double trouble - rosewood institute · image experience by cheryl musick, eagala advanced certified...
TRANSCRIPT
Double Trouble
The Relationship between Diabetes
and Eating Disorders
Title Here
36075 S. Rincon RD, Wickenburg, AZ, 85390, 928 -684-9594
The Rosewood Institute
• Original Founders had a dream for the Rosewood Treatment Centers…..
• An Education and Training branch of The Rosewood Centers for Eating Disorders
• The dream unfolded…….
What Does TRI Do?
• Continuing Education training (Internal & External)
– Approved Provider with: NBCC, NAADAC, CBBS and CDR
• Training professionals on the specifics of eating disorders/addictions and co-morbid complications
1. West Coast Symposium for Addictive Disorders
2. Cape Cod Symposium for Addictive Disorders
• Present/participate in eating disorder conferences
– IAEDP, AED, NEDA, BEDA, BFI
TRI Initiatives and Goals:
• Invite Guest Speakers to share their specialties with our treatment staff
• Monthly Webinars and On-demand trainings
• Co-Sponsor Workshops/events and present locally and nationally with fellow field professionals
• Outreach & Education Projects for K-12 Grades & College– Operation RecoverED, Shannon Hershkowitz
• Internship program and Curriculum – Dr. Dena Cabrera, Clinical Director
Presenter Bio
Kim Collins, MS, RD, CDE
Registered Dietitian
Kim is a Registered Dietitian and Certified Diabetes Educator. She joined
Rosewood with multiple years of experience working with adolescent and
adult patients. Her wide-spread knowledge of disease management and
wellness contribute to her specialized work designing community-based
nutrition programs, and authoring nutrition articles. Kim completed her
Master’s Degree in Dietetics with an Emphasis in Counseling, an important
component assisting her to follow her passion in her work with the Eating
Disorder population. Kim’s specialized knowledge enables her to individualize
nutritional therapy care while assisting with the delicate balance and
management of blood sugars. Additionally, Kim’s twelve years as a certified
pharmacy technician have given her medication knowledge highly important in
designing patient care treatment planning. Kim takes a realistic approach to
meal planning and combines that with the standards of practice for nutritional
care.
2015 Webinars At-A-Glance
• JAN 16: After the Binge: Using the Mindful-based Strategies to Treat Binge Eating Disorders by Nancy Romanick, RDN, MBA, MAPC, LAC
• FEB 27: Treating Complex Trauma: A SensorimotorPsychotherapy Approach by Holly Finley, LPC, CEDS
• MAR 27: Shaping Foundations: How Three Decades of Prevention Research has Transformed Education Outreach and Treatment of Eating Disorders by Dr. Michael Levine
• APR 24: Do no Harm-Ethics and Eating Disorder Treatment" / "The Implementation of Ethics and Eating Disorder Treatment by Dr. Jessica Rodriquez
• MAY 22: Nutrition Medicine: The Acute Care of Eating Disorders, Stabilization and Recovery by Megan Kniskern, RD, CEDRD
• JUNE 19: Does DSM V Really Change Anything? A New Look at Classifying Eating Disorders by Jessica Setnick, MS, RD, CEDRD
• JULY 24: Refeeding Syndrome: Complications of Anorexia Nervosa, by Amelia Davis, MD
• AUGUST 21: When Eating Disorders & Addiction Collide: Assessment and Management in Adults and Adolescents by Nicole Garber, MD
• SEPTEMBER 18: The Diabetic Dilemma: Treating Eating Disorders in Diabetic Adolescents and Adults with Eating Disorders by Kim Collins, MS, RD
• OCTOBER 22: Body Dysmorphic Disorder: Application of CBT and Mindfulness-Based Interventions by Jennifer O’Connor, PhD
• NOVEMBER 13: Controversies in Approaches to Weight Management by Dena Cabrera, PsyD, CEDS and Eliza Kingsford, MA, LPC
• DECEMBER 11: Mirror, Mirror? Treating the Body Image Experience by Cheryl Musick, EAGALA Advanced Certified
Go to www.rosewoodinstitute.org to view recorded CE webinars and to register for upcoming webinars.
