Signs of
disordered eating can be hard to spot in people with
diabetes, and some red flags to look for include:
Erratic
blood sugars
A
reluctance to talk about foods, or an unwillingness to
consider adding or changing dietary practices. Rigidity
and ritualization often accompany disordered eating
behaviors.
And be
aware that a patient who has met glycemic goals but does
not express joy or contentment with that, and is
unwilling to consider moving to a maintenance phase, may
be struggling with anxiety or shame.
Signs to look out for:
Erratic blood
sugars
Reluctance to eat
with others/discuss eating with others
Frequent dieting,
anxiety associated with specific foods or meal
skipping
Chronic weight
fluctuations
Rigid rituals and
routines surrounding food and exercise
Feelings of guilt
and shame associated with eating |
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Another
special group are those patients whose insulin needs do
not match their glycemic outcomes. For example, a
patient who reports, or whose insulin pump shows, that
they are taking all mealtime insulin but their blood
glucose remains consistently high, or rises between
meals. These patients may be omitting insulin for weight
loss.
This is a
condition referred to as diabulimia. It may or may not
accompany an eating disorder.
Special Considerations: LGBTQIA+
Members of the LGBTQIA+ community face hardships and
inequities throughout the healthcare experience.
From more bias and judgement from clinicians that
leaves them less likely to seek care, to less access
to knowledgeable care providers, these patients are
often underserved.
Members of this community also have rates of
depression and suicide that are 2-4x higher than the
national average. With transgender individuals
having the highest risk for suicide of all societal
demographics.
Gay
men report 3x the rates of disordered eating as
their heterosexual peers.
When
diabetes is an added stressor in the lives of these
individuals, the risk for reduced self-management or
mental health impacts multiplies.
Higher rates of
depression and suicide (2-4x)
Experience more
clinical judgment and bias – less likely to
seek care
Have less
access to knowledgeable clinicians
Gay men report
3x the disordered eating rate
Support systems
in “renovation”
Housing,
Financial security and sexual security
compromised |
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It is
also important to be mindful that the support
systems of LGBTQIA+ individuals may be in a state of
“renovation”. As one shares one’s self with one’s
supports some will choose to leave or shun the
individual, and the time of discovering one’s
“found” or “made” family takes time. This is a very
vulnerable time for their mental health. These
individuals may also experience times of transition
in which their housing, financial security and even
their physical safety and sexual safety are all
compromised. When their basic needs are compromised
they oftentimes lack the resources and mental
bandwidth to properly manage the often complex needs
of diabetes self management. Additional supports
from social, and clinical services are vital to
keeping these individuals safe and moving forward.
Clinicians may wish to seek out LGBTQIA+ competent
training in order
to
empower them to utilize the full diversity of the
diabetes community for their patients.
Special Considerations: Age 65+
Another group? seniors.
Seniors are always at an increased risk for mental
health decompensation. Aging is a phase of life
where their self actualization and esteem are
directly impacted. When younger, they identified
with their role in society, professionally, or
within their family or culture. But with retirement,
or children leaving the home, those identities are
compromised and seniors can feel they are losing
their ability to contribute to their community. This
is referred to as stagnation.
Higher rates of
depression
Higher rates of
isolation
Higher risks
associated with hypoglycemia
May have Longer
duration of diabetes diagnosis
Factors associated
with aging make diabetes
management more
difficult – vision/hearing impairment,
reduced mobility,
financial instability, loss of social supports |
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Seniors also have higher risks of hypoglycemia as
their body’s hormonal compensatory systems are not
as reactive, so they are less likely to feel low
blood sugars before losing consciousness. And should
they have a hypoglycemic event-related injury, the
ramifications on their health are far greater with
age.
Seniors are also likely to have had a longer life
with diabetes, making their risk of complications
and other health decline higher than younger
individuals with diabetes. So though they’ve done
everything “right” for decades they may now perceive
their body as “betraying them”.
And at
the same time factors associated with aging are
making it ever more difficult to continue to manage
their diabetes effectively and independently.
Seniors are more likely to have impaired sensory
abilities, mobility, and are at a far higher risk of
financial instability due to the unforeseen costs of
health maintenance that come with age, and the loss
of social supports as friends are also aging.
Generational differences also increase the stigma
associated with seeking and needing mental health
care. This may cause seniors to be resistant to
discussing their struggles, feelings or deficits.
Ongoing assessment and careful listening over time
can be the key to gently uncovering areas of need.
And educating, even when need is not immediately
apparent, is beneficial.