On this episode, Dr. Karen Nelson is joined by Gina Patnoe, a registered nurse and certified diabetes educator at Melrose Center. Gina and Karen will discuss how eating disorders can impact a person with diabetes as well as some tips and encouragement that healing is possible.
On this episode, Dr. Karen Nelson is joined by Gina Patnoe, a registered nurse and certified diabetes educator at Melrose Center. Gina and Karen will discuss how eating disorders can impact a person with diabetes as well as some tips and encouragement that healing is possible.
Click here for a transcript of this episode.
Dr. Karen Nelson 00:02
Eating Disorders thrive in secrecy and shame. It's when we create a safe space for honest conversation that we'll find the opportunity for healing. Hi there. I'm Dr. Karen Nelson, licensed clinical psychologist at Melrose Center, welcoming you to Melrose Heals, a conversation about eating disorders, the podcast designed to explore, discuss and understand eating disorders and mental health. On today's episode, I'm joined by Gina Patnoe, Gina is a registered nurse and a certified diabetes educator here at Melrose. Gina and I will discuss how an eating disorder can impact a person with diabetes, and the importance of support from family and friends. Now, before I begin, I invite you to take a deep breath and join me in this space. (Music swells) Gina I'm so excited to have you with me today. Welcome to the podcast.
Gina Patnoe 01:03
Thank you, Karen, I really do feel privileged to be able to join you today.
Dr. Karen Nelson 01:07
Before we begin, I'd love it if you could introduce yourself and tell me your role here at Melrose.
Gina Patnoe 01:13
Sure. So my name is Gina Patnoe, my background is in nursing. And I am a diabetes educator here at Melrose. So I meet with all of our patients that struggle with the co-occurring diagnosis of both an eating disorder and diabetes. And that's any type of diabetes.
Dr. Karen Nelson 01:29
So you're a registered nurse with a Bachelor's of Science in Nursing. But I actually hear that there's more credentials behind your name, C, D, C, E S, so those..
Gina Patnoe 01:41
(Overlapping) That's a lot of letters, right?
Dr. Karen Nelson 01:43
So tell me what that stands for
Gina Patnoe 01:45
Sure. So it's a mouthful, it's a Certified Diabetes Care and Education Specialist. So really, what that means is just some extra training to to have knowledge around around all types of diabetes and how to help manage that.
Dr. Karen Nelson 01:59
What really comes up for me, you know, hearing that additional credential is that this is a complicated issue, and that it would make sense if I am a patient, I would need support around that, that, you know, sometimes I think there is a misconception that I should manage it on my own. And what I really hear you saying is, that's, that's what you want to do is support your clients in managing that diagnosis.
Gina Patnoe 02:22
Absolutely. You know, doctors, endocrinologists often only have 20-minute visits, right. And so they may be able to change your medication or do something brief in that visit, but really to have, you know, longer visits and more support around the day to day living, you know, so yes, technology, but also Hey, what am I going to eat? How am I going to move my body? And how does that fit in with managing the diabetes as well. So just much more beyond just that little medication tweak.
Dr. Karen Nelson 02:47
Tell us about that piece of day to day living and having diabetes? What might that look like?
Gina Patnoe 02:52
Yeah, so for someone in particular, with type one diabetes, you know, I like to say, we could write everything down that they have to do on a note card, okay, so they have to check their blood sugar before every meal, or if they're feeling off, or before they drive, they have to take insulin, before, before every meal, based on their carbohydrates, or counting carbohydrates for every single meal or snack, have to go to their endocrinologist every three months and get get labs drawn. So that like no big deal, right?
Dr. Karen Nelson 03:22
That's a lot
Gina Patnoe 03:23
Right so when we actually look at it. And you know, all those things that I could write down on a note card, really, it just can be very consuming and is you know, really just a challenging disease that you, you have to always think about.
Dr. Karen Nelson 03:35
So today, our focus is actually on type one diabetes, we're going to be talking most specifically about that diagnosis and the interaction with an eating disorder when a patient has them both at the same time. So it's kind of a unique experience type one and the diagnosis of an eating disorder. Let's take it apart a little bit to really fully understand what some of these patients might be facing. So let's start with some general information. Help us know, what is diabetes?
