The meaning of hypo awareness

This week (23-30 September) is hypo awareness week

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I wrote this for last year’s awareness week. Originally posted October 2017

This is such an important subject to keep talking about. At best hypos can be a irritating disablement, but at worst they can be traumatising, anxiety provoking and quite often fatal. 

At the forefront of my mind is how yes, hypoglycemic episodes can be difficult for anyone with diabetes to endure, however it’s a whole different playing field when you add an eating disorder into the mix.

A hypo launches you into survival mode. The options are simply to obtain and ingest glucose ASAP or die. There is no other alternative. But for someone with an eating disorder and type 1 diabetes this can be hugely distressing. and prompt challenging thoughts. The choice to submit and take in those calories may trigger a whole load of guilt to sit on top of that which already exists.

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During my last admission as an inpatient on an eating disorder unit hypos became an extreme fear for me As I felt my hands start to tremor a sense of dread would set in as I tried to pretend it was not happening and I was no different to anyone else.. I felt guilty, so guilty, of having extra in addition f the prescribed diet. This was in a place where so many others around me were trying to trim their meal plans down as much as they possibly could. Biscuit crumbs and slivers of butter hidden in covert places, a splodge of jam left under the container lid.. Every calorie was counted and any unexpected increase in portions, or even a slice of pie that looked too large or scoop of mash that was overly heaped, often resulted in dinner table meltdowns.  

I can't deny that such obsession was inapplicable to me, but when it came to hypos, I had no right of refusal. It became quite frightening as my insulin was increased and i was experiencing hypos on a daily basis. I had to guzzle down cups or Lucozade, measured to the hundred ml (I always told them it wouldn't be enough, and so another 100ml and often yet another would follow). followed by biscuits, all while shaking and disorientated. But most of all I felt I would be judged for being weak somehow,  for giving in, perhaps not directly by my fellow patients but by their eating disorders. I felt gluttonous and so ashamed of giving my body what it needed. That’s an eating disorder in a nutshell, really.

How dare I allow myself any semblance of good health?

Eating during a hypo is unplanned, it is frenzied and without containment. It can easily lead to binging; desperately inhaling sugary foods as you try to grasp reality, often leading to high blood sugars. More guilt. Surrounded by a pile of chocolate wrappers and an empty cereal box. Emerging from a blurry, half conscious state and berating yourself for a loss of control.

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So this year, following the release of the BBC Documentary which has led to a rise rise in press and advocacy concerning Diabulimia and ED-DMT1, please consider what hypoglycemia might mean for sufferers of these conditions. Being hypo aware is about more than just having glucose to hand and knowing the signs and symptoms. For people with type 1 diabetes and an eating disorder it involves being aware of the difficult emotions that come alongside. It means accepting medicine and acknowledging that treating a hypo is about essential need, not greed. It’s about giving yourself permission to fight against that toxic 'voice' that tells you that you do not deserve to eat, to norish yourself, to live.

By Claire Kearns.

Clouding Over

The Reality of Retinopathy

(Please ignore typos/errors, I have a good excuse!)

I never meant to do this. It wasn’t supposed to go this far. This was not the person I ever imagined myself becoming. But I am here and it’s happening and I am terrified. I hit a concrete wall, smacked my face hard against a reality that despite being in front of me I did not see, literally could not see.

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In the beginning I was just flirting. Experimenting with diets and slight adjustments to my insulin plan, a trim of some units, a lie here and a secret stashed away there, but it was nothing serious, I just wanted to lose a bit of weight and then I’d stop, right?

Here we about 17 years later. The start I mark as September 2001: the implementation of my back to school “diet which soon became bulimia, then anorexia, with spurts of Diabulimia and erratic blood sugar control throughout. I don’t know how I even got here. I can’t even understand how or why or where all those years went. I feel cheated. I am not this age, I did not live those years. It’s almost like I’ve been comatose as each day ad month fell into each other beneath a fog.

21 years of type 1 diabetes. Oh, it’s been a strained relationship, one of resentment and bitterness. I’ve pushed and I’ve kicked and I’ve denied its existence. Now it feels like it’s paying me back, reminding me of my neglect, the damage I’ve caused. It’s pointing and laughing and saying, “Ha! Thought you were invincible huh?”

In the past I’ve shrugged off the complications that have been caused by my eating disorder and diabetes. I’ve not been so bothered by them, and scare tactics or warnings relayed to me by health professionals, my friends or my family have had little effect. Part of it is because I don’t care much about myself, and partly because I have the tendency to put my head in the sand ingrained in me. So, I shrug things off and say oh it’s nothing serious or I am not worth the worry anyhow.

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But when the issue is right ahead of you, blocking your view and pressing on your brain, it’s impossible to ignore. My eyes are failing me. I’ve had diagnosed retinopathy for a couple of years now and undergone 4 bouts of extensive laser surgery. I’ve had numerous floating islands and wispy strands of black appear at the backs of my eyes that have mostly dispersed gradually or been corrected by laser. sessions My left eye has always been worse and this time it is chief troublemaker. again.

During the evening of Friday 27th July, I noticed blurriness over my left field of vision and it seemed to gradually thicken throughout that evening. I struggled through Saturday hoping that it would break up and dissolve like the similar patches I’d had occur. But it stayed put and on Sunday seemed to be even more serious.

This prompted an A&E visit, a 7-hour long day, out of hours on call eye clinician, and relying on my patient brother to take me and stay with me.  I was utterly exhausted by the end of it all.

The verdict was that I have a huge bleed right on the macular of my left eye and I cannot see anything besides blurriness out of that side. I was told they could do a procedure to break up the bleed but that nothing could be done outside of regular clinic hours and so I’d be given an urgent appointment that coming week.

Three appointments followed, and it was determined that I most likely needed to have a vitrectomy operation as the bleed was just too large to attempt anything less invasive.  For that I was to be urgently referred to a London specialist hospital.

I waited, and I waited.  Finally, the week before last, I chased them with a phone call to the London hospital. They had no recent record of me, they’d not heard a thing. I went back and forth and back and forth between secretaries and appointment staff on both sides and discovered that my local hospital had messed up big time. A letter has been written on the 10th and yet London hadn’t received it, and neither had I a copy of which I’d been expecting, suggesting this wasn’t just a case of lost mail within the system. It wasn’t sent.  I eventually had to ask them to email it directly over and so the date it reached the intended destination was the 4th September. I now have to hold on an additional two weeks for their allowed response period. It’ a bit of a joke.

These are boring details, but hard to explain the current situation without the lead up. I started this blog with a centre to reach but have lost myself a bit. But that’s a fitting place to be. Lost. I feel so very lost at the moment.

I am wandering aimlessly, disoriented, dizzy, drifting and confused. From my left eye the sky is only indistinguishable by colour and direction, from the ground. I can see a waving hand but not the number of fingers held up. I can see a bright light but no letters on the reading chart. I look at a word, or a sentence and the middle part is all mixed up with pieces missing. Then today, actually within the last 3 hours I can now see a black inky puddle floating ahead of my right side of vision. Just…. no.

This is me admitting I am scared. This time I am fretful. It has been raining heavily for a decade but the damp is only just soaking and sinking in.

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I am a reader and a writer. Those two things are what I love to do. I feel stunted. All I am doing is watching endless TV shows, as I can see moving shapes as long as there’s no text. I can’t work at the charity shop I usually volunteer at because I am not safe. I am clumsy and have broken too many dishes and dropped so many items over the last month or so. I struggle to read cooking instruction labels and unscramble the digits of telephone numbers. Typing is made easier, with autocorrect and spell check but it is an effort and mentally exhausting. I won’t manage to proof-read this, so please forgive any mistakes for which there may be plenty. I guess I just wanted to put some words to screen because that is possible as far as I can mostly make out which letters are where with my right eye and from memory. Checking back over it is harder.

I want to take it all back. I wish I could time travel and be able to shake my naive 14-year-old self back to sense, right at the moment I stepped over the edge. Like I said, I didn’t mean to do this. I was only trying things out. By this age, I would have a career and a relationship, maybe a family. I’d be successful and able to be a proper adult. That was the plan. But it’s faded to dust in my hands. I want to rewind and stop myself right at that line that was crossed. I want to say,

“It’s not worth it, it’s a trap, come back, talk to someone, get help.”

By Claire Kearns.

Talking about complications

Language matters around the subject of diabetes complications. We want to hear your thoughts and examples of good/bad practice

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Please share with us any ideas you have on how people with type 1 diabetes and most particularly those with additional eating disorders should be spoken to when it comes to complications. This could be relating to real life experiences you've had with health-professionals or just general thoughts on what you believe is the most helpful or unhelpful ways in which these discussions should play out.

Your ideas will make up a document provided for the benefit of subscribers with DWED health professional memberships, to offer additional insight into the way patients with T1-ED wish to have conversation around complications broached within a clinical setting. July brings about the conclusion our mini series of members only resources which over 4 months have  highlighted common type 1 diabetes complications; retinopathy, neuropathy, gastroparesis and finally nephropathy. 

For your reference you may also want to read a highly relevant recent blog written by staff writer Claire Kearns: Complications, Scare Tactics and Survival.

All your comments will remain anonymous and we have no doubt that any and all submissions will be hugely worthwhile to the people reading them. To be a part of this project just fill in the form below, and thank you so much!


What type of language do you feel health professionals should use when discussing diabetes complications with their patients? Please feel free to include your own specific examples of good and poor practice. 

