blood glucose
- Diabetic Keto Acidosis
- Multiple organ failure
- Low blood glucose when starting the refeeding process
The best treatment is a team approach with a knowledgeable, experienced and skilled treatment team including:
Addressing the underlying psychological issues, along with restoration of physical health are key interventions. This includes weight restoration and stabilization, through balanced, varied, and healthy meal plans that provide adequate calories and nutrients along with blood glucose control, and balanced exercise. Medication management, with the use of psychiatric medications to address depression, anxiety, is also the cornerstone of treatment.
- Physician - Endocrinologist and Potentially a Psychiatrist
- Registered Dietitian
- Licensed Mental Health Therapist
- Certified Diabetes Educator
What about Yoga?
For someone with diabetes and an eating disorder, the benefits of yoga can be a powerful adjunct to treatment. Yoga can help an individual by heightened awareness and improved perception, body acceptance and appreciation, the ability to begin to feel vs masking emotions and begin to let go of control through confronting their fears. Yoga teaches mindfulness. Individuals learn to experience the taste, texture, and other sensual qualities of food and begin to enjoy and appreciate food for its nourishing qualities.
Yoga targets the sympathetic nervous system, which in turn can help to lower heart right and blood pressure. The regulation of the nervous system can aid in the management of anxiety and depression. Yoga also works on the parasympathetic nervous system to regulate metabolism and emotions. In addition, yoga can raise gamma amino butyric acid (GABA) levels in the brain responsible for calming the nervous system. Yoga's work on the cerebral cortex, can improve decision making, aid in irrational thought process and reduce impulsive behaviors.
If an individual with diabetes and an eating disorder is planning on starting a regular practice of yoga, medical clearance needs to be obtained along with a baseline blood glucose, A1C, blood pressure, weight and behaviors. The individual needs to check blood glucose levels before and after yoga. The dietitian can help the patient manage a meal plan in relation to the intensity level of the yoga practice. In addition, since yoga involves all body parts, including the feet, the individual needs to understands the importance of checking their feet after each session to make sure that they are not irritated.
By the basic breathing techniques and simple movements, that yoga can offer an individual with diabetes and an eating disorder, individuals may find it easier follow a food and lifestyle plan, while becoming more aware and in tune with their condition and behaviors. The end result is improved disease management.
BEVERLY S PRICE is a certified eating disorder registered dietitian and IAEDP supervisor, experienced registered yoga teacher and IAYT certified yoga therapist. Beverly is recognized for bringing mindfulness-based yoga to the eating disorder treatment community along with yoga therapy training programs in eating disorders for professionals.
June 09, 2017
We Are Diabetes National Provider Network: Amy Ornelas RD, CEDS Serving San Diego, CA.
Amy Ornelas is a Registered Dietitian and Certified Eating Disorders Specialist. She has had the pleasure of working exclusively with people who struggle with disordered eating and exercise for the past 10 years at the residential, partial hospital, intensive outpatient, and outpatient levels of care.
Utilizing a non-diet approach, principles of intuitive eating, and mindfulness, Amy works with clients collaboratively in order to help them reclaim their mind-body-food connection and rediscover the joys of eating. Aside from her career in dietetics, Amy is also a yoga teacher and loves to use this modality to help people reconnect with and understand their intuitive drives for movement and rest.
Amy graduated Cum Laude from San Diego State University with a BS in Foods and Nutrition and received her clinical training at the VA Healthcare Dietetic Internship in La Jolla, CA. She is a current Board Member Elect of the International Association of Eating Disorder Professionals and has been featured as a nutrition and eating disorders expert on the news, internet radio, healthcare videos, medical websites, in many published news articles, and as a guest speaker at several conferences.
Amy believes that nutritional recovery is not about going without; it is about going within and learning to work with your body in a whole new way. She is deeply passionate about helping others find their peace with food and a newfound appreciation for their bodies.
May 05, 2017
The We Are Diabetes Recovery Toolkit!
