At Penn Medicine Princeton Center for Eating Disorders, a multidisciplinary team developed an evidence-based protocol for the optimal clinical and therapeutic management of children and adults with type 1 diabetes and an eating disorder. The initiative brought together five disciplines with eating disorders expertise: psychiatry, endocrinology, nursing, nutrition, and psychotherapy.
“It’s not unusual for people with diabetes to feel sadness, burnout, or a sense of being overcontrolled from the constant need to manage their condition, and an eating disorder can be seen as a way to gain control,” says Assistant Nurse Manager Corinne Timberman, RN, BSN, PMHN-BC. “Through multidisciplinary interventions, we’re helping patients bring back masterful control in a positive way.”
When patients have an eating disorder and diabetes, especially if they are limiting insulin and have dangerous blood sugar levels, complications like diabetic ketoacidosis can quickly intensify and become life-threatening. Longer-term damage can range from neuropathy and retinopathy to kidney failure.
At Princeton Center for Eating Disorders, care is structured to help patients build the tools and knowledge necessary to work toward recovery from the eating disorder while managing their diabetes independently—skills they will need upon discharge. Components of the protocol include:
Medical stabilization and care: Patients have seamless access to on-site medical specialists at Princeton Medical Center, and an endocrinologist is consulted upon admission. Throughout a patient’s stay, endocrinologists are available for ongoing assessments and precise insulin management, and other specialists can be consulted as needed.
Psychiatric care: Board-certified psychiatrists specializing in eating disorder treatment provide individualized behavioral health care and medication oversight to optimize patient outcomes.
Nursing oversight: Giving structure and oversight to the protocol, nurses help manage patient care and monitor blood sugar levels before every meal and snack, once during the night, and as needed. Nurses also provide continual education on diabetes management and disease processes.
Nutrition management: From day one, dietitians work with patients to monitor caloric intake and carbohydrate balance with precision while educating them about nutrition needs and menu planning. With this knowledge, patients advance from checking off preselected menu items to writing in their preferences.
Therapeutic interventions: Through individual and group therapy, therapists help patients examine areas like emotion regulation, coping mechanisms, and how to manage urges to withhold insulin. The team has developed a system for tracking mood and other parameters, including blood sugar fluctuation. Each day, patients self-assess areas such as emotional intensity, urges, meal plan compliance, and the ability to care for themselves.
Patient and family education: Education is integrated throughout care, with topics including diabetes and nutrition, how mood states can fluctuate with blood sugar rates, and managing emotional distress. Examining family dynamics and achieving more effective communication with family members are also important components of the program.
Throughout treatment, overall progress is organized in a tiered system. As patients show mastery at each level, such as self-administering insulin with nursing oversight, they move toward greater independence.
"Those with type 1 diabetes and an eating disorder are an extremely vulnerable population, and treatment is a complex balancing act requiring insight from all angles,” says Rajshree “Ria” Patel, MD, a board-certified endocrinologist at Princeton Medical Center. “We’re very unique in New Jersey in our ability to offer this level
of multidisciplinary care.”
Team members who have played an integral role in developing the diabetes care protocol at Princeton Center for Eating Disorders include: |
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| Robbi Alexander, PhD, APN, PMHCNS-BC Director |
Lauren Firman, RN, MHA, BSN, CNML Nurse Manager |
Kari Mastro, PhD, RN, NEA-BC Director of Professional Practice, Innovation, and Research |
| Jennifer Campbell, LCSW Senior Eating Disorders Therapist |
Kristina Krill, MS, RD Nutrition Therapist |
Rajshree “Ria” Patel, MD Board-certified endocrinologist |
| Jenna Deinzer, RD Lead Senior Nutrition Therapist |
Allison Lansky, EdS, LMFT, CEDS, NCC Lead Senior Primary Therapist |
Corinne Timberman, RN, BSN, PMHN-BC Assistant Nurse Manager |