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Complications, scare tactics and survival

I’ll go blind or lose a leg if I don’t take care of my diabetes: that’s the one lesson I feel I took away from the information given to me when I was diagnosed in 1997, just prior to my 9th birthday.
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It’s all quite a blur but I remember those warnings. I remember feeling small and not understanding what I had done to deserve it, why me? Feelings of insecurity, self-doubt and hatred that would later fuel the beginning of my eating disordered behaviours had already started to simmer away in the background. For a long time I was in a state of denial, a little of which still remains in me. I used to pretend I wasn't any different to anyone else.

Language matters. Certain remarks are always remembered: I can vividly recall attending my diabetic clinc appointment at the age of 14 and just prior to the emergence of anorexia. I was at the upper limit of the healthy BMI range and my endocrinologist told me to be careful not to put on any more weight and that losing a few pounds would probably be beneficial to me. The next time I saw that doctor he congratulated me on the far lower number on the scale. He’ll have had no clue whatsoever as to how those words stuck with me and made me so fearful of becoming fat as I started to starve and shrink.

It seems that care has improved quite significantly for children diagnosed with diabetes these days, and the structure of treatment has changed: We no longer have to take set amounts of insulin and so stick to a regular, proportioned diet. Instead the basal and bolus routine means we can adjust our doses and take the right amounts needed to cover any kind of food we want to eat. Advances in technology such as pumps and CGM’s provide even more flexibility and some freedom from feeling so much like a pin cushion. But the rhetoric of blame and guilt for having diabetes and furthermore, the complications it causes is still put onto us. Most of all by the media and carried by members of the public that consume those headlines and read or hear inaccurate reporting regarding diabetes and so just don't know any better. The diabetes community which is most active within the social media sphere is fully informed and yet the ignorance that falls outside of that is still damaging and hurtful.

I see a lot of coverage of the potential complications of type 1 diabetes, even from charities and such that do it in a sensitive manner, but still I don’t see too much out there on management of them, advice on how to cope with additional chronic conditions in both a physical and mental sense. This is important and there needs to be guidance and resources available.

DWED are in fact in the midst of the production of a series of content packages which highlight on 4 separate common complications – these materials are available to our members. We have covered retinopathy, gastroparesis, and neuropathy so far and next we are moving on to nephropathy. For this I have interviewed a number of people with T1ED as case studies who also have direct experience of these complications. Common themes have emerged which also mirror my own history: shame, embarrassment, frustration at the false assumptions that other people around you may make. But also there’s hope, there’s perseverance and bravery.

Still, it can be too simple to think you are invincible and don’t need to worry about any of the longer term ramifications, not just yet. You aren’t at your goal weight yet. You’ll totally stop this stupidity after you’ve made it there. You’ll recover and graduate and be in your chosen career - you’ll be a proper adult, right? But months tumble into each other and then into years. You look back and think ‘damn, I really didn’t mean to do this.’

With complications you can feel totally safe until the **** hits the fan. Sorry, no way else I could put that! You don’t ever know when or what will come first, everyone with type-1-diabetes is different. Every time a new issue crops up I still feel like I am making a big deal and using up valuable appointment slots that could be used for other people. Again, that’s the sneaky self destruction in me. I know it too, but that doesn’t seem to make it any weaker.

I think that for people who also have an eating disorder the onset of complications often seems to come alongside a sense of fault and failure. Failure for being unable to control and cope with diabetes in the way they “should” do and putting themselves at risk through insulin restriction for weight loss purposes (“Diabulimia”) or/and the more ‘typical’ disordered eating behaviours such as purging by vomiting or cutting down food intake and calories [T1-ED].

T1ED can stamp you down with a double dose of guilt. Despite what other people may think about diabetes and the misinformed judgements they might make,  anyone that lives it knows the real facts, eating disorder or otherwise: That type 1 diabetes is not caused by poor lifestyle choices, and cannot be reversed or prevented. Yet, what about the complications it may lead to? You can never be certain as to when they may have developed and whether your eating disorder means you are experiencing them at an earlier rate. Honestly, I’d guess from hearing other people’s   experiences, for most it will be a definite contributing factor. For that you might feel real, raw guilt, guilt that feels more justifiable in comparison to the irrational-that-you-know-is-irrational Type 1 Diabetes guilt.

But is it, really?

An eating disorder is a mental illness and can feel all consuming. In the beginning you don’t think of the future, of still being ill in ten years time. Of having to deal with neuropathic pain and frequent laser eye sessions, a stomach that doesn’t work properly and can lead to quite unpleasant effects, far from glamorous or just that little thinner and fitter, like you intended to be. You don’t even consider that you might have to someday walk with an aid and not be able to go far on your own. But this is the truth of it, and I am merely glossing the surface. An eating disorder is sneaky, deceptive and can prevent the ability to seeing any kind of wider perspective Your world revolves around food and numbers and secrets, avoided diabetes clinic and nurse appointments, pretending you’ve taken insulin or eaten, or not eaten (after binging), lies that fall out your mouth with added embellishment for authenticities sake. It can make you feel completely powerless.

Confirmed diagnosis of complications may help or hinder someone attempting recovery from an eating disorder/T1ED or Diabulimia. It may feel they have been given a concrete reason that they need to try to take better care of themselves and so reduce further risk. On the flip side it is common to feel defeated and damaged beyond repair. From a fast moving car you look out the passenger seat and lose yourself in your own heads, until your body becomes so tired and the dissociation begins to lift – you notice the trees, grass. The breeze against your face and realise that none of it was ever worth it. You climb into the driver’s seat and try to steer but nothing is familiar. You want to stop and breathe but you realise the brakes are faulty; you’ll survive mostly unscathed after crashing the car against a safety barrier.

Nobody means to end up with a list of complications that for some reason seem to all hit at once like falling dominoes. Take me: coincidentally I’ve had a horrendous week with neuropathy, quite possibly due to medication changes. On Friday my balance was so compromised that I couldn’t walk in a straight line or hold myself up, and the pain felt unbearable – numbness and pain consecutively which seems like a contradiction but you’ll know exactly what I mean if you’ve been there. Next thing was on Tuesday I noticed another black ‘floater’ in my left field of vision so have an emergency eye clinic tomorrow.

I can’t really say how it makes me feel. I’ve had retinopathy for a while and three laser surgery sessions, but I’d ever been through neuropathy to the degree where it left me pretty much incapacitated. I did feel momentarily scared, when it was happening and my balance was totally off kilter, but that floated away and I am left with numbness, a whole lot of nothing, to a degree where I am almost nonchalant about it all.

The main element I wanted to bring into this is the effectiveness (or not) of “shock tactics.” I have recently concluded that I am pretty much immune to them. I think this is for two reasons: the first is because I have trouble giving a damn about myself – all that mental health head crap. The second I feel may be relevant to other with type 1 diabetes that were also told the horror stories growing up of losing legs and eyesight and even becoming bedbound. Some like me may have heard such horror stories numerous times over., thrown at you during another attempt to give you a 'wake up call'. It all gets a bit old. It perpetuates the isolation we already feel from the people around us without type 1 diabetes.

We know all the risks without even reading sensationalist ‘real life’ type stories. We are the experts of our own condition. Personally, nothing anyone could say to me in terms of possible dangers of  mismanaging my insulinr would ever faze me.

This is something I wish my family and some friends could accept. I KNOW it comes from a place of care, but the things they can say to try and jolt me out the eating disorder I’ve had for over half my life, and make me face up to what I am doing to myself. I don’t need that. It doesn’t help, and it can actually hurt. Instead I need to be listened to and be able to rant about type-1- diabetes, about neuropathy keeping me awake at night and blurred vision that means I have difficulty reading some labels. Being told I brought this on myself just makes me want to withdraw and beat myself up inside a little more. The bottom line is that shock tactics have no influence on me beyond causing upset. Too many lectures over the years have worn me down and people should save their breath.

I’d be interested to know if this immunity to ‘scare tactics’ is a trait many other type 1’s feel they have. Do you suddenly ‘wake up’ and tighten your monitoring and dosing accordingly if you develop signs of complications? Furthermore, if people tell you that you might need amputation one day or lose your sight is it effective in causing you to act and try to regulate your sugar levels? Or is it support and an acknowledgement that you are doing your best to get through the days that is more useful in helping you to start making changes? I wonder if this is different for people with T1ED due to the influence of how we feel about ourselves.

The names of diabetes complications are not even of use, really. It’s the impact they have on us and our general quality of life that counts. Burying our heads in the sand is no use, but still, there is no need to catastrophise. Complications may not be completely cured but they can be treated. Health Professionals have the means to try and stop progression with medications, changes to diet for gastroparesis and procedures for retinopathy ranging from laser eye surgery to vitrectomy surgery.

Complications are not a death sentence or burdens weighing us down. Every single person I interviewed on the subject was surviving despite really tough circumstances. Type 1 diabetics are the strongest people I know and stronger more for dealing with such life altering complications. We keep going and even on low days, we don’t give in. We hold each other up if we need to and remind each other that guilt and blame has no place. Dwelling on what might have been is futile.

By Claire Kearns.

Action plan

Sometimes I worry that I’ve completely exhausted blogging about type-1-diabetes and eating disorders to death. But then when I can’t sleep at night my mind won’t shut up; it’s over thinking all of the things that I haven’t said, niggling doubts and grievances I feel I need to let out. I just hope nobody reading these blogs is sick of my rambling!

Diabetes is always there, canoodling with anorexia and my fall back insurance of running high blood sugars without taking quite enough insulin. I fear hypos most of all and struggling to accept the basal adjustments my specialist nurses urges me to make. It’s still a constant battle to stay attached to my pump, and it’s disheartening to still hear ignorance and judgment on both type 1 diabetes and eating disorders wherever I go. The combination of the two still seems to be a wildly foreign concept to most members of the public that have no personal investment in the issue.