We are beyond thrilled to announce that the We Are Diabetes Recovery Toolkit is now available for use! The We Are Diabetes Recovery Toolkit is FREE for anyone to download and use on their recovery journey!
The We Are Diabetes Recovery Toolkit was created for any individual working towards recovery from ED-DMT1 (sometimes referred to as "diabulimia"). We've taken note of the most frequently asked questions about recovering from ED-DMT1, and with the help of our contributors, we have addressed those questions here in this free toolkit.
This Recovery Toolkit is here to make your journey to recovery a little clearer. Many have successfully found a full and joyous life after their battle with diabetes and an eating disorder. Their strength and courage are the core inspiration for this project.
Our toolkit is meant to be shared, and to be read over and over again!
April 28, 2017
We Are Diabetes Is Now A Myabetic Affiliate Member!
We have exciting news to share! There's a new way to support We Are Diabetes! We are now an official Myabetic Affiliate! When you purchase your lovely Myabetic gear through our special customized WAD page We Are Diabetes receives a small percentage of each purchase! Make sure to use the code "WAD" at checkout to receive 15% off your purchase!
March 24, 2017
We Are Diabetes National Provider Network: Daphna Shiffeldrim MD, MPH Serving New York, NY.
Daphna Shiffeldrim MD, MPH is a board-certified Child, Adolescent, and Adult Psychiatrist working in private practice on the Upper East Side of Manhattan. In addition to treating general psychiatric disorders, Daphna specializes in treating children with chronic medical conditions; particularly type 1 diabetes, as she is a type one diabetic herself. Daphna was diagnosed with T1D at age six years. Living with a life long chronic medical condition has helped her gain a deep understanding of the intimate connection between the mind and body, and the power of one to influence the other.
Daphna’s individualized multifaceted approach to treatment includes a combination of psychopharmacology, various psychotherapy techniques, extensive work with and support for parents, coordination with schools and other treating physicians, as well as lifestyle modifications (relaxation techniques, sleep, nutrition, and exercise). She strongly believes that optimizing one’s physical health requires optimum mental health and vice versa. We couldn't agree more!
Daphna has a bachelor's degree in computational biology from Cornell University and attended medical school at the Medical School for International Health at Ben Gurion University in Israel. Following completion of her medical studies she received a master's degree in public health from Mount Sinai School of Medicine, with focus on health promotion and disease prevention, particularly in the area of type 1 diabetes. Daphna completed both adult psychiatry residency and child and adolescent psychiatry fellowship at the Hofstra Northwell School of Medicine (formerly North Shore- LIJ). Additionally, she has completed training in Trauma Focused-Cognitive Behavioral Therapy, a model that can be used for children who have suffered medical trauma and those with chronic illness. In every stage of her training, Daphna has sought to deepen her understanding of the mind-body connection, and to develop skills to help children maintain a balance between the two.
Dr. Daphna Shiffeldrim has a private practice located in New York, NY. Call 929-249-1580 to make an appointment.
February 26, 2017
National Eating Disorder Awareness Week Is Here!
One of the topics we’re focusing on this year is the fact that type one diabetics of all ages struggle with eating disorders. Although the media primarily focuses on teens and "twenty-somethings", a large percentage of adults also struggle with ED-DMT1. It can often be even harder for this population to make the decision to seek treatment; they have families, full time jobs and commitments that don’t allow for a lot of time for the self-care that is necessary for someone working on recovery. Many people above the age of 30 avoid eating disorder treatment because it normally caters to younger people. Older adults may feel also feel ashamed to be dealing with an eating disorder in this phase of their lives.
Fortunately, there are many treatment options beyond inpatient (if individuals are healthy enough to stay at home). Partial hospitalization, intensive outpatient, or building up your own personalized recovery care-team (contact us at email@example.com for more information about how to do this) are all options to consider. The most important thing for any adult T1D struggling with an eating disorder is to know is that there ARE options and that they are not alone!
