Specialized Treatment for Diabetes & Eating Disorders

When individuals diagnosed with type I diabetes begin taking insulin, they often gain weight. This weight gain is a sign that the body is functioning properly. However, as type 1 diabetes is commonly diagnosed in childhood or early adolescence, young image-conscious individuals often struggle to accept weight gain as a byproduct of their illness and begin manipulating insulin or engage in other disordered eating behaviors such as dietary restriction or purging to control weight gain. Studies show that women diagnosed with type 1 diabetes are two and a half times more likely to develop an eating disorder than their peers.

The highly specialized diabetes program at Center for Hope of the Sierras is among a small handful of programs in the country with the ability to address both the medical and psychological components of co-occurring diabetes and eating disorders. The diabetes program opened in April of 2009 and has since helped numerous women of all ages on the road to recovery from their eating disorder while effectively managing their diabetes.
Center for Hope of the Sierra’s diabetes program is run by a comprehensive team of experts in the field including:

• Consulting Board Certified Endocrinologist
• Registered Dietitian with a Ph.D. in nutritional biochemistry
• Licensed Marriage & Family Therapists
• Licensed Clinical Social Workers
• 24-hour Nursing
• 24-hour Resident Assistants

A Gradual Recovery Process

At Center for Hope of the Sierras, we understand that treatment for co-occurring diabetes and eating disorders requires finding a balance between appropriate insulin intake and slow, gradual weight restoration (if indicated) while closely monitoring the individual’s progress. It also requires educating individuals about their bodies and their conditions so that they learn to regulate the amount of sugar and calories they’re consuming. This way, individuals find a balanced, healthy weight they can be happy with, without feeling compelled to abuse insulin.

“There is a certain degree of urgency that accompanies chronic high blood sugar,” explains Kathryn Eckert, M.D., a board certified pediatric endocrinologist. “Because it is often accompanied by hospitalizations, there is often a limited window of time to get blood sugars under control.”

At the same time, normalizing blood sugar levels too quickly can be equally harmful. “For medical and emotional reasons, we don’t want patients gaining 10 pounds in just a few days, as can happen when patients follow the optimum medical recommendations right away,” says Dr. Eckert. “Ideally, the recovery process is slow and calculated with a great deal of medical monitoring and management.”

The Need for Concurrent Treatment

Co-occurring diabetes and eating disorders is a mental illness which indicates that treatment professionals must do more than tell individuals to stop restricting their insulin or to take better care of themselves. Treatment is much more complex than simply gaining weight and learning to properly use insulin. Rather, it’s about finding a balance between what the body needs (insulin) and what the individual can handle emotionally.
The best outcomes are achieved when individuals receive integrated treatment for their diabetes and their eating disorder simultaneously. “It’s fruitless to engage people in eating disorder treatment without addressing the medical issue of diabetes,” says clinical psychologist Steve Graybar, Ph.D. “Treatment for both conditions must occur simultaneously, which means bringing blood sugar levels back into the normal range slowly while at the same time adjusting to weight changes and addressing emotional issues in individual, group, and family therapy.”

At Center for Hope of the Sierras, residents receive intensive support and medical management for their diabetes in addition to the proven treatment program for their eating disorder. The diabetes program accounts not only for the biology of eating disorders and diabetes, but also the psychological, social, and cultural implications that are interwoven into the biological process. With treatment anchored in the biopsychosocial model, residents receive:

• Comprehensive medical management including nutrition education and rehabilitation, blood sugar monitoring/testing, insulin administration, and a monitored exercise program.
• Individual, group, and family therapy that address the food, weight, body image, and interpersonal issues underlying an eating disorder as well as the emotional factors that are interfering with responsible self-care for the treatment of diabetes.
• A home-like environment with 24-hour nursing and social support where women can connect in a meaningful way with peers, staff, and themselves.
• Comprehensive care from a team of experts in a CARF-accredited residential program, including a consulting board-certified endocrinologist, a registered dietitian with a Ph.D. in nutritional biochemistry, licensed psychologists, marriage and family therapists, a psychiatrist, and 24-hour nursing and patient assistants.

With treatment and medical stabilization, residents learn that constant feelings of irritability, dehydration, and fatigue are not normal and that they can feel better when managing their diabetes in a healthy way. Residents learn better ways to cope with the feelings brought on by weight gain, gain education about nutrition, diabetes management, and healthy living, and develop a support network that understands the implications of a dual diagnosis.