Objectives
• Learn criteria for eating disorder diagnosis
• Learn medical concerns for someone with diabetes and an eating disorder
• Learn nutritional interventions for treatment
• Learn about continued care needs to maintain optimal health status
Eating DisordersAnorexia Nervosa- DSM-V
– Restriction of energy intake leading to a significantly low body weight
– Intense fear of gaining weight or becoming fat or a persistent behavior that interferes with weight gain
– Disturbance in the way in which one’s body weight or shape is experienced
Diagnostic Statistical Manual 5
Anorexia Nervosa Subtypes
Restricting Type:
• No binge eating
• No purging behavior
• Weight loss is accomplished from dieting, fasting and or excessive exercise
Binge-eating/purging Type:
• Engages in episodes of binge eating
• Engages in episodes of purging behavior
Diagnostic Statistical Manual 5
Severity
Normal BMI 18.50 - 24.99 kg/m2
Mild: BMI ≥ 17 kg/m2
Moderate: BMI 16 -16.9 kg/m2
Extreme BMI 15.0 - 15.99 kg/m2
Severe: BMI <15.0 kg/m2
Diagnostic Statistical Manual 5
Eating Disorders
Bulimia Nervosa DSM-V
• Recurrent episodes of binge eating
• Followed by inappropriate compensatory behaviors
Diagnostic Statistical Manual 5
Bulimia Nervosa
Binge:
• Eating an amount of food larger than what most individuals would eat
• Sense of lack of control while eating
Including:
• Behaviors to prevent weight gain
• Both occurring, at least once a week for 3 months
• Influenced by body
Diagnostic Statistical Manual 5
Severity
Mild: 1-3 episodes a week
Moderate: 4-7 episodes a week
Severe: 8-13 episodes a week
Extreme: 14 + episodes a week
Diagnostic Statistical Manual 5
http://patienteducationcenter.org/information/diabetes
Diabetes Basics
Diabetes Basics
Type 1 Diabetes
• Little to no insulin
• Multiple Insulin shots daily
Causes:
• Family history of diabetes
• Virus
• Immune system
Type 2 Diabetes
• Insulin is present
• Insulin is not working correctly
Risk Factors:
• Family history
• Overweight or obese
• Inactive
• Ethnicity
Diabetes Basics
Signs:
• Frequent urination
• Increased thirst
• Appetite change
• Unexplained weight loss
• Dizziness
• Dry, itchy skin
• Fatigue
• Blurred vision
Medical Complications:
• Neuropathy
– Feet, hands
– Kidneys
• Retinopathy
• Heart Disease
• Skin
• Amputations
Diabetes + Eating Disorder
=
ED-T1DM
ED-T1DM
• Specific to Type 1 diabetes
Two separate avenues
1. Deliberately withhold insulin for the purpose of weight loss; Calories are purged through glucosuria
2. ED separate from DM
Case Study• 12 years old
• Admit Ht: 62.0”
• Admit Wt: 138.8#, 63.0kg
• Diagnosed with DM T1 3 years prior
• Uses insulin pump
• Uses CGM
• Attends Diabetes camp every summer
• Presenting Behaviors:
– Restriction
– Meal skipping
– Fluid Restriction
Case Study Cont.
• Disordered eating and body image concerns
• Started wearing long sleeves
• Meal Skipping
• Decreased portions
• Self harm
• Stopped eating at the hospital to avoid gaining weight.
• Meals: sometimes as a family, some times alone in her room.