This is still frustratingly the case even after a number of notable print and online articles that have been published over the last couple of years on Diabulimia and the prevalence of disordered eating in individuals with type-1-diabetes. The brilliant documentary “The World’s Most Dangerous Eating Disorder” which was aired by BBC Three last year led to widespread acclaim and we were so pleased. For a while, with a surge in our website traffic and social media interest, it seemed like it could be a major breakthrough.

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In retrospect it merely splintered the glass surround which makes it easier for outsiders to see through but the other side which means options of treatment and true acknowledgment is still so unreachable. This despite coverage of far too many unnecessary death and statistics revealing staggering mortality rate that prove that those with T1-ED and/or Diabulimia walk shakily close against the edge of a tall building every single day.

Yet the reaction to that reality is quite predictable a lot of the time, still: “how stupid can they be? How difficult can it be to just inject if it’s a matter of life of death? Don’t they realise how crazy they are to do that?” and oh of course, there friend or relative has type 1 and lives a healthy life, their diabetes does not really affect them at all!” The eye rolling and that frustrating and wholly misjudged that is still used by clinicians: “non compliant.”

There has certainly been positive change lately and that is an achievement, small feats that add up like another stone to the fortress walls and chip away at attitudes that ultimately need re-education. More of us are asserting ourselves, challenging stigma when we hear it.  Some health providers have really stepped up and trained themselves and their teams (whether that be diabetic clinics or eating disorder units) as best as they can in the shadow of NHS funding cuts. On a wider level there have been conferences and numerous new research studies on the disorder.

Widespread discussion on the importance of the right language used within healthcare settings has been a hot topic on social media just recently. Twitterites Renza/Diabetogenic (@RenzaS) and The Grumpy Pumper (@grumpy_pumper) have been fantastic advocates on this matter, as well as Dr. Partha Kar (@parthaskar) and a handful of other HCP’s, all of which should be applauded. I only hope that this evolving dialogue continued to spread further afield beyond the tight knit diabetes community that is mostly found on Twitter or\ Facebook.

We are shouting, hollering.  Louder now after some people have begun to notice, to react, largely as a result of the documentary. Still, it can be entirely frustrating and exasperating.  It can often feel like you are left with nothing but a sore throat and strained voice as the people that should be listening walk away oblivious. It’s hard not to feel bitter, to dwell and let resentment fester.

Hope can fuel a surge in determination one minute, almost excited by the common goals, the shared anger and upset, and that camaraderie found among a group of fellows with type-1-diabetes. It can be a fierce energy that rises up and bounces back and forth with re-tweets and the swapping of blogs that for the most part, are completely spot on and relatable to you, in at least some parts.

That understanding, compassion and sense of community is truly valuable, it means we know we can fall down and be held back up. That we can feel comfortable to rant and moan about unpredictable sugar levels, neuropathic pain or even giggle over the humour of common #diabetesprobs. Plus those diabetes memes which can be hilarious to us, (well me anyway! Perhaps I’m too easily amused,) but absolutely baffling to those with functioning pancreases. I’ll never forget sending a friend some of those “diabetes cat” images and protesting about how funny they were. On the contrary, she was completely baffled and the humour I saw didn’t compute to her one bit. Not her fault at all, but hey a fellow diabetic would probably find them as funny as I do.  Is there anyone with type-1-diabetes that can’t appreciate the thought of Hansel and Gretel style blood test strip trails and those don’t-give-a-fuck-attitude ee cards (see below!)? Laughing is a good remedy.

Friends and family can be amazing when they try to appreciate our daily struggles and be compassionate, but the fact is that only we can know what it feels like to deal with chronic and largely invisible illness every day, every minute and every second without any reprieve from it. For me at least, despite a sense of patience and the fact that I know I am cared about, it is still all too easy to detect a sense that I am a miserable bore when I talk about diabetes woes. I’ve been told that I am obsessed with my own disease and need to find other things to focus on by so called friends.  I’m always complaining, and there’s always some medical pain I am suffering with. It makes me feel like a huge drama Queen and hypochondriac.

There is some truth in it, in that yes distraction can be good and thinking about your problems can make you more miserable. But the reality is that this illness never relents, and it can’t be ignored. The control it has over our bodies and our minds is like a swarm of hovering gnats hovering around us as we stand in a room with the windows bolted shut. You can swat them away but you’ll never catch and kill them. The only way to breathe is to let in some fresh air, and give them a way out. It’s not fair that we should be told to ignore the biting to the back of our necks when it just means we’ll be left covered in a rash of sore red welts. Why should we be ashamed to vent, if that is something that helps relieve the burden and ache of it all a little?

So I may have gone on a bit of a tangent here, down a rabbit hole. But I do have a point ultimately and that is the urgency of some real action. Awareness is always positive but it isn’t enough, especially when it is rarely put out into the public sphere. We need strategy, we need government action, and crucially we need the godamn media to sit down and pay attention for once. They seem to be completely deaf, the newspapers anyway, some more guilty than others of course. But every time there’s a ridiculous headline, they lump type 1 and 2 together or suggest we cure ourselves with okra, cinnamon or a better sleep routine, we make a fuss and call them out, sometimes they apologise and then a few weeks later the exact same kind of thing occurs. It’s blatantly disrespectful and insulting to be placated and then blatantly ignored for the sake of causing a reaction or even a moral uproar to stats on the amount of money diabetes care is draining from the NHS. (And yeah, better care and earlier interventions=less hospitalisation and less expenditure, isn’t it a no brainer?!)

I am saying all this but do I have any idea myself? Well yes, I do. First of all with the papers - as a DWED representative I am challenging myself to call the big wigs at some national papers and confront them on their failings. Starting with the Daily Express, yep. So wish me luck, right now a frustration is motivating me but I may want to hide scared tomorrow. Which is why I am stating this here: I will do this. I will record those calls and I will report back in a later blog.

Second is a project where you all can chip in and put your case forward if you wish. When I spoke to (the truly amazing) Norman Lamb in May for a recording which is uploaded in our members area, he offered to take DWED’s case forward to Jeremy Hunt and have it raised in parliament. This would be in the form of a letter that we will address to Jeremy Hunt that will specify just how crucial it is that people with T1-ED and Diabulimia have access to better care, which can be done with the shuffling of money, with training across the boards, more knowledge given to GP’s, AN OFFICIAL DIAGNOSIS. It may fall on death ears, but it’s worth a good damn shot.

What we need from you are testimonies that we can add to the letter. Real life truths from people with T1ED that want to push the message that further change is needed NOW, those that feel devastated and worn down, and let down by a lack of adequate support services. Submissions from friends, family and carers would also be so helpful, especially as sometimes their loved one is unable to advocate for themselves, or in the worst, most saddening instances, they are no longer with us to do so.

I will be setting up an online form for submissions in due course and will amend this blog with that link. [4/7/18: Please find the submission form here.]

Keep fighting everyone, it’s cliché but all of you out there with type-1-diabetes, with or without an eating disorder, are fighters and probably so much stronger than you believe. Hold on. Let’s act on this. We are all in this together. Keep looking at the stars instead of blackened night’s sky. We might not ever be able to shoot for the moon but we can aim for the stars.

By Claire Kearns.

What's In a Name?

“Some of the most wonderful people are the ones that don’t fit into boxes.”

That’s one of my favourite quotes by Tori Amos that celebrates those of us that feel alien or abnormal as wonderful freaks. It rejects the idea of fitting into moulds or being confined and rectangular. I don’t like the idea of type-casting people and stamping their heads with statistical criteria. This very much extends to the notion of diagnosis, particularly when it comes to mental health.

Why? Because it feeds into the concept of being defined by a disorder and having it steal identity. Nobody is the sum of their eating disorder, their depression or personality disorder. It may feel like you have lost yourself when you are entrenched by your illness and diagnostic labelling can exasperate that. The case may be especially true when it comes to eating disorders that are distinguished by weight guidelines that seem to categorically define you al too easily.. It has always seemed bizarre to me that you can be a bulimic one week but a few pounds less the next and you are suddenly ‘anorexic type 2, (with binging and purging). Of course as much as we might deny that weight matters in determination of how sick you are, that anorexia classification is a prize in place of bulimia, when weight loss is always the sick goal.

But someone with type 1 diabetes shouldn’t be given a diagnosis or either anorexia or bulimia, even if those disorders are recognisable by behavioural features. A person with type 1 diabetes and an eating disorder always needs to be treated in a different way to someone without diabetes. This is why we actually DO need some official terminology.

Diabulimia is not the best term for a number of reasons that I won’t go into now, but it’s something that has become familiar, largely by way of the media. ED-DMT1 is a foreign language to most people, fairly so as it’s a clunky mouthful of a word and so T1-ED is a better fit and literally states what is in the tin, Type-1-eating-disordered.  Regardless of what it is, we need to have SOMETHING formally recognised and defined by clinical features as a matter of urgency. The lack of such is costing lives. People with diabetes and eating disorders that are in serious need of sufficient care are being routinely overlooked dismissed and invalidated by doctors that can’t distinguish an issue worth dealing with, ir's one that they cannot put in a pin into or find in their medical books. This kind of reaction from health professions can be hugely damagiing and make someone feel even more reluctant to seek out help. It can lead to the false conclusion that their problem is not a serious one as a disordered mindest creeps in too easily: a toxic, irrational voice  whispering that you are not sick enough or worthy of support.

