“This is not a group of bad kids,” she stressed. “This is a group of very smart kids. They are just too smart for their own good.”
Once a clinician suspects a patient has diabulimia, it's time to get skilled professional help from a team consisting of an endocrinologist or nurse practitioner, a dietician experienced in treating patients with eating disorders, and a psychotherapist skilled in treating diabulimic patients.
Finding such a team can be difficult. Ms. Shih has three private practice clinics throughout the San Francisco Bay Area, so she knows most local psychotherapists. Many are comfortable treating eating disorders. Few are comfortable in situations where type 1 diabetes is integral to the psychopathology. Exactly the opposite is true among dieticians: Many are highly skilled at diabetes management but don't have the passion or background to take on youths with comorbid eating disorders.
On her Web site (www.gracenutrition.org
Her own treatment approach involves taking the time to get to know the diabulimic patient and figuring out that individual's potential motivator for change. To the young person who is an academic overachiever eager to get into a top university, Ms. Shih might point out that taking her insulin as directed would bring more energy, a better attention span, fewer headaches – and better grades. For the athlete, the appeal might be the prospect of loss of lean body mass because of uncontrolled diabetes.
To the patient with blurred vision caused by swelling of the lens because of osmotic changes induced by very high blood glucose levels, it might be the argument that her eyesight changes, unlike retinopathy, are reversible with improved diabetes control.
“Most of these patients don't take insulin at all, so set small goals and start slow,” the dietician advised.
Ms. Shih disclosed having no conflicts of interest.
Diabulimic patients weigh themselves often and may take issue with the accuracy of the clinic scale.
Source MS. SHIH