Despite recent media attention, diabulimia is hardly a foreign concept. “The term [diabulimia] is not a new concept. Everyone who has done pediatric diabetes care has known about it for the past 20 years,” Dr. Rapaport says. “As part of routine care, a team of diabetes specialists, physicians, nurses, educators, and especially mental health care professionals and nutritionists would be paying attention to eating habits. Calling attention that eating disorders occur in youth with diabetes is a good service alert for health care providers. Inventing a new term is not useful.”
Parents of teenagers with diabulimia should implement a treatment team including: a primary care physician/nurse practitioner, endocrinologist (either primary or consultant), nutritionist, and educator. “It is critical that there is a team in place to focus on the management of the diabetes regardless of the status of the anorexia,” says Dr. Steingard. “I think that successful intervention requires full knowledge of both disorders,” he says.
Dr. Rapaport stresses that, “People should routinely discuss adherence to the management regimen—which includes nutrition, exercise, and insulin administration—with their diabetes healthcare team. If and when eating disorders are identified, referrals to appropriate specialists should occur promptly.”
Hunt, now a licensed independent wellness coach, never received treatment as a teenager. “I never joined a support group or turned to friends or family,” she says. “After 22 years, I finally told the truth to my doctor. I had to get really honest with myself and own accountability for the choices that led to the illness.”
Tips for Parents
Join a support group. “Be sure you build a network of support for you, the parent,” Hunt says.
Seek support from professionals. “You need to have a team [that is] in tune [with one another] to identify if an individual skips insulin or has atypical or disordered eating habits,” Rapaport says. Some professionals suggest parents monitor the patient’s blood sugar, have mandatory weigh-ins, or require a food journal, though Hunt disagrees: “I believe that, at best, approaching an eating disorder in this way will only address the behavior of the illness, not the illness itself,” she says.
“If you are able to find a place that says they have expertise in both disorders, ask about their experience and qualifications,” Dr. Steingard advises. “Don’t be shy. If you are working with two different teams of experts, you need to push for coordination between the two teams."
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