A concrete diagnosis would make the medical profession sit up and listen as well as providing those with T1-ED with the means of validation. It would open the gateway to appropriate treatment facilities and become simpler to explain when raising awareness and informing those that are unfamiliar with it as an illness.

 But furthermore, setting parameters around the means of identification are important. By this I mean distinguishing exactly what T1-ED consists of. It should ideally contain subtypes for anorexia and bulimia that run alongside but not separate to type 1 diabetes. Insulin omission or ‘diabulimia’ certainly needs to be pinned down by a particular number of omission episodes, because of course missing an insulin dose one time does not mean someone has diabulimia, just like one episode of self induced vomiting does not equal bulimia. Other documented factors may involve a fear of insulin and rejection of diabetes care services.

I still don’t like labels.  I feel that classing someone as a person and not a diagnosis is important. Essentially, I feel that patients should always be considered individually rather than being lumped into a pile with others that share a diagnosis. No one person with an eating disorder is the same as someone else and so treatment should be tailored accordingly.  This means listening, and allowing doctors the time to do so. Evidently an injection of NHS funding could not come soon enough.

So, what’s in a name? Nothing, yet absolutely everything.

By Claire Kearns.

 

My Recovery From Diabulimia

Please read this story of hope shared by one of our members. Recovery is possible.

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 My story is much like that of many others with type 1 diabetes.  I had just turned twelve-years-old when I was diagnosed and had no clue what I was doing but I checked my sugar levels and aimlessly injected random amounts of insulin in the hope I was getting it right.  Two years down the line the only thing I#d ever heard at my regular clinic visits was “you need to lose weight”.  This became something I rebelled against in the years that proceeded. This in the form of eating anything and everything, avoiding clinic check-ups and telling lies to the healthcare professionals and worst of all my family.

I got to a stage where I never checked my sugar levels and no longer took my background insulin.  I knew I was making myself Ill but found it hard to get back to a routine because I never really had a routine.  The advice I had been given as a newly diagnosed T1 was completely wrong by today’s information and knowledge into the condition.  I took the courageous step of writing down how I felt and what I was doing and gave it to the diabetic specialist doctor.  She was very kind and told me it was okay but nothing else was said and I was given no guidance.  I felt let down.  I continued with my life and no positive changes were made as I didn’t know how to do it on my own.

I started to cut back on the amount of injections I was taking after a trauma in my life.  My big brother passed away and for the first time in my life I didn’t turn to food for comfort, I felt the complete opposite and found I couldn’t eat without feeling sick.  I started to lose weight and it felt good but felt I needed to lose a lot more weight as I had reached my heaviest.  I became obsessed and found out that the less insulin I was taking the more weight I lost.  I regained my appetite and liked the idea that I could eat what I wanted and kept my weight low. 

By the time I hit the age of 27 I had it down to an art and had lost a large amount of weight.  I loved hearing people gasp and telling me how great I looked.  Someone told me in disgust that they could see my collar bones but this only played to my ego and I took it as a compliment.  For the first time in my life I could wear beautiful clothes, men found me attractive and people were telling me I looked great.  At this point I wasn’t suffering any side effects unless of course you couldn’t tolerate feeling extreme thirst, nausea and exhaustion.  I continued to live this secret life and lied to everyone that it was easy: “oh I just don’t eat as much” - which I didn’t and that it was just down to walking. This was the perfect diet and I’d cracked it.

Slowly though I started to notice my hair falling out,  damage to my vision was detected and I was vomiting a lot.  On numerous occasions I tried to gain some control and sought the help of my GP who in turn referred me to the eating disorders team.  Sadly it never helped me as the only treatment available was what would be the same for an anorexic or bulimic. They didn’t understand the complexities of this eating disorder and so I gave up my visits.

I felt lost and depressed; as if nobody knew how to help me even when they tried.  I wanted to help myself but wasn’t strong enough to break the cycle, my addiction to being thin.  It got to a point where I wasn’t injecting at all and ended up in bed for a week. I was so weak and tired that all I did was constantly vomit into a bucket at the side of my bed.  One day I got in to the bath to wash and warm my frozen body up. I floated there far beyond the time I should have and the bath was so cold again it hurt my skin.  I had no energy to pull myself out of there but I somehow summoned enough to do so and wrap a towel around myself.  I stumbled through to my sofa and lay down.

Stressing the difference between type 1 and type 2: Why do we care?

“That’s what people get when they eat too much sugar.”

A chance remark and nothing of note to the woman that said it. But to me, it stung.

This was overheard while waiting for my prescription in Lloyds Pharmacy. A little boy keen for knowledge asked his mother to explain what a poster concerning undiagnosed diabetes was about.

I have been irked by the campaign this poster is a part of for some time already. They were first displayed during diabetes awareness week back in June but have remained in stores, tacked to the front desks and to outside windows, ever since. They state that “11 million people have undiagnosed diabetes in the UK. It uses the word ‘diabetes’ as one sweeping, blanket label. If you squint you might notice a tiny little asterisk alongside the word, which denotes ‘type 2’ written in nondescript letters in the bottom right hand corner.

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Within the diabetes online community the lumping together of Type 1 and Type 2 diabetes is often a hot topic. But it recently occurred to me that I’ve never addressed it myself in a blog despite having spoken a lot about it in offline conversations and on social media. After the incident in Lloyds Pharmacy it struck me that I needed to write that blog. This one.

Let me stress from the outset -this is not about attacking people with type 2 diabetes or waging a war of type 1 vs. type 2. That unpleasantness is something I hate. Diabetes is a pain in the arse for anyone that has it, and we all have the right to moan and vent if we need to. But there are differences here which must be made clear whenever the conditions are referred to.

So to the facts.

Type 1 diabetes is an autoimmune condition whereby a fault in the immune system triggers an attack to beta cells in the pancreas. When these beta cells are destroyed the body is unable to producing insulin which can lead to blood sugar levels rising to dangerous levels. Type 1 diabetes must be treated by insulin injections or use of an insulin pump. It diabetes cannot be reversed or prevented and is never a result of any kind of lifestyle choices.

Type 2 diabetes comes as a result of insulin resistance in that the body cannot use insulin as it should or from the pancreas being unable to produce enough insulin. It can usually be controlled by medication in the form of tablets alongside diet but in more advanced stages some people need to inject insulin.

A type 2 going onto an insulin regime does not mean they are a type 1. Type 2 diabetes is most commonly diagnosed in later life but is becoming more prevalent in young adults and even children. This is due to poor eating habits and lack of exercise which results in obesity. I must stress however that type 2 diabetes is certainly not always caused by poor lifestyle habits. There are a number of other factors that can be a trigger such ethnicity or genes as you’re two to six times more likely to become type 2 if you have a parent, brother, sister or child that has it.

Why is all this important? Why does it matter that people realise the difference between type 1 and type 2 diabetes?  Essentially because they are separate diseases with very significant differences.  Conflating the two is akin to believing breast cancer is the same as bowel cancer. Yet new research by healthcare provider Abbott into Britain’s views on diabetes recently found 43 per of UK adults can’t tell the two types apart.

This lack of comprehension can be upsetting to people with type 1 diabetes as it often can lead to ignorance and stigma. It is not uncommon for a type 1 diabetic to be faced with unwelcome views from the misinformed public that may believe they did something to contribute to the onset of their condition. Advice given on how to cure type 1 by way of various ridiculous remedies (okra, cinnamon, more sleep) can also be a frequent occurrence. It may be believed that type 1 is more easily controlled than it is which reduces acknowledgement of its severity and threat to life. All of these reactions can cause someone with type 1 diabetes to feel a misplaced sense of guilt or shame and lead to mental health problems.

I can envisage it now. A scenario has played out in my head repeatedly since I heard that exchange in the pharmacy: that little boy approaching a newly diagnosed type 1 in his class at school and asserting that they must have it because they eat too many sweets.  It happened to me. It’s happened to so many of us. It’s not the boy’s fault, he knows no better, but the kid that he talks to will take it in, it will be remembered. For me those kinds of comments festered, and grew into paranoia about what people might think; that I was greedy and had brought my condition on myself, which led to a very damaging belief that I needed to remain a certain size as some kind of effort to challenge that.

Also, you know what? Lloyds focused entirely on type 2 in their coverage of Diabetes Awareness Week, which is just not right. They may have stuck some information on their website but I certainly saw no mention of type 1 diabetes in any of their publicity. One in ten of the diabetics in the UK are type 1, and we should not be marginalised. We deserve to be heard and have people made aware of what we go through everyday

 It just keeps happening, again and again and again despite many people’s efforts to educate the press and repeated polite requests that media coverage become more mindful and stop presenting diabetes as just one illness.  The roll call of Daily Express front pages that shout “Yoghurt is key to beating diabetes”, “Eat fruit to fight diabetes” or “Diabetes risk in red meat” (all genuine headlines)  has become quite a joke, one that is a matter of laugh or you will cry.

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In fact, the media has a lot to answer for when it comes to perpetuating misinformation about both types of diabetes. Not least when it comes to the reasons why someone could develop type 2.  Given the way the relationship between eating habits and type 2 is covered in the media, it’s unsurprising that so many people think that the only cause is obesity.

Newspaper headlines are a case in point. 'Wonder cure for diabetes'” (The Express, again), 'Is there a natural cure for Diabetes'  (Mail Online) and 'Eating potatoes before pregnancy increases risk of diabetes' (The Telegraph), to name just a few more.,  Sensationalist splashes like these only need one tiny word and a single digit number to become more accurate and less damaging. Is it so fucking hard to add 'Type 2' before the word diabetes? Or to stick in the word “some” when reporting on obesity and diabetes? When will they listen?