Gina Patnoe 04:05
Yeah, great question. So diabetes is a chronic disease, where the body is not able to process glucose or sugar. And so what happens when we eat say we eat a potato, that potato breaks down into glucose or sugar, and that sugar should move from our bloodstream into our cells, or we can use it for energy. Right? So a little side note, you'll hear me say, carbs can be used for energy,
Dr. Karen Nelson 04:32
Yay
Gina Patnoe 04:32
We need them right?
Dr. Karen Nelson 04:33
We need carbs
Gina Patnoe 04:35
Yes! and when someone has diabetes, particularly type one diabetes. The hormone called insulin that moves that sugar from the bloodstream to the cell is not being produced.
Dr. Karen Nelson 04:47
I love that you said we need carbs. You hear - you heard it here first, right?
Gina Patnoe 04:51
Yes!
Dr. Karen Nelson 04:52
Like we don't have to completely demonize them, but also understanding just the functionality of what's happening if I have diabetes, that diagnosis of diabetes. Is there a difference between type one and type two diabetes?
Gina Patnoe 05:05
Yes. So, I like to describe insulin as an Uber driver, okay you with me?
Dr. Karen Nelson 05:11
(Overlapping) Perfect Got it. I'm on it.
Gina Patnoe 05:11
Alright. So insulin, a hormone that's produced by our pancreas should be released in response to that sugar being in the blood. And that that Uber driver that insulin is going to go over to the bloodstream, pick up that sugar and drive it over to its house. Okay, so it's driving that over. When someone has type one diabetes, there is a shortage of Uber drivers, we cannot get an Uber..
Dr. Karen Nelson 05:33
There's a snowstorm in Minnesota, no Uber drivers.
Gina Patnoe 05:36
Yes. When someone has type two diabetes, the Uber drivers might be there. But the cells are putting up a big roadblock, a big stop sign, so that insulin is there, but it's not working effectively to move that sugar to the cells where we want it.
Dr. Karen Nelson 05:50
What a beautiful description. Absolutely. Tell us about what might be some common misconceptions around the the reality that someone might have diabetes? Are there misconceptions that people might have around that?
Gina Patnoe 06:03
Yes. And I'm very passionate about helping helping to get rid of those and eliminate that stigma. So thanks for asking. You know, I want to say first, both type one, type two, any type of diabetes is not someone's fault.
Dr. Karen Nelson 06:18
Amen.
Gina Patnoe 06:18
Okay. Yes. So both have very strong genetic components. And I also want people to know, people in all shapes and sizes of bodies can have both types of diabetes, too.
Dr. Karen Nelson 06:30
I think we talk a lot about debunking myths here at Melrose. Right. And so what I really hear you talking about is those misconceptions, these myths, that somehow it becomes my fault if I become diagnosed with this, and really, in your work of education to help people understand just the biology of the disorder.
Gina Patnoe 06:50
Exactly, exactly. And just like people can carry a lot of shame with with their eating disorder, there's also a lot of shame that people can carry with their diabetes. And so helping patients to reduce that shame in both of those disorders.
Dr. Karen Nelson 07:01
Oh such a good point, I think about that aspect of shame, and how I talk a lot about how shame keeps us stuck. And it keeps us from one from wanting to potentially access the help that might be there. And so working to debunk those myths and really share the facts can be helpful and empowering for our patients.
Gina Patnoe 07:21
Absolutely.
Dr. Karen Nelson 07:22
Can I get type one diabetes by eating too much sugar?
Gina Patnoe 07:25
You sure can't.
Dr. Karen Nelson 07:27
I can't.
Gina Patnoe 07:27
Nope
Dr. Karen Nelson 07:28
Cannot
Gina Patnoe 07:29
Correct. Cannot.
Dr. Karen Nelson 07:30
Ok beautiful. Because I, I actually hear that question a lot, where people will ask me, and I always defer to the medical team, right. But again, it speaks to that space of misconception, and potentially placing blame on myself for something that is a biological disorder.
Gina Patnoe 07:46
Absolutely. Absolutely. And you hear I hear patients all the time who get, you know, the very helpful diabetes police who are asking them, Hey, are you supposed to be eating that? So even when you do have diabetes, you're still allowed to eat sugar too.
Dr. Karen Nelson 07:58
Right, right. Absolutely. Well, we're we will talk about that, actually, in our conversation today about how friends and family might support us, and what are the supportive pieces and maybe what aren't so supportive. So do people with type one always need to take insulin?