NEDA has a lot of cool stuff to help support anyone who wishes to do their part to advocate and spread awareness this week - so make sure you check out all their resources!
February 05, 2017
It's Finally Here! Prevention And Recovery From Eating Disorders In Type 1 Diabetes: Injecting Hope
We're beyond thrilled to announce that We Are Diabetes Board Member Dr Ann Goebel-Fabbri's book "Prevention And Recovery From Eating Disorders In Type One Diabetes: Injecting Hope" is finally available for purchase!
Prevention and Recovery from Eating Disorders in Type 1 Diabetes: Injecting Hope sheds light on an often overlooked and misunderstood issue: the problem of eating disorders in women with type 1 diabetes – referred to by lay people and the media as "diabulimia" and characterized by insulin restriction as a means of calorie purging for weight loss.
Drawing on a series of recent interviews and over 16 years of research and clinical experience with this unique phenomenon, author Dr. Ann Goebel-Fabbri provides groundbreaking insight into the lives of women who have recovered from eating disorders in type 1 diabetes. She explores the condition's origins, its effects on the lives of those affected, and possible paths to recovery. Also included are suggestions for prevention and treatment as well as practical and inspirational advice from now-recovered women.
Prevention and Recovery from Eating Disorders in Type 1 Diabetes is a valuable guide for patients and loved ones, diabetes treatment teams, and eating disorder clinicians.
Currently there's a 20% discount available! Enter code IRK71 at checkout!
January 26, 2017
Worried About The Affordable Care Act? Turn Your Worry Into Action!
A message from We Are Diabetes Founder and Executive Director Asha Brown:
There’s a great deal of uncertainty for those who live with a preexisting condition right now given the current political climate. This issue is deeply personal to every individual and family that lives with chronic illness. I think it’s important that we channel our anxiety and concern about the future of the Affordable Care Act (ACA) into effective action.
As an avid worrier I know all too well how much worrying about the unknown can consume every waking moment of my day; leaving me useless to function in the “now” of my life. I used to let my personal self-care fall apart and I’d forgo my commitments and responsibilities; just so I could give myself more mental and physical space to worry even more! As my personal recovery continues to deepen I’ve become more tuned in to how negative the effects of worrying about the unknown can be.
Now, when faced with a situation where a resolution remains to be certain I do my best to ensure that I’m focusing on what is within my control in order to promote a favorable outcome. In regards to the unknown fate of the ACA I know the best thing I can do to support the continuation of this lifesaving program is to participate in the initiatives that the Diabetes Patient Advocacy Coalition (DPAC) generates.
The following is a quote from DPAC’s Founder and CEO (and my dear friend) Christel Marchand Aprigliano:
"Every day we make a choice to be healthy, especially for those with diabetes and ED. We face internal struggles, which is up to us to conquer and seek support from trusted sources, like WAD.
But how much influence do you have over the external struggles that we're facing right now in the U.S. political system? Where are the resources and support for us in government? Who will help to keep us motivated and fighting for our continued health on a political advocacy front? More than you think. And DPAC can help.
Diabetes Patient Advocacy Coalition (DPAC) is the WAD of diabetes policy advocacy. We are the patient voice in diabetes policy and we are an easy way to take action and share our stories with policy makers. By joining DPAC (it's free!), your message on protecting the health of all people with diabetes and ED can be quickly sent.
DPAC focuses on safety, quality, and access to diabetes medications, devices, and services for all people with diabetes. We share information on issues that we all need to know, and then with a few clicks, you can send messages to your policy makers (and insurers, too!).
We fight every day to stay healthy as individuals. DPAC helps us fight to stay healthy as a community."
Please take a few moments to sign up for DPAC and help us protect a program that has allowed so many of WAD’s clients to finally be eligible for insurance. There is still time to protect this lifesaving program!
