Wednesday, February 13, 2013

The growing problem of diabulimia

Most people refer to anorexia or bulimia when they talk about eating disorders. However there is one eating disorder which people know little about - diabulimia. As part of Eating Disorders Awareness Week we look at this condition and what we are doing at SLaM to treat it.

Imagine being a teenage diabetic and having to inject insulin every meal time, sometimes at school. Not only does that make you different from your peers but it is a demanding and intrusive activity to have to do every day. And if you don't do it, you may die.

But then imagine you can stop doing that - by limiting insulin levels you can avoid those embarrassing injection times and lose weight at the same time. This can lead to a potentially fatal eating disorder called diabuilmia.

Many people would never have heard of diabulimia. It is an extremely debilitating condition and one where there is still a massive misunderstanding, even within some parts of the medical profession.

The term has been used to describe people with Type 1 diabetes with bulimia nervosa who use insulin omission as a form of weight control.

Some people develop symptoms of anorexia nervosa and this also has an impact on diabetic control. The nutritional consequences of starvation on the brain and body are very severe when limiting glucose and insulin.

Janet Treasure, Professor of Psychiatry and Director of the Eating Disorder Service at South London and Maudsley NHS Foundation Trust (SLaM), said:

"It is estimated that 40pc of Type 1 females aged 15-30 regularly omit insulin for weight control. The combination of diabetes and an eating disorder produces a serious, pervasive and complex psychiatric condition and should be treated as such, with understanding and compassion but also with urgency as per NICE guidelines.

"Complications include blindness, limb loss, neuropathy blindness and fatality."

At SLaM we are carrying out pioneering research work to treat people with diabulimia and we are one of the only trusts in the country to specialise in this little-known illness.

SLaM provides care across inpatient, day patient and outpatient sites. Our unit provides a safe healing space where people can explore their difficulties and gain control over their eating disorder, working one-to-one, within a group and as part of their family.

A wide range of evidence-based care packages are available and can be tailored to suit specific needs. The agreed therapeutic aims will vary, but may involve gaining weight and establishing regular eating patterns.

An important part of our work involves family members and carers, helping them come to an understanding of eating disorders, their likely causes and their consequences and also providing support and care in the most effective way. The unit offers an extensive programme of training and consultancy for eating disorder professionals, voluntary workers and teams

Our unit is internationally renowned for its research and is at the forefront of treatment development, having generated much of the evidence underpinning contemporary eating disorder treatments. The Director of the Eating Disorder Unit, Professor Janet Treasure, has recently been awarded an OBE for services to people with eating disorders.

Treatment for this condition is complex and requires good physical and psychological care. Psychological therapy, which relies on a brain which can learn and reflect, is less effective if brain function is compromised by poor diabetic control. Also if diabetes professionals ignore emotions around food and body shape then diabetes education will be ineffective.

Signs and Symptoms of Diabetes with eating disorders DWED :

  • Recurrent episodes of hyperglycaemia
  • Frequent hospitalisations for poor blood sugar control
  • Delay in puberty or sexual maturation or irregular menses / amenorrhea
  • Frequent trips to the toilet
  • Frequent episodes of thrush/ urine infections
  • Nausea and stomach cramps
  • Loss of appetite/ eating more and losing weight
  • Drinking an abnormal amount of fluids
  • Hair loss
  • Delayed healing from infections/ bruises

Recent research shows that not only are females who have type one diabetes at twice the risk of developing anorexia or bulimia, as many as 40pc of 15 to 30 year olds regularly omit insulin.

SLaM, within Kings Health Partners, provide a unique service for diabetics with eating disorders with psychiatrists in the diabetes teams and eating disorder teams - bridging physical and psychological care. The team at SLaM and KHP are involved in developing and testing new interventions in combination with the charity DWED (Diabetics With Eating Disorders).

Professor Janet Treasure will be joining members of Beat, the national eating disorder association, at a parliamentary debate tomorrow, Thursday 14 February at 1.30pm, Westminister Hall, House of Commons.

The debate is being led by Caroline Nokes MP for Romsey and Southampton North and chair of the All Party Parliamentary Group on body image. A Minister and Shadow Minister will be present to answer questions.

For more information log onto:

http://www.b-eat.co.uk/

www.dwed.org.uk



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