Gina Patnoe 08:15
They do. Insulin is the only medication that is approved. And that works for people with type one diabetes, that's really replacing what they're not making enough of right? It's given them that Uber driver to move that sugar over. So insulin is definitely needed every day, all day, forever.
Dr. Karen Nelson 08:34
So that aspect of needing to take a medication, it makes sense to me that I would need support on how to integrate that into my lifestyle.
Gina Patnoe 08:43
Absolutely.
Dr. Karen Nelson 08:44
How do patients know how much insulin they should be giving themselves?
Gina Patnoe 08:49
It's, it's complicated. before meals, a patient will calculate how many grams of carbohydrate they're eating generally, and then take a prescribed insulin dose based on that amount of carbohydrate. So they're matching it to their food. And it's something that that may need to be changing through the years, their insulin dose when they're, you know, when they're 13, when they're 20, when they're 40, when they're 70, will not always be the same. And it is, you know, there's lots of factors that can impact someone's insulin needs. So it is it is very complex. And that's what I encourage, you know, families and healthcare providers to really connect with is that complexity and that this is the only disease where someone has to calculate their own medication dose on their own every single day, multiple times a day.
Dr. Karen Nelson
What might a lull look like to a loved one, maybe watching someone that they care about? They have type one diabetes, and they're in a lull in insulin, what might that look like?
Gina Patnoe 09:35
A low blood sugar or hypoglycemia is just like it sounds when there's not enough sugar in that blood and that that can make someone feel really, really awful. So someone might see them being really shaky, sweaty, lightheaded, maybe irritable, that that hangry, hungry, angry feeling right? We all know that and it can, it can be dangerous, it could lead to someone passing out or seizure as well. So really important to watch for those. And just another thing again, someone with type one in their family has to really be aware of.
Dr. Karen Nelson 10:12
So when their blood sugar is low, the patient does need to administer insulin.
Gina Patnoe 10:18
So actually no, when a person's blood sugar is low, they need to eat carbohydrates. So insulin is what lowers the blood sugar. And carbohydrates or sugar is what brings it up when it's too low to get it in that safe range.
Dr. Karen Nelson 10:34
Okay, makes sense. And so I think also, too, I think about that aspect of again, watching a loved one having to manage their diabetes. Often people associate, like pricking their finger, and like, you know, having to check their blood sugar. Tell us about that. I mean, do patients share with you does that get old? Is that painful? What might that be like for someone?
Gina Patnoe 10:56
Yeah. So honestly, a lot of the patients that I see with type one diabetes, if they've been doing that, since they were four years old, it really is second nature to them. And they actually express more frustration about someone else being like, Oh, you're poking your finger, you're using needles all the time. And they're like, Hey, I don't have a choice, right? So, so I think, I mean, it is just very much a normal, part of their normal life.
Dr. Karen Nelson 11:19
It becomes problematic for the others around the person who has diabetes.
Gina Patnoe 11:23
Right, right.
Dr. Karen Nelson 11:24
So now not only am I managing my diabetes, but now I'm managing your distress.
Gina Patnoe 11:28
Exactly.
Dr. Karen Nelson 11:29
So interesting. So interesting.
Gina Patnoe 11:31
And I think there's distress too, depending on the age, especially in those adolescent years of, hey, this makes me different, right? Because the last thing you want when you're in middle school is often to be different. Good point. And so having to do those things and have people draw more attention to it, or you know, the poking the finger, the the injections, all of that just can add more distress as well, just because it's something different you have to do.
Dr. Karen Nelson 11:52
Why might someone decide to stop taking insulin?
Gina Patnoe 11:56
Withholding insulin can actually be a symptom of an eating disorder for someone with diabetes.
Dr. Karen Nelson 12:01
Qnd that that's a beautiful leeway into where we're going to be moving next. So tell us about how does an eating disorder typically show up for someone who has diabetes?
Gina Patnoe 12:15
So I want to just clarify too, that...yeah, so if someone is not taking their insulin, whether intentional or not, it will lead to to weight loss over time, just because again, that that Uber driver is not there, that sugars all staying in the blood and being rid through the urine. And so none of that sugar is moving into the cells for that fuel, and that energy, so basically, none of that food you're eating is being utilized how it's supposed to be. And so if somebody is omitting insulin as part of an eating disorder, honestly, what it looks like, is non compliance. And I hate that word.