After the incident in Lloyds I spoke to a representative from their head office about my objections with their campaign. She was apologetic and seemed to be listening. She told me she would take my points forward and that Lloyds would endeavour take more care with such representation in the future. Time will only tell if that will be the case. All I know is that now, during Diabetes Month, those posters are still up and there are no amendments to the information displayed.

Fortunately in social media we have a powerful tool which is the growing strength and camaraderie of the online diabetes community. This blog will I hope serve to contribute to our endeavours to counter the ignorance and myths. I plan to retweet it far and wide. We need to reach out far beyond the parameters of just the #GBdoc bubble.   There are people who need to read this, and that is why I needed to write it

I am trying to imagine that little boy from the chemist in 20 years time. Perhaps he will have his own curious son who will be interested to know what diabetes is all about. As a father the boy will be informed and have the right insight to relay. Without hesitation he’ll explain that diabetes is actually a term that is used for two distinctly separate conditions. This can be the reality if we continue to chip away at ignorance and collectively object to every myth and inaccuracy we come across. We are in this together and we need to keep shouting.

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By Claire Kearns.

The meaning of hypo awareness

This week (2-8 October) is hypo awareness week

This is such an important subject to keep talking about. At best hypos can be a irritating disablement, but at worst they can be traumatising, anxiety provoking and quite often fatal. 

At the forefront of my mind is how yes, hypoglycemic episodes can be difficult for anyone with diabetes to endure, however it’s a whole different playing field when you add an eating disorder into the mix.

A hypo launches you into survival mode. The options are simply to obtain and ingest glucose ASAP or die. There is no other alternative. But for someone with an eating disorder and type 1 diabetes this can be hugely distressing. and prompt challenging thoughts. The choice to submit and take in those calories may trigger a whole load of guilt to sit on top of that which already exists

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During my last admission as an inpatient on an eating disorder unit hypos became an extreme fear for me As I felt my hands start to tremor a sense of dread would set in as I tried to pretend it was not happening and I was no different to anyone else.. I felt guilty, so guilty, of having extra in addition f the prescribed diet. This was in a place where so many others around me were trying to trim their meal plans down as much as they possibly could. Biscuit crumbs and slivers of butter hidden in covert places, a splodge of jam left under the container lid.. Every calorie was counted and any unexpected increase in portions, or even a slice of pie that looked too large or scoop of mash that was overly heaped, often resulted in dinner table meltdowns.  

I can't deny that such obsession was inapplicable to me, but when it came to hypos, I had no right of refusal. It became quite frightening as my insulin was increased and i was experiencing hypos on a daily basis. I had to guzzle down cups or Lucozade, measured to the hundred ml (I always told them it wouldn't be enough, and so another 100ml and often yet another would follow). followed by biscuits, all while shaking and disorientated. But most of all I felt I would be judged for being weak somehow,  for giving in, perhaps not directly by my fellow patients but by their eating disorders. I felt gluttonous and so ashamed of giving my body what it needed. That’s an eating disorder in a nutshell, really.

How dare I allow myself any semblance of good health?

Eating during a hypo is unplanned, it is frenzied and without containment. It can easily lead to binging; desperately inhaling sugary foods as you try to grasp reality, often leading to high blood sugars. More guilt. Surrounded by a pile of chocolate wrappers and an empty cereal box. Emerging from a blurry, half conscious state and berating yourself for a loss of control.

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So this year, following the release of the BBC Documentary which has led to a rise rise in press and advocacy concerning Diabulimia and ED-DMT1, please consider what hypoglycemia might mean for sufferers of these conditions. Being hypo aware is about more than just having glucose to hand and knowing the signs and symptoms. For people with type 1 diabetes and an eating disorder it involves being aware of the difficult emotions that come alongside. It means accepting medicine and acknowledging that treating a hypo is about essential need, not greed. It’s about giving yourself permission to fight against that toxic 'voice' that tells you that you do not deserve to eat, to norish yourself, to live.

By Claire Kearns.

Too Many Losses

After every death by suicide or misadventure comes an onslaught of familiar comments. Mostly well meaning and kind-hearted comments but ones that also make me want to scream.

Lately, a number of these types of losses have been close-to-home. The first, around a month ago was one link away via mutual friends that were left devastated, with circumstances that resonated a little too much. The second, quite close to heart that I am still struggling to comprehend. The third, most recently made the news of my small local home-town. All of them have me poignant somewhat numb, and extremely sad. All of them were individuals that seem precious and have left a space, an ache.

Everyone reacts differently to shock and grief. No way of trying to cope, adjust, regroup, is wrong or anything to be ashamed of under the circumstances. But there are some people that will understand the pull of mental illness, and some that just cannot. There is no fault here, but I want to offer some words of clarity. Words I feel the need to say.

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The fact is that depression does not care if you are young and full of promise and potential. It does not consider that you have so much more to experience in life or that throwing your future away is 'such a tragic waste'. Neither will it grasp that you have money, a good job, a loving family or privilege over others.

Crippling anxiety cannot rationalise that things can pass, get better, that those moments of sheer terror will not overwhelm you. It will not comprehend that there are GOOD sources of help to be found, sources of valuable support and health professionals willing to listen.

Eating disorders are blind to the concept of existing without starving or harming yourself in an attempt to shrink. At their worst they will not allow you to see that you you deserve anything more but that constant misery. Anorexia, bulimia, EDNOS, BED or Diabulimia: they all have the potential to diminish your sense of worth to dust and stamp all over it.

When mental illness is at it’s most unrelenting and ferocious, it simply does not give a shit about anything besides a destruction, whether that be a way to cope or an end goal. It will take any opportunity it can to knock you over, and with every swing and punch you fall further down, further away, until you're left with a bashed up broken brain that cannot think straight.

I can see how it can get to the point where somebody might feel like they've no other option, and no strength left to fight. That is not a sign of being flawed or any kind of weakness. Rather, it is the full-force impact of defeated by something too powerful and suffocating, like a lump of coal clogging your throat.

Most of all, a message to the moronic that at times like these seem to rise from the ground like clusters of worms with their oh-so-important utterances: suicide is not stupid or selfish or ungrateful. Those views are vile and completely ignorant. Also, media, please take note that in this age describing suicide or attempted suicide with the damnation of“commit” is unacceptable, as it is no longer a criminal offence and has not been classed as such since 1961.

To the aforementioned: you are not that person, you have no right to pass judgement on them. You have not stood where they have, seen or thought what they have, or rather been unable to see what they need to.

In essence, what it essentially comes down to is that severe mental illness can blot out facts like thickly splodged Tippex.

It's a fucking parasite of a thing to have to battle with. Some do it every single day, and it can hurt like hell.

If you are one of those people then try to hold on with the tightest grip you can, and try to remember despite that stalking cloud and the trailing whispers or smoke, that you are not doing it alone.

By Claire Kearns.

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FRIO INSULIN COOLER GIVEAWAY WITH DWED MEMBERSHIP!

Frio are a company that produce insulin coolers that are recommended by hospitals and diabetic clinics worldwide. They offer a wide range of choices in shape and design to suit individual needs and preferences, from large coloured wraps and wallets to smaller pouches. They take away the need for refrigeration or ice packs when carrying insulin pens and vials for pump technology on route. They are ideal for journeys on hot summer days, in the car or packed in luggage cases, but are also recommended for daily use if required such as student halls or stays in hostel accommodation. Diabetes should never hold us back!

I tried out one of the small duo Frio’s which are able to hold either two pens or two vials of insulin. The larger wallets have room for 5 pens of 10 vials so have plenty of space for all the medication supplies you need. I use an insulin pump so a smaller pouch was ideal for me to be able to carry one spare pen and a vial of Novorapid in my bag, just for those sometimes unavoidable emergencies where you need extra insulin to hand. The Frio I chose has a decorative daisy design which suited me well, too, and it’s these individual touches that make the entire range appealing.

The Frio definitely does what it promises, and my insulin was kept completely cool. The science behind it basically involves a reusable evaporative cooler insert which activates with water.

For July DWED have 4 free Frio’s to giveaway which were kindly donated by the company themselves. Two are plain kip wallets in pink and bright green, and another is of a similar large size but is monochrome and wrapped with a pretty polka dotted bow. The fourth is a smaller one like mine but has a black and white skull and crossbow design. Please see the photos below!

This month everybody that signs up for a new membership package for just £3 a month and opts in will be entered into a prize draw to win one of the four coolers.  If you want to be part of the competition just fill in the form below and we will verify your subscription against your given email address.

Membership also as always will provide access to regularly updated premium content that is available nowhere else.  Please see more details here and after completing the payment process register for your unique log in via the user area at the top right hand of our homepage.

Good luck to everyone that enters! We will reveal winners on the last of the month via our social media pages.

  For more information on all Frio products please refer to their website
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Choice

Backtracking slightly, this is my blog for Diabetes Blog Week Day 2, for which the focus was: The Cost of a Chronic Illness - Tuesday 5/16
"Insulin and other diabetes medications and supplies can be costly.  Here in the US, insurance status and age (as in Medicare eligibility) can impact both the cost and coverage.  So today, let’s discuss how cost impacts our diabetes care.  Do you have advice to share?  For those outside the US, is cost a concern?  Are there other factors such as accessibility or education that cause barriers to your diabetes care?"

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There's been quite a bit of media coverage and discussion on the dire state of medical care of those with chronic health conditions in the USA just lately. I’ve read a number of reports relating to people with diabetes having to resort to skimping on insulin doses due to the expense and even buying knocked-down, knock-off supplies through the black market.  As a citizen of the UK with access to the NHS I cannot imagine the hardship of such a situation and find it difficult to fully comprehend. I won’t try to do that because I feel the only people truly at liberty to comment on it are those in the thick of it. All I can say is that I feel very much for them. It isn’t right and it isn’t fair. I very much hope that the situation will change.

