In anorexia nervosa (AN) treatment would bring the patient to stop controlling his food intake; but in Diabetes Mellitus food intake often have to be strictly controlled in order to maintain glycemia. Moreover, glycemia control could be used by AN patients to control their weight gains. How could we reconcilliate these two lines of treatment ?
I think that glycemia control can be used as a stymolus to optimization of food intake: if the patient is sure that glycemia control is the main scope she probably have a sufficient food intake to avoid ypoglycemia
Type 1 Diabetes is per se a challenge in adolescents; a coexisting Anorexia Nervosa makes treatment of Diabetes very difficult, because hyperglycemia is used to loose weight even if the nutricional plan is OK, changing insulin doses. I think the mainstay in this two diseases is the psychiatric control of AN, achieving acceptable levels of HbA1c and avoiding DKA.
What level of glycemia control do you found in AN patients with DM?
The less control of food intake can make suggestions anyway, like fruits (fructose) better than sacharose, or lipids and proteins better than sweetmeats. But in this two problems we should note that in the order of priorities AN is more serious than DM. (DMt2).
But in DMT1 insulin tratment without normal food intake is dangerous and must be very controlled, but insulin can help in the weight gain.
Because needs an uniforme, constant, regular intake of foods and sugar, the insulin tratment can help in a better action against AN. (Psychological conviction).
This is a dangerous, and sometimes fatal combination. It is critical to intervene and usually hand over self-care (both nutrition and insulin treatment) to caring others at first. They then gradually return control and responsibility to the patient for both eating and insulin administration as (s)he becomes able to accept it. A very structured environment is necessary - at home if feasible, or when there is a real danger in residential or hospital treatment. Details of the process will depend on level of severity, age, available support, motivation and more.
Take a look:
Outpatient Management of Eating Disorders in Type 1 Diabetes
Ann E. Goebel-Fabbri, PhD, Nadine Uplinger, MS, MHA, RD, CDE, BC-ADM, LDN, Stephanie Gerken, MS, LD, RD, CDE, Deborah Mangham, MD, Amy Criego, MD, MS and Christopher Parkin, MS
http://spectrum.diabetesjournals.org/content/22/3/147.short
Inpatient Management of Eating Disorders in Type 1 Diabetes
Ovidio Bermudez, MD, Heather Gallivan, PsyD, Joel Jahraus, MD, Julie Lesser, MD, Marcia Meier, RN, CDE and Christopher Parkin, MS
http://spectrum.diabetesjournals.org/content/22/3/153.short
Eating Disorders and Diabetes
Criego, Amy;Jahraus, Joel
Diabetes Spectrum; Summer 2009; 22, 3; ProQuest Health & Medical Complete
pg. 135
I hope it's useful for you.
I treated two cases who suffered of anorexic symptoms and diabetes, one adult and one child. Both were females. I found it very difficult to cope with that symptomatologic co-presence, that obliged patients to focuse on body functioning. In the case of child diabetes offered a way to establish a better relationship with the mother, in the adult diabetes was a way to be in touch with the dead father.In both cases, the main difficulty was in joining the psychic reality, were the body was so preminent. Would you like to discuss about that? L
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