Dr. Karen Nelson 12:50
Right, right.
Gina Patnoe 12:50
But that is the word that you will often see from, from doctors or providers that maybe you know, don't have the time or the energy, or the patient is, you know, not not ready to talk about it. It shows up as noncompliance. Because blood sugars are really high, they may be in the hospital regularly in in something called diabetic ketoacidosis for blood sugar's are really dangerously high and they're in the hospital. You know, you may see they're not refilling their medications, they may not be bringing in blood sugar records are even checking their blood sugars, because they, they don't want to see those high numbers, you know that that makes you be a bit more accountable when you see them.
Dr. Karen Nelson 12:51
That's right.
Gina Patnoe 13:25
So maybe no data for you, you know, you definitely may see that weight loss, or just, just like we might see with other eating disorders, you might see someone really struggling in school or at work, having difficulty concentrating and in relationships.
Dr. Karen Nelson 13:38
So the non compliance piece is not following the treatment plan for managing the diabetes.
Gina Patnoe 13:44
Right. So often someone might say, gosh, why-- they are not taking their insulin, like they're supposed to they're not doing what they need to do, they are just non compliant and might just write them off. Whereas really, when we're looking deeper in it, we know, hey, this is not a matter of noncompliance. This is a matter of someone being really, really sick. And this eating disorder telling them not to take their insulin.
Dr. Karen Nelson 14:03
Very good point, I think about that piece of when, when a behavior shows up. One of the things that I as a therapist often talk about with my patients is looking at the function of that behavior. And so what I hear you talking about is being curious of like, okay, if this diabetic patient is noncompliant with their diabetes treatment plan, what's the function of that? Or can we be curious about what are those behaviors trying to get at? Does that make sense? Or does that resonate?
Gina Patnoe 14:33
That's Yes, absolutely. And that's where again I hate the word noncompliance at all right?
Dr. Karen Nelson 14:38
True! I know! Kind of an icky...
Gina Patnoe 14:40
Yes, so that's where again, as soon as someone's even thinking that or you know, you might see that in a if I see it in a chart I'm like, Okay, we're gonna we're gonna look at this what is this actually because most of time, if not noncompliance. Most of the time these patients can have wonderful diabetes knowledge know what they quote, should be doing and they are just unable to because of that, so certainly it's, it's needing to look at that at with a closer lens.
Dr. Karen Nelson 15:05
And again, being curious, rather than judgmental.
Gina Patnoe 15:10
Thank you. Yes, love it, love it.
Dr. Karen Nelson 15:12
Let's talk about how patients might find you. And treatment here at Melrose.
Gina Patnoe 15:17
We're really proud of our program at Melrose. And the reason is because we treat the type one diabetes and the eating disorder together. And that would be advice to anyone, anywhere in the country seeking treatment to make sure that those things are not being addressed separately in silos, but together, and so at Melrose, you'd come in for an intake, you know, just like someone with a an eating disorder that doesn't have diabetes. And if you have type one diabetes, you'd automatically be connected that same day as your intake with an endocrinologist from Park Nicollet. So we work really closely with them. And then you would see me every day that you're that you're at Melrose as well. And again, just that team approach, being able to talk about the diabetes and the eating together as one is so important in that treatment.
Dr. Karen Nelson 16:02
That's right. What might you do first, when you meet with someone, a new patient? What are some of those things that you might be addressing in those first appointments?
Gina Patnoe 16:12
I think initially, we are looking at very slowly getting somebody back on insulin.
Dr. Karen Nelson 16:18
Yeah.