Even further away, people with type-1-diabetes in third world countries don’t even have the resources they need to survive. Some won’t even get a diagnosis and will die painfully without any access to insulin whatsoever. T1International is an amazingly worthwhile charity that endeavours to help those people where they can.  It hurts my heart to consider the struggle of those individuals. I know what untreated diabetic ketoacidosis feels like and I wouldn’t wish it on my worst enemy.

With respect to all of this, I am hugely thankful for the NHS, I must stress that. Most of all, that lifeline we have to be able to access our prescriptions without any cost at all is huge. A vial of blood test strips can cost upwards of £25 and with my erratic blood glucose levels, I can go through them quickly. That’s not to mention the cost of insulin itself, of pump supplies and equipment.  Then there’s the option to be able to walk into hospital and be seen if we need to be, without an itemised bill arriving afterwards which lists every blood sugar reading taken, every nurse check and glucose urine dipping test. Yes we may sometimes have to wait, and yes sometimes we can be pushed aside when we need priority, but elsewhere there is simply no option of being able to walk in and that receive medical attention without a price.

The above is a disclaimer of sorts before I continue, to state that I am so they say ‘checking my privilege’. That said, I feel that what I have to say still deserves serious acknowledgement. I must speak of what I know.

An area where the NHS needs significant improvement concerns allocation of funds for the treatment of people with type-1- diabetes and a mental health condition, most significantly eating disorders. There is a fundamental flaw to be found in this area which means money is being wasted, flushed down the drain, often alongside a desperate cover-up of bleach, the stench of which is strong and lasting.

“In the NHS, when it comes to treatment for mental illness, you do not have any choice.”

This is what I was told by a psychiatrist that was overseeing my care as an outpatient at my local eating disorder service. I was on the verge of being sectioned if I did not submit to an inpatient hospitalisation. In agreement to this, I had found a facility that was trained in eating disorders and type-1-diabetes and would be willing to admit me with the appropriate referral, and had an advocate that helped me to stress the importance of this. However, this was not their go to route and so my view was dismissed. Instead, I was sent to the allocated unit that every patient was unduly sent to, the cheapest option.

The first day I arrived at that unit they did not have any needles on the ward to give me my insulin. They had not been trained and some of the staff were surprised to find out I was diabetic. 6 months down the line I was at the centre of a complaint concerning negligence and had been safeguarded by a whistleblower as a vulnerable adult. I had lost hope of recovery and felt traumatised by the entire experience. Now three years later, I still have nightmares about some of the situations I was put in.

On the flip side, while some of the health workers on that unit were downright ignorant and dismissive of my additional needs, others, mainly a handful of the nurses, were undoubtedly fantastic at their jobs. While overstretched and under-resourced, they did all they could, but they were just not clued up on type-1-diabetes and they should never have been put in a position whereby they had to try and cope without full expertise.

I am not the only one with a story like this to tell, far from. Those with diabulimia are routinely being ‘treated’ as those with more typical eating disorders.  This is never going to work.  There are studies that back up the notion that we need to be considered as having separate needs and that recovery must encapsulate care for both our physical and mental conditions.

I have heard accounts from those with diabulimia that are of a normal or even above ‘healthy’ weight that have been put on an anorexic diet. Many have suffered from oedema and have experienced rapid weight gain alongside flair up of complications such as retinopathy and neuropathy. All of this can be hugely distressing not to mention dangerous. 

Other considerations readily overlooked may be the need for extra water, and the entire fact that to become better a type 1 diabetic needs to be MORE hands on with regards to acknowledging food intake, whereas usually someone with an eating disorder is encouraged to step back and become more relaxed, less fixated about what they are eating.

Changes have been made, but the bottom line is that funding is being tossed away when it could be carefully put into specialist care, the right care.  Ignoring this makes a mockery of the fact that we have a national health service, and is an injustice to those people in other parts of the world that do not.

Returning to the words of my psychiatrist, I believe that everyone should have options and be listened to in a discussion regarding their own treatment.  Mental health difficulties can happen to everyone. Having an eating disorder does not mean all our thoughts are automatically scrambled and become irrational, especially where medical knowledge of a condition we have lived with for many years is involved. Often we are the expert more so than the practitioner we are speaking to.  Discussion and sometimes disagreement can be understood (yes, particularly when mental capacity may be compromised), but blatant disregard will automatically casts battle lines.

We are not just patients. We are not just statistics on a chart, a summary of our weight or BMI or HBA1C and we do not need a price tag around our necks.

We are people. We should all be given choice.

By Claire Kearns.

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Keep talking, but don't forget to listen

There’s a belief I want to challenge. One that prompts similarly phrased sayings that are tossed around frequently and readily, in an attempt to disrupt and ultimately lessen the stigma of mental illness.


“You wouldn’t feel ashamed of having cancer, the flu or diabetes!” “Taking antidepressants should be regarded the same guiltless way as a diabetic taking insulin!” “Physical illnesses hold no disgrace!”


Ring a bell? The medication one I hear most often. Taking insulin might be listed alongside treatments such as a cast on a broken leg, painkillers to nurse headaches, a plaster for an accidental wound. Offered as an aid that is seen as easy and without any questioning as to its need. 


I understand the perspective and the intention, but it’s so very inaccurate. 


Am I picking holes? What’s the harm, right? Wrong. It IS damaging. It adds to the mistaken regard of physical illness as entirely separate from psychological. While attempting to normalise conversations about mental illness, a regard for the emotional influence of some ‘physical’ conditions is being thrown under the bus. This is especially important in relation to ED-DMT1 and diabulimia. For those that struggle with an eating disorder and type-1-diabetes taking insulin is not an action that is thoughtlessly undertaken without fear or worry. In fact, it is far from, that fear can feel crippling.


The notion that there is no ignominy attached to physical conditions is a lie. This most related to the misconceptions attached to the presence of what are labelled ‘invisible illnesses’. Many people assume that if an ailment is not in plain sight it must not have any significant impact. This makes it harder to let some aspects of it be seen when they need to be. And honestly, the sheer principle that having a bodily malfunction that can never be fixed (unless there’s a cure) is not going to be mentally burdening is quite ridiculous.


There’s also the commonly held assumption that diabetes being like doing X and taking Y which will equal Z. This can often be based on interactions people have had with those that have type-2-diabetes which is treated by tablets and so rarely the cause of disabling erratic blood sugar levels. I mean, your friend tells you her grandfather is diabetic but it doesn’t let it affect him at all so why should it get you down!


Of course, it’s brilliant that the barriers around mental health stigma are being pushed through. Talking and overcoming our embarrassment over distress and anxiety and depression is a hugely positive thing, but that shouldn’t come at the expense of widening understanding of the link between chronic health conditions and emotional strain.


Moreover, if you don’t have direct experience of something you should always consider your words relating to it with care. Yes, we need to keep talking, but we also need to be listening more intently, with an acknowledgement that teaching is one success, but learning from others is another that is just as important.


By Claire Kearns.

Depression, diabetes and eating disorders

Depression: another big D word and largely silent, invisible illness. Standing alone it can be emotionally devastating and incredibly difficult to cope with. With diabetes involved, depression is often given further means to fester and grow quite dramatically, with stable blood sugar control often overlooked or given less attention than it needs to have. Most recent studies show that depression is twice more commonly found in individuals that have diabetes than those without. It has also been reported that around one in three people with long term chronic conditions experience poor psychological well-being, compared to one in four within the general healthy population.

But why? And how do we address it? Uncontrolled diabetes can be problematic enough to treat, especially with many health practitioners not addressing the emotional roots of the diagnosis at all. A dominating precense of depression can cause the pro-active approach a diabetic needs to take can fall easily by the wayside, with self-care becoming a burden. Of course, such despondency can often be a part of someone experiencing diabetes with an eating disorder as well. Depression, diabetes and an eating disorder make up a dangerous mix whereby each condition can be fuelled by the others, maintaining a cycle that is difficult to break out of.

Despite the high numbers of diabetics that also experience depression, any information available upon diagnosis is sorely lacking. You are typically given all the education that you need in relation to what insulin to take, what to do in cases of hypo or hyperglycaemia and which snacks are better than others, but what about the emotional issues? It seems quite rare that any insight or support is provided to acknowledge what coping with diabetes can do to your head.

Undoubtedly the realisation that type-one-diabetes is an incurable, unrelenting illness which will be with you for life can be difficult to accept at diagnosis. Then there's the possible perceived alienation from peers, the confusing and unanswerable question of 'why me?', the loneliness and isolation of it all. Furthermore, there is the urge to be free and able to do everything your friends can do without having to stop and test your blood/inject/eat every few hours. Such yearning can trigger a sense of denial and rejection of acceptance: what blind-sighted health professionals can term “non-compliance”. It can also be hugely challenging to deal with the influence of mixed media messages that can spread ignorance to the public and the barrage of unhelpful, intrusive comments that may come from the people around you. Nobody seems to tell you about any of this in the beginning.

Of course, this isn't always the case, some people do have good accounts of the process, where the right resources are offered and they feel supported. However, for every success story, there seems to be several other cases whereby a newly diagnosed diabetic is given a few leaflets, a clinic appointment in four months, and is then sent on their way.

