Since the recent development of a multifaceted treatment protocol to care for those with eating disorders and diabetes—often referred to as diabulimia or ED-DMT1 when accompanied by insulin restriction—the Princeton Center for Eating Disorders team has successfully implemented the plan of care for a number of patients. The protocol addresses both medical and psychiatric care in an evidence-based format with expertise from five disciplines: psychiatry, endocrinology, nursing, nutrition, and psychotherapy.
“One of the interesting facets has been the degree of family distress for both adult and adolescent patients due to the complex combination of an eating disorder and diabetes,” says Jennifer Campbell, LCSW, Senior Eating Disorders Therapist. “It reinforces our belief that family involvement is essential, and we accomplish this through family psychotherapy and psychoeducation sessions as well as supervised family meals for adolescents.”
As part of Princeton Medical Center, Princeton Center for Eating Disorders can effectively address the higher degree of medical comorbidities that can stem from having both conditions. The team also takes into account the fact that individual needs can vary widely in this patient population, and develops the care plan accordingly within the framework of the protocol. One example included a patient with co-occurring Crohn’s disease requiring a gluten-free meal plan.
“We’re seeing an array of positive outcomes, including improvements in education levels, distress levels related to the ability to care for oneself, and patient/family communication and support,” adds Assistant Nurse Manager Corinne Timberman, RN, BSN, PMHN-BC. “As we to continue to collect data, we plan to incorporate findings to make the protocol even more robust.”
Warning Signs of Diabulimia
Endocrinologists and other outpatient providers should watch for these potential warning signs of ED-DMT1:
- Unexplained high A1C
- Episodes of diabetic ketoacidosis
- Hypoglycemia
- Reports of excessive exercise, discomfort with eating or taking insulin in front of friends and family, and hoarding food
- Frequent canceled appointments
- Claims of being unable to upload tracked blood glucose information onto data-sharing software
- More test strips, lancets, or other supplies for checking blood glucose than expected