• checks blood sugar: before meals, bedtime, 2am; shaky, dizzy
• Fear of weight gain
Medical Concerns
General:
• Blood sugar management
• Insulin management
• Elevated A1c
• Meal plan
• Psychological aspect
Diabetes Specific:
• Ketoacidosis
• Eye complications
• Foot complications
• Neuropathy
• Nephropathy
• Gastroparesis
• Heart Disease
• Stroke
Case Study Assessment
• Refusal to change her own pump site
• Refusal to place her own CGM
• Minimal understanding of carb counting
• Acceptance of DM diagnosis
• Parents role
– Protection
– Support
– Guilt
Treatment
• Restoration not required
• Management of behaviors
• Consistency with meals
• Nutrition education
• Impact of not eating on diabetes/medical status
• Grief work and acceptance
ED-T1DM
Warning Signs for Family and Friends
• Excessive thirst
• Avoiding checking their blood sugar
• Not wanting to give a shot/ “forgot”
• Tired
• Complaints about body image
• On and off dieting
Treatment- withholding Insulin
• Carbohydrate controlled diet
• Insulin dosing
• Education around diabetes and complications
• Nutrition education
• Psychological work around desire for thinness
Treatment- withholding Insulin
• Controlled environment
• Initiate treatment with stabilizing medical complications
• Frequent blood sugar checks
• Control over insulin administration
• Syringe vs pump administration
Treatment – Both avenues
Mean while….
• Meal plan stability
• Carbohydrate controlled diet
• Education around meal plan
• Intensive therapy
Continued Care
• Intensive Outpatient Team
– Medical Doctor
– Therapist
– Psychiatrist
– Dietitian
– Certified Diabetes Educator
• Support Team
Recovery
• Following a carb-controlled diet
• Dosing and administering insulin accurately
• Management of medical status
• Continued therapy work
LIVING LIFE
Case Study
• Female
• 16 years old
• T1 since age 10
• Grew up feeling “pudgy”
• Age 10: sudden weight loss, hungry, thirsty
• Age 10-14
– Good insulin mgt
– Carb counting
– A1c within normal limits
– High in carb/sweets
• Age 14-16
– Compare with peers
– Significant A1c increase
– Weight loss
– Change in eye sight
Case Study: Inpatient
• Stabilize patient and eliminate crisis
• Evaluate by multi-disciplinary team
• Monitor and Educate
– Glucose Goals
– Monitoring schedule
– Insulin Dosing
– Purging
Case Study
What to do about weight gain
• Avoid discussing weight # during treatment
• Focus on health benefits
• Therapy
• Body image work
What Doesn’t Work• Scare Tactics
• “You are going to be on dialysis before you are 40 if you don’t start taking care of yourself”
• Guilt Trips• “ You are going to ruin another family vacation because
you won’t take your insulin”
• Put-Downs• “Don’t you have any common sense? Don’t you know what
you are doing to yourself?”
What Works
What motivates this individual?
• Pre-teens what to grow taller
• Athletes want to build muscle
• Young adults want to be healthy to have babies
• Parents want to take care of their children
• Hard workers don’t want to miss work
• Most don’t want to lose eyesight
Body Facts
• Heart Beats:
• Use:
• Breathe
• Move
• Perspire
• Blood travels
• You speak
• Hair grows
103,689 times
7,000,000 brain cells
23, 040 times
750 major muscles
1.43 pints of moisture
168,000 miles
48,000 words
0.1717 inches
What Works
Set small goals
• Observe taking basal insulin
• Check blood sugar and make corrections
• Bolus insulin for carbohydrate intake
What Works
Develop a Healthy Life Style
• Establish sound eating habits
• Shift focus away from weight
• Promote appropriate exercise
• Continued education
Continuing Education Certificate
– Within a few hours following this Webinar you will receive an email with an Evaluation Form and Post-Test attached.
– Complete both forms and return to: [email protected]
– Upon receipt of the Post-Test and Evaluation Form, and successful completion of the post-test (score of
80% or better), a CE Certificate will be sent to you.
Questions & Answers
Send questions or slide requests to:
For additional information visit us at:
www.rosewoodinstitute.org
Contact Information
Questions & Answers Email us at [email protected]
For Complimentary CE Webinars
Go To:
www.rosewoodinstitute.org