Approaches at Odds in Eating Disorders, Diabetes
Jancin, Bruce, Clinical Psychiatry News
KEYSTONE, COLO. -- The disparate and often conflicting management philosophies for type 1 diabetes and eating disorders are evident in the contrasting meal plans traditionally advocated for individuals with one disease or the other, Stephanie H. Gerken said at a conference on the management of diabetes in youth.
Diabetes management focuses on numbers. Diabetic patients are taught to count and record calorie consumption, grams of carbohydrate, and minutes of exercise--not to mention blood glucose levels, glycosylated hemoglobin, and body weight.
In contrast, eating disorder (ED) clinics stay away from numbers altogether. In fact, at some ED clinics food labels are covered up so patients won't fret about them. In the diabetes world, however, reading food labels is taught as a core skill, noted Ms. Gerken, a diabetes educator and registered dietician at the International Diabetes Center, Park Nicollet Clinics, Minneapolis.
She is part of a joint team from the Park Nicollet diabetes and ED centers. Their goal is to improve outcomes in these challenging patients. A collaborative approach such as this is optimal, she said, because psychiatrists know little about contemporary diabetes care, while few pediatric endocrinologists are comfortable treating EDs.
Snacks are another huge issue for dual-diagnosis patients. The ED clinic view is snacks are essential for weight restoration and to reduce bingeing and purging. The meal plan for ED patients typically calls for three meals and three snacks daily. But the diabetes philosophy is snacks aren't necessary and require additional insulin injections.
Diabetic patients are taught to focus on one food group: carbohydrates. The ED treatment philosophy is that all seven food groups are important. Fat is an important dietary component for ED patients because it promotes satiety and weight restoration. Fat isn't encouraged in diabetic patients because of their increased risk of cardiovascular disease, she said at the conference sponsored by the University of Colorado and the Children's Diabetes Foundation, Denver. …