Gina Patnoe 16:18
So we are not going to resume what their previous doses were and get them on all the insulin they were on right away. Again, that can actually, it can exacerbate that risk for that insulin edema, that swelling that we talked about. And it doesn't feel good if blood sugars come down really quickly. So we will slowly get someone back on their insulin and little by little together at the patient's comfort level work to bring those blood sugars down to a safe level. We'll also talk about how that eating or excuse me how that diabetes has impacted their eating disorder, you know, I want to hear about their diagnosis, what messages they've received from that, you know, how how their family members or friends or loved ones talk about food around them? And what that looks like, and how that has impacted their diabetes too. So just hearing their story, certainly one thing, you know, we there's extra components that we have to address an eating disorder treatment when when someone has diabetes, you know, for example, in the inpatient unit at Melrose, all of our labels are covered up, right? No one, that's great, we say great, don't look at labels. But unfortunately, we know with type one diabetes, you have to read every single food label and read those carbohydrates. So there's, I think there's just some different reframing that has to come around that eating disorder treatment to know hey, we still have to have this awareness of food and what does that look like. So that can really be a challenge. Something else managing high and low blood sugars can really impact moods and someone's effectiveness or ability to engage in treatment. So like I said, high blood sugars can really cause a lot of fogginess, depressed feelings, being really sleepy, just not able to really be engaged, just like malnutrition, can, right? We know that in those early days, we need we need nutrition, we need insulin, and also low blood sugars can make someone feel really sick, really confused. Again, we thought you know, and that can last for several hours after a low too. So just something extra that we have to navigate in treatment and in sessions.
Dr. Karen Nelson 18:14
That piece of looking at treatment collaboratively, right, and that you're working with your team. But also, I think you bring up such a good point of of working to manage both of them at the same time, that we're not just going to say we're going to forget about the eating disorder first and get your diabetes solved or managed pardon me, or the other way around.
Gina Patnoe 18:37
Right. And you know, the eating disorder thinking in diabetes management can really exacerbate one another. And that's part of even the development of it is if you think about it, from from often a young age, like we said, these individuals have been reading food labels, they have been looking at numbers every day constantly, right? Eating Disorder loves numbers, diabetes is all about blood sugar numbers, A1C numbers. And so there's just so many ways that that we need to look at both of those together and how they how they feed into each other.
Dr. Karen Nelson 19:08
It really speaks to that space of just the appropriateness for specialized care that this is a specialized issue and that getting specialized support around that is intimately important.
Gina Patnoe 19:20
Exactly.
Dr. Karen Nelson 19:21
What might it take for someone to recover from an eating disorder and manage type one diabetes?
Gina Patnoe 19:29
I want to say first, it's possible.
Dr. Karen Nelson 19:31
Yay. You bet it is.
Gina Patnoe 19:31
Okay, and it will take time. Again you know, it'll take patience that we know it'll take really hard work and again, we know it's possible. So a lot of it again, the initial treatment is really getting that person back on their insulin slowly bringing blood sugar's down and and then slowly having that that meal plan fit in with that as well, right? So how do we get back to that routine of of those three meals and snacks and taking insulin before that, and, and I think too, just a lot of grace and self compassion. You know, me, your team, we do not expect that someone will be... have perfectly managing blood sugar's right away or even at any point, right? That's something that diabetes too.. Is it is it is really challenging to manage even when you are taking your insulin, and so certainly not expecting it to be perfect right away either. And being patient with that.
Dr. Karen Nelson 20:26
Absolutely. I think that piece of not expecting perfection, right? A lot of my patients, we talk about that, that sometimes they might even have a picture in their mind as they start treatment of oh, that, you know, this is what it's going to look like. And it sometimes isn't realistic. And so you know, what I hear you saying is having compassion for the process. And we're here to support you in that. How could someone like me tell if a patient with diabetes is not taking insulin? So I'm a mental health therapist. I am, I am not a trained nurse or diabetes educator. But I may have a patient that's sitting in my office who is diagnosed with an eating disorder and also insulin.. pardon me, needing to take insulin. What might be some things I look for as a therapist?
Gina Patnoe 21:16
Yes. So I think one thing is just listening to how someone is talking about their diabetes and their relationship with their diabetes, you know, some things to look for, ask for..Hey, do you? Do you ever have difficulty taking your insulin, you know, or do sometimes take partial insulin doses? And you may see, something I see is someone really struggling to actually just give that injection, right sitting there for a long time struggling with it, not wanting to even you know, look at their body or inject that insulin dose. And you might see a lot of eating disorder symptoms you're used to seeing again, you know, just that withdrawal from, from school and relationships. You're probably going to see them be really, really, really tired, and maybe feeling really, really depressed. And what's tricky with that is high blood sugars can sometimes mimic symptoms of depression, and make someone just feel extremely fatigued. Again, you have all these high blood sugar levels, that sugar is not getting to your brain, you have no food energy to keep you going. And so that's something common as high blood sugars can can really mimic those depressed feelings too.