December 30, 2016
The Last New Year’s Resolution You'll Ever Need
The following is a guest post from Positive Psychology Coach (and our good friend) Leann Harris:
New Year. That time of year where people try and decide if they have lived up to the goals they made 366 days ago and whether they should bother making new ones. The concept of creating New Year’s resolutions is enticing: a year from now we could be a better person than we are right now. Who doesn’t want that? Changing my calendar out for another year is a great opportunity to change my life, right?
This thought is tricky. While I certainly have goals I want to reach, it’s the way I go about reaching them that’s become important to me. While I certainly was on the “New Year, New Me” bandwagon, I’ve created one resolution that surpasses all other resolutions and I’d like to share.
Who Says I Must Change?
What am I listening to that says I’m not good enough just the way I am? If I say I want to lose 10 pounds, I need to ask myself why. I listen and try to identify the voice in my head that is trying to convince me I should do it. Is there some old message from long, long ago that doesn’t help me anymore running through my head? Is it someone else's voice, or the generic "well everyone thinks so" message? If so, I may ignore it altogether or go to my next measurement.
Will This Change Make Me Happy?
I can certainly find the potential benefits to almost any idea that pops into my head. Maybe I’d like to fit into my jeans better or I think I’d be "healthier." I can imagine how happy I’d feel. Wait, but why? Why do I think that changing my weight will lead to more happiness? This happiness measurement is the one that eliminates 99% of my ideas for change. Typically, anything I come up with does not lead to true happiness. They are signs of a sense that "I am not doing enough" or "I should be MORE." If asking myself “more WHAT?” returns only silence, then I know that this is not a good idea. Using my energy to run away from my feelings of unworthiness or sense of inadequacy does not make me happy. Making strides towards something that feels good—that makes me happy and content. Trying to make ourselves feel worthy by being perfect doesn’t truly help. Ten years from now I will not look back and congratulate myself for finding another excuse to hide from my own sense of failure. Perfectionism is a false shield we wield to try and pretend we have everything we need when we actually feel the opposite.
Is This Kind?
Let’s say my idea to lose weight makes it through my first two criteria and I decide to go for it. My #1 rule for this process is to make sure I am being kind to myself and I give myself permission to abandon the idea at any point. This used to make me nervous—isn’t that just an excuse to quit? What I’ve found is that NO resolution is worth being cruel to myself, punishing my body, or being mentally exhausted all the time. Kindness is my guide. If I don’t know how to be kind to myself and still accomplish my goal, I have a much bigger problem! Perfectly completing my external goal of fitting into clothes is not worth sacrificing my mental health.
What Do I Need?
The last thing I ask myself is "what am I really looking to feel?" I don’t ignore my urges for change, because something in me trying to get my attention. Most of the time when I feel a need to overhaul something about myself, it’s because I’ve been busy and haven’t been meeting my own needs. Maybe I need a "me day" where I do whatever I want—guilt free. Maybe I need a new book (or two) and actually take the time to read it. Maybe it’s a massage or a bubble bath. Even if it’s only 30 minutes crammed into my day, that urge to change with New Year’s resolutions can be completely transformed into a reminder to practice healthy habits and not add the stress of self-imposed pressure. Accepting that I am worthy enough to take time out of my life to care for myself gives energy and meaning to everything else I do.
So create one resolution for yourself and for all of your New Years to come: be kind to yourself and trade in self-perfectionism for self-care.
Leann Harris has lived with type 1 diabetes for 16 years. As a Positive Psychology Coach for people with diabetes at Delphi Diabetes Coaching, she focuses on the mental fears and emotional challenges of thriving with diabetes. She is passionate about helping others learn resilience skills, counteract shame and blame, and overcome diabetes burnout. Her motto is "Know Yourself, Know Your Diabetes."
December 09, 2016
The T1D Guide For Mental Health Care Providers!
Are you having trouble finding a Therapist or other mental health care professional who understands T1D? There's only a handful of mental health practitioners in the US that are fully capable of treating someone with the dual diagnosis of an eating disorder and type one diabetes. So what do we do?!? We educate! This is a great resource from our friends at Beyond Type 1 to give to your mental health provider!