Diabetes UK explains the following on their website: “Everyone reacts differently when they hear the news that they have diabetes. You may be initially overwhelmed, shocked, afraid, angry and anxious. Some people go through a stage very similar to mourning – as though they are grieving for lost health. “

Diabetes can also become a tool for self-harm, with suicidal behaviours complicating the issue even further. As well as the highly dangerous practice of omitting or reducing insulin which can be largely associated with an eating disorder, a sufferer of depression may misuse their medication in other harmful ways. This could be by overdose or purposely prolonging a precarious state of hypoglycaemia. Depression can jump on diabetes as a way of pushing the boundaries of life to a desperate and potentially lethal knife edge.

Patience Blystone spoke of how at the height of her illness depression provided her with yet another tool to hurt herself with: “Along with my eating disorder being shown through poor diabetes control, my depression has done the same.... Whether it's me screaming out for help or to be noticed, punishing myself because I feel I deserve that, or just neglect because I can't muster the energy to take care of my body.”

Talking about how she is now able to manage her depression more appropriately through an on-going process of recovery, Patience said: “I've coped with it by finding out what makes me depressed. I am a huge perfectionist, have terrible anxiety and in general am very pessimistic towards my own life. By realizing that setbacks won't ruin my life or make people dislike me, I've managed to always feel the need to be perfect. I can tell myself 'Well if this goes wrong I have THESE alternatives' and move on. My anxiety is a daily battle of tiny bouts of courage, tears, yoga, and just pushing past my comfort zone. And the being negative is just a day by day thing. I find if I enjoy the small things and try not to focus on the hard problems for too long it lessens.

Lucy O'Meara also believes that diabetes has played a role in the development of her depression. She talks of how the condition “majorly decreases (her) motivation which makes relapsing more likely and diabetes control go out the window.” Kayleigh Lovell, who was diagnosed with both type-one-diabetes at the age of six believes her own severe depression started gathering roots at the same age. “I find basic tasks like brushing my teeth or getting dressed almost impossible so taking care of my health is difficult. My eating disorder, OCD and depression have always prevented me from making my health a priority.” she says, “I often feel like I am committing a slow suicide.”

This is not to say that advances in treatment settings are not happening. Recent years have seen the link between psychology and diabetes being considered a lot more has been previously seen. Reports on the association of disordered eating have been a small part of this. Most significantly the National Institute of Clinical Excellence (NICE) released new guidelines which outline the importance of psychological support for children and young people with diabetes. They also updated their existing recommendations concerning this area in relation to adults.

But we need to continue making a noise.  Progress is being made in ripples but we need a crashing wave. If you are reading this and suffering from depression please speak out and don't be afraid.  There is nothing whatsoever to be ashamed of.  Vocalise your distress, shout about it if you must. Go to your GP, diabetic nurse, consultant or even a friend who can advocate on your behalf because you shouldn't have to suffer alone. Nobody should have to suffer alone or in silence. You deserve to be heard.

By Claire Kearns.

How Anxiety Can Feel

If depression is the black dog in the corner then anxiety is the gnawing monster on your back. It will cling to you, drain you of energy and leave you shaking like a steam train on rusty railway tracks.

If you'd told me a few years ago that anxiety would be such a significant problem for me I might not have believed you. Mental health issues have been familiar since my early teens, mostly that looming shadow of catatonic depression, but I'd never really experienced anxiety beyond what is considered the norm. It was only in my mid to late twenties that it started to creep up on me, and now at the age of 28 it is a constant, stalking presence.

There are two types of anxiety. Generalised anxiety disorder can develop as a nauseating terror that sits in your stomach. In can rush over you in waves, suddenly rising, falling and churning around like the inside of a washing machine. It stops you going out and tells you something bad will happen if you do, something awful. In response you squirrel yourself away indoors and avoid interaction with people which ultimately only feeds the original fear.

Acute episodes are those moments where you are pushed right to the edge and suddenly the world around you is distorted. Everything speeds up and you can't reach out or steady yourself. There are usually identifiable catalysts, the small errors that your mind can run with and blow up to extreme proportions.  Perhaps a smashed plate, a late bus, a spilt drink, the anticipation of a particular event or occasion that you are facing. Your head will play tricks; add two and two together to make five, and obsess to an extent where you feel tied in knots.

I am currently in London, dog sitting for a friend while she is on holiday. My aim has been to use the opportunity to meet up with friends who live nearby and be as social as possible while I am here. This is proving to be quite challenging and I am having to draw on various coping mechanisms to get by. Busy train stations and fast moving crowds are very much a trigger for anxiety, as well as the pressure of interaction with others. It is a wearing but worthwhile struggle to stay present instead of avoiding and retreating into a safe but ultimately smothering shell. But I refuse to give up and let anxiety win.

There can be some real strength to be gleaned from the familiar lesson "fake it till you make it". Although putting on a pretence long term is not a solution as recognising your own self worth is important, courage taken in small bursts of role playing can be beneficial. Take on the character of the woman stood next to you waiting on the underground platform. She is smart and has her head held high, she is on the way to work or an important interview or appointment. Transform yourself into her shoes and detach yourself from the mental processes that are holding you back.

 It is also crucial to try to understand that a situation may be less than ideal and bad experiences do happen, but it does not mean the end of the world. Ask yourself ‘what’s the worst that can happen?'  Then keep questioning and pushing, "and so what if it does....what would that mean?' 'So what if I do make a fool out of myself, so what if someone doesn't like me, so what if I get into a disagreement.... so what? Why does it matter?' We all mess up and make mistakes, it is part of being human. You may come up against judgement, discrimination or prejudice, but that has more to do with the instigator than it does about you. Not caring about the insignificant things is far more difficult than it should be, but it is a goal that can be achieved with practice. In turn, be patient with yourself and recognise baby steps that will eventually add up to a mile. It is easy to throw in the towel and label yourself a failure if you do not manage to do something you intend to, but on the days that you just make it as far as the end of the road when the day before you only made it to the front door, that is still a success!

 My own anxiety manifests very much in a deluge of thoughts that run through my head at marathon speed. I am usually able to distinguish irrational from rational but when my anxiety is particularly raging it can be harder to do so. Paranoia sets in and I find myself interrogating myself and harshly assessing my every move, how I look, how I act, the words that come out of my mouth.  Even after walking away from social situations I will pick apart my actions with a fine tooth comb and find imaginary evidence to support flaws and wrongdoing. Regret. Guilt. Self-hatred. I have to step away for a second. I have to try and remind myself that I cannot rely on those thoughts, I cannot trust myself. It is common for me to want to seek a lot of reassurance from other people but I also have to resist this doing too much, as it can create annoyance and unease where there was not even an issue to originally address.

Being able to identify and separate the physical elements of anxiety from the mental is also really important. The racing heart and quickened breathing that may come on either in a fight or flight nervous episode, or as a result of mental distress, is simply the body's reaction to panic. It does not mean that you are in any actual danger.

 Distraction is a key element in addressing anxiety. If available to you, talking therapy can be of great benefit. But individual mindfulness exercises or meditation can also make a real difference and there is an array of Mental Health literature and information available in relation to practicing both. Adult colouring books or games that sharpen your brain into a focus beyond the anxious feelings can also be of great use, as well as knitting, drawing or writing. It is okay and entirely healthy to need time out and space to yourself. Make a list of activities you can read through and try out during those moments when everything starts to feel too much and your mind becomes too distorted to think straight. In doing so your anxiety should gradually begin to lessen until it is at a more stable level.

Most of all remember you are not alone. Mental illness can feel personal and isolating but it is far from uncommon. According to anxietyuk.org More than 1 in 10 people are likely to have a ‘disabling anxiety disorder’ at some stage in their life and an estimated 13% of the adult population will develop a specific form of anxiety known as a phobia at some point. That woman next to you on the tube platform could have just repainted her face after an emotional breakdown among the crowds. Reach out if you feel yourself slipping and let others support you. Good friends will be there to hold you up when you are lagging.

Anxiety might often feel completely overwhelming but it can be controlled and contained. Although it is unlikely to ever be a complete after-thought, it can be put into a box that sits in the background of your thoughts, which slowly through experience and the testing out of different situations will become smaller. Try to enjoy spending time with other people and letting them spend time with you. Those moments can be treasured and put into a new box of positive memories.

By Claire Kearns

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This article was originally written by a DWED contributor in 2016 and then published by www.healthisyourwealthmagazine.co.uk. It is reproduced here by the author for Mental Health Awareness Week.

BREAKING NEWS: NOT ALL THOSE WITH MENTAL ILLNESS ARE CRAZED MURDERERS

This is an old piece I wrote for DWED's past website which centres on the dire state of some newspaper reports on mental health. Sadly this is still a very relevant topic which is why I am re-publishing for Mental Health Awareness Week 2017:

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Monday’s disgusting front page article from The Sun Newspaper has been quite rightfully blasted from all corners. It’s scathing headline “1,200 KILLED BY MENTAL PATIENTS” is glaringly unsettling and sensationalist on first impact. The article that follows reads as damaging and woefully inaccurate. Social network users were responding to the tabloid in force last night, with many calling for a full apology from the paper.

A response penned collectively by charities Time to Change, Rethink Mental Illness and Mind condemns The Sun piece as ‘disappointing’ and ‘damageable’. They state that it “will only fuel the stigma and prevent more people from seeking help and support when they need it.”

Information that The Sun article is based upon is twisted to suit a scaremongering, screaming agenda. Their headline, while based on the message that many people have been let down by mental health provision, is distorted into an attack and focuses on minority details. First of all there is no such thing as ‘mental patients’ but instead individuals that struggle with poor mental health – sorry to break your monstrous and unstable, axe-wielding image there Mr Murdoch. True figures reveal that the number of homicides carried out by those with mental health issues, including those experiencing psychosis has decreased.

