Type 1 Diabetic Paper

Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss (NEDA). This disorder plays severely against Diabetes Mellitus type 1 because in order to manage the blood sugars accurately and reduce the risk of becoming hyperglycemic or hypoglycemic, diet plays an important role. This patient that is anorexic will need to have intense teaching and education/ therapy sessions in collaborations to go over the importance of managing a healthy lifestyle, to adequately control their glucose levels and save their life. According to the World Journal of Diabetes (2011), “to be diagnosed with type 1 diabetes mellitus represents a very hard experience that requires subsequent psychological

adaption”( Larranaga, Docet, Garcia-Mayor, 2011 p. 189). Since the majority of patients with type 1 diabetes are children and adolescents, management and monitoring can be severely compromised due to the lack of compliance and mindset.

Diabetes mellitus type 1 is controlled by mandatory insulin injections several times a day. Since insulin encourages fat storage, adolescents with anorexia nervosa diagnosed with type 1 DM exhibit difficulty in maintaining optimal weight and are more prone to distress about their weight” ( Larranaga et al., 2011 ). This patient would have a nursing diagnosis of disturbed body image. As stated by the Journal of School Health, adolescences with type 1 diabetes may restrict or omit insulin as a form of weight control. This is called diabulimia. It serves as a high risk for dehydration, muscle breakdown and a long term continuance of this can result in kidney failure, eyes disease, vascular disease, and even death (Hasken, Kresl, Nydegger, & Temme, 2010 p. 466). During an interview of six mid to late teen women, all of the women have omitted insulin injections to control their weight. Four of the women said they found information in magazines and friends, where the other two said the injections hurt, so they stopped (Balfe, Doyle, Smith, Sreenan, Conroy, & Brugha, 2013). This imposes a need for education and nursing interventions to help this patient. As well as provide knowledge and awareness that withholding insulin can be detrimental to their bodies, in ways they don’t realize.
In addition to disturbed body image, the anorexic patient would also have altered nutrition: less than body requirements. Anorexia Nervosa affects the patient with diabetes in a negative way. Having the desire to be thin and doing everything in their power to control their bodies puts this patient at an increased risk for diabetic ketoacidosis. Being anorexic the person starves their body of nutrients and/or exercises constantly to reduce weight gain. The ketones are then produced because the body is breaking down fat for energy (Espes, Engstrom, Reinius, & Carlsson, 2013 p. 130). Since anorexia nervosa is considered a psychiatric disorder that fears gaining weight and diabetes is an autoimmune disorder, which relies on proper nutrition and exogenous insulin, the patient that is diagnosed with this concoction, is severely compromised.
For this reason, the nurse needs to encourage consults. The nurse can make a huge impact because they are with the patient the most. Statistics show, “adolescent girls with type 1 diabetes are 2.4% higher risk to have some type of eating disorder” (Jaser, Yates, Dumser, Whittemore, 2011 p.759). That being said, the nurse can automatically start to involve registered dietitians, diabetes educators, and Psychiatrist at the onset of the treatment. Screenings are key. Since adolescents are not forthcoming, it is up to the nurse to sit down and gain the trust of the patient. A statement made by Balfe et al., ( 2013) says “ we lack a sufficient understanding of the natural history of disordered eating in young women with type 1 diabetes…” This is huge and shows where there needs to be an increase in knowledge. The nurse needs to thoroughly interview the patient by asking direct questions. An interview style called HEADSSS should be used on every patient with diabetes, especially, adolescents with type 1 DM. This screens for risks in the area of “home, education, eating, activities, drugs, sexuality, suicide/ depression, and safety” ( Jesar et al., 2011 p. 760). It is known that adolescents with anorexia nervosa do have other underlying conditions that go along with it (Papadopoulos, Ekbom, Brandt, & Ekselius, 2009 p.11). So having the patient go through psychiatric therapies would be needed, to help to them to psychologically manage their disorders properly. The registered dietician’s role would be to manage the patient long term with weights and nutritional choices as appropriate, along with the multi-disciplinary team.
All things considered, the nurse is the person that has the greatest impact on the patient by providing holistic care. Not just to diabetes or anorexia, but to all aspects of their lives. The nurse assesses for nutritional history, family situations, etiologic factors, and lab values. The nurse recognizes the hopelessness of the individual and takes the steps to initiate further collaborative care. The nurse needs to provide extensive teaching on the use of insulin and the effects on the body, as wells as, the diabetes educator. Since the nurse has this patient’s trust, it is important that they are there every step of the way.

References
Alejandra Larrañaga, M.

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Balfe, M., Doyle, F., Smith, D., Sreenan, S., Conroy, R., & Brugha, R. (2013). Dealing with the devil: Weight loss concerns in young adult women with type 1 diabetes. Journal of Clinical Nursing, 2030-2038.
Daniel Espes, J. E.-o. (2013). Severe diabetic ketoacidosis in combination with starvation and anorexia nervosa at onset of type 1 diabetes: A case report. Upsala Journal of Medical Science, 130-133.
Deborah Young-Hyman, C. D. (2010, Mar). Disorders eating behavior in individuals wiht diabetes. Diabetes Care, 3(33), 683-689.
Fotios C. Papadopoulos, A. E. (2009). Excess mortality causes of death and prognostic factors in anorexia nervosa. The British Journal of Psychiatry, 10-17.
Hasken, J., Kresl, L., Nydegger, T., & Temme, M. (2010). Diabulimia and the Role of School Health Personnel*. Journal of School Health, 80(10), 465-469.
Jaser, S., Yates, H., Dumser, S., & Whittemore, R. (2011). Risky Business: Risk Behaviors In Adolescents With Type 1 Diabetes. The Diabetes Educator, 37, 756-764.
NEDA. (n.d.). NEDA Feeding Hope. Retrieved from National Eating Disorders:

https://www.nationaleatingdisorders.org/anorexia-nervosa