The Sun also conveniently failed to mention that suffers are in fact ten times more likely to be victim’s, rather than perpetrators of crime and violence than anyone else. They are also a much larger risk to themselves through self-harm, neglect or suicidal intentions than they are to others. Mental illness can quite often be secretive and contained with many sufferers going about their lives without ever harming anybody else. With the right treatment many can go on to fully recover.

In spite of the reality, sadly the stigma against those suffering from mental illness is still rife. Research by YouGov revealed that people with mental health problems are regarded as the most discriminated-against group in Britain.

A petition has been started by Twitter user and psychology teacher Rhiannon Lockley at Change.org. Miss Lockley requests that The Sun “Recognise that they have acted unethically in misrepresenting information about the mentally ill in this harmful way, and to print a full correction to this effect.” while also asking them to “Make a donation to mental health charities to cover any profit made from this story and to apologise to those misrepresented.”

By Claire Kearns.

 

10 Things I Took Away From TADtalk 2017

Birbeck College London was the setting for Talking About Diabetes (TAD) 2017 last Saturday the 22nd April. The event - now on its second run, was organised by a group of diabetes consultants, notably Dr Partha Kar, associate national clinical director for diabetes and consultant at Portsmouth hospital; Dr Catherine Peters from Great Ormond Street Hospital; and Professor Peter Hindmarsh, of University College Hospital. Hosting was Sky News Journalist Stephen Dixon, who has lived with type-1-diabetes for twenty-five years and introduced a line up of brilliant and inspirational speakers with different stories to tell. The day also provided the chance to interact with fellow individuals with type-1-diabetes and health professionals united with the condition as a significant area of interest. Here I share just ten topics that stood out to me after attending TADtalks.

 
  • Diagnosis is a difficult experience for everyone. “The world tells you, you are wrong in all ways - you have to learn to like yourself,” said Jen Grieves, the first speaker, who is a blogger, as well as BBC Radio 1 journalist. Gavin Griffiths, who followed Jen onto stage, spoke about bullying he experienced as a child because of his diabetes and how he managed to overcome it. Speaking of poor clinical treatment Jane Cummings, chief nursing officer for NHS England said she felt “dismissed and undermined by health professionals.” which now motivates her in attempting to improve patient care. Teacher Adrian Long, who was diagnosed with type-1 at the unusually late age of 40,  also provided the fascinating fact that a type-1 child will have 27 extra thought processes every morning prior to starting school than their peers.

 

  • Being kind to yourself is crucial. Jen spoke at length about this with poignancy, stating that "managing diabetes, just like self-acceptance...is a marathon not a sprint...When you have a chronic condition like we do it’s even more important that you show yourself some love.” Many parts of Jen’s talk seemed fitting to individuals struggling with mental health difficulties and eating disorders. She stressed how we all need to give ourselves credit for handling this illness every day, remarking "did you keep yourself alive today? Yes? You're freaking awesome."

 

  • Having type-1-diabetes doesn’t mean you can’t participate in or even excel at sporting activity. Thirty miles in thirty days? No problem for diathlete, Gareth! We also heard from former international cyclist Roddy Riddle who completed the 6633 Ultra. Known as the most extreme marathon on the planet, the terrain stretches 352 miles across the Arctic Circle. Pretty damn impressive! Sprinter and trainee dietician Mel Stephenson  explained that “A lot of the qualities needed for success in diabetes are the same in sport.” Furthermore, Novo Nordisk cycle team member Thomas Raeymaekers explained: “When I was diagnosed, my doctor told me to stop racing but that day I saw what was to become Team Novo Nordisk on TV and saw that they had diabetes but were professional cyclists.“

 

  • Ultimately, diabetes does not have to stop you from doing anything you want to do. Gareth told us “If you have to remember one thing from today, don’t let diabetes stop you.” and Mel spoke of her belief that “You can still achieve your goals despite having diabetes.” Alluding to how coping with type-1-diabetes can sustain our sense of courage to succeed, Jen shared the following quote by unknown: “I am thankful for my struggle, without it I wouldn’t have found my strength.”

 

  • Social media can be hugely useful in connecting with other people that have diabetes. Adrian who is a regular user of Twitter told us of how he only spoke to one person with type-1-diabetes during the first sixteen years of his diagnosis but then “a little blue bird came along.” Jen also described the diabetes online community as "a handheld cheerleading squad."

 

  • Diabetes technology has come a long way. There were a number of comments to random beeping and synchronised blousing at lunch time! Many attendees and speakers were using pumps after originally starting their diabetic 'journey's' on multiple daily injections. Such repeated references to the influence of modern devices highlighted just how truly exciting the future may be when it comes to further technological advances.

 

  • Volunteering and as a result meeting others with type-1 can be motivating. Mel said such opportunities had “given [her] so much, but always allowed [her] to give so much back.” Roddy spoke of the support and comradely of having his marathon team alongside him during challenges and difficult times: “It makes you take stock and be able to carry on.”

 

  • ·It helps to make light of diabetes when you can. Stephen was certainly not short of quips and kept us all laughing with his comedic commentary. One particular anecdote was a confession relating to airport security. He admitted always choosing the “fittest” security attendant’s queue as it meant that due to having a pump he’d be treated to a full body pat down! Adrian also brought on the laughs with his run through of ’10 good things about diabetes.’ The list included being allowed to eat sweets on account of medical emergencies and the ability to get out of boring work meetings by claiming blood sugars are too high or low! These mutual appreciations showed that focusing on the lighter moments of dealing with diabetes when we can is important.

 

  • ·We are not diabetics but people with diabetes. "I don't want to be a diabore who just talks diabollocks." stated Adrian, while Jen said: "I don't want to be defined by my suffering." Jane revealed how many people that know of her and what she does do not know she suffers from type-1-diabetes "I've never let [diabetes] define me... I'm Jane.” she said.

 

TADtalk2017 showed how spending time with others that have this condition and so truly understand can be extremely beneficial and spirit-lifting. Type-1-diabetes can make you feel lonely at times, especially among those ‘muggles’ or the ‘non-pancreatically-challenged (that’s a mouthful!) people, that while may try to empathise, can never truly know how it feels. It felt really comforting to be among a group of people that were all on the same page with particular concerns and views, and experiences to share. It was a thoroughly worthwhile and enjoyable day, so bring on TAD 2018!

By Claire Kearns.

 

Source: TAD2017

Early Intervention - NEDAW musings

Today is officially the last day of Eating Disorder Awareness Week. Before it passes over I feel the need to talk about the focus for 2017 as set by B-eat which is Early Intervention.


The topic is a difficult one for me, most of all because any focus on early intervention felt very lacking all those years ago when I became ill. It was more of case of waiting for sufferers of eating disorders to reach a point of acute danger before offering any substantial help, sometimes pushing so far that there was no in between from being given no care to then suddenly passing a line whereby you are an emergency  case. Weight was always the quantifier, and so often it felt like you had to lose more in order to get any kind of recognition or treatment. Messed up is having to push yourself to get worse just so you can get better.


This is still happening. But I have also noticed progress, with some being taken seriously at an early stage, where the outcome of recovery is more likely. The sooner the better, as more quality of life can be preserved. Unfortunately despite the change of direction funds are still being squeezed, with the NHS budget out of breath and gasping. Mental health beds are continuing to be cut, and so it’s still a struggle for many treatment facilities to take anyone beyond those at great medical risk. It’s further down that some head-way can be made I feel, using outpatient and day patient resources to stop further admissions down the line if at all possible.


I can’t stress how much those with diabetes and eating disorders need early intervention. The danger that someone omitting insulin can be in despite presenting as a normal weight is immediately life threatening. This HAS to be recognised. So often I hear that anorexia has the highest mortality rate out of any psychiatric condition, yet I’d take a wager that ED-DMT1, particularly involving insulin omission would overtake if it had an official diagnosis and the appropriate studies and statistics were available.


The need for early intervention AND timely recognition of ‘diabulimia’ symptoms alongside understanding of its seriousness must go hand in hand. Recently updated NICE guidelines are definitely a step towards that as type 1 diabetics are now listed as in need of urgent attention under eating disorder care guidelines.  If untreated the long term complications of ED-DMT1 can be so devastating, I won’t list them as we all know, the end of the line being loss of sight of limbs.


I do wonder where I might be now if I’d had help earlier. It’s hard not to dwell on that somewhat, 15 or so years down the line. I am definitely not the only one either. 


They have two patients with type 1 diabetes in the day-patient program I attended 3 years back now. They are getting trained up on the right way to deal with them, the NICE guidelines nipping at ankles with the worry they could get into trouble. This is the same unit that would hear nothing about that kind of specialist input while I was there. They told me they did not need training, and I felt like they were collectively sighing whenever I spoke of diabetes. I came out of that program far worse than when I went in. So yeah, that’s difficult to swallow. 


But I’m trying to let it go. 


Looking at younger people that are so vulnerable these days makes my heart sink. Even more so those I spot dabbling in eating disorder behaviours. I want to shake them or hug them and tell them to stop, but of course that would sound completely patronising and it’s not my place. I worry about the increasing coverage of diabulimia in the news being used as the catalyst for ‘ah maybe I will try that?’ thinking, but that’s the underside of creating awareness. Sensationalist reporting that focuses on weight and pounds lost certainly have a lot to answer for there, EDAW has once again shown that the media will never learn.


The emphasis needs to be on saving those years, months, hours that can be eaten away by an eating disorder. Of the lives that have been lost because help has come too late. 


Early intervention. To those who can act, make it mean something, please.