Dr. Karen Nelson 22:25
So interesting. That piece that we speak about again and again, at Melrose is bringing it up, having the conversation, right? Of of just checking in, one thing I've really learned as a therapist is sometimes it can be too much for my patients to start the conversation. And so if I start it for them, you know, any any thoughts about taking your insulin or anything ever come? Could I could I be that general about it?
Gina Patnoe 22:55
I think you definitely could. And, you know, especially I think not asking that question allows allows those behaviors to continue. And and I heard you say in some earlier episodes, Karen, eating disorders love to be sneaky.
Dr. Karen Nelson 23:09
Right!
Gina Patnoe 23:09
Right. So if we can talk about it. And again, I think a general question give someone permission, like you said to, to talk about it. So I think that's great.
Dr. Karen Nelson 23:18
I think something that might come up as a therapist, I might feel like I don't know enough to ask the question. And so working to just be curious with my patient, rather than, you know, I share all the time, you know, My patients love to give me, you know, some flack for it, because I'm real quick to say, I don't know the answer to that question. But we could find out together. Right? And so just being curious, like, are you having any feelings about giving yourself insulin? And just being curious with them.
Gina Patnoe 23:48
And I think that's great. Again, people, people with type one diabetes are always getting opinions and thoughts. And from someone else and assumptions maybe so I think not assuming, asking and really asking those questions, allowing them to educate you and Hey, me, too, right? I do not live with diabetes. And I always have a lot to learn too. And someone with type one is truly the expert on their own disease. So I think just asking those questions is really important.
Dr. Karen Nelson 24:12
Wonderful. I think conversations like this just end up being so helpful to know that I don't have to know everything. But if I have some awareness, I could just start the conversation.
Gina Patnoe 24:23
And I think that's that's the biggest thing with this type of eating disorder with the insulin omission is... and especially for, for diabetes educators and endocrinologists too where it often might might be recognized before getting to you, Karen is knowing it exists. And, and again, not being afraid to, to in a non judgmental way, bring it up and just talk to someone about it.
Dr. Karen Nelson 24:44
I love that, that that space of non judgement can be kind of the distinguisher between if someone is willing to have the conversation, right? You know, it might feel a little different if I come at my patients. Well, what's wrong? Why aren't you taking your insulin? What's wrong with you? I don't know how I would respond to that question. So if if I have type one diabetes, and I'm focused on dieting and losing weight, potentially stopping my insulin, or maybe I'm pretending not to take it. Is it true that I'm probably not feeling well, most of the time?
Gina Patnoe 25:17
Oh, very true. Very true.
Dr. Karen Nelson 25:19
Okay.
Gina Patnoe 25:22
Again, it just... so exhausted peeing all the time, probably not sleeping, because you're peeing so much extreme thirst, dry mouth, confusion, maybe blurry vision, nausea, maybe vomiting. You're gonna feel really, really awful. And, and you know, what one thing to know, Karen is sometimes that that numb, foggy feeling is actually what someone with an eating disorder is, is looking for.
Dr. Karen Nelson 25:49
That's right.
Gina Patnoe 25:49
Right. So I think gosh they must be feeling awful. But it is helping to numb out something else, right? We both know, eating disorders aren't about food, right? So if they are using that symptom to numb out something else, and to keep those blood sugars really high, that can be really challenging and something to watch for as well.
Dr. Karen Nelson 26:05
Absolutely. I think that piece of, you know, if there's other, just pain in my life, sometimes a feeling of numbness is preferred over, you know, panic, anxiety, deep, deep feelings of depression, I might choose numbness over that. So let's maybe talk about body image and how that potentially might play a role in eating disorders and the interaction of having an eating disorder and type one diabetes, any thoughts on that?
Gina Patnoe 26:33
When someone is initially diagnosed with diabetes, they may see that they have lost weight from again, not having the insulin that they need to, you know, as that disease is is coming on, and, and so they may lose some weight, and then as they restart their insulin quickly gain that weight back, we know again, it's fluid, it's important weight to gain back, it's necessary, it's that energy. But that can be really challenging from a body image perspective to see, well, hey, wait a minute, this insulin made me gain weight when I was losing weight. And we know again, it wasn't a healthy weight loss. But that can be really challenging for some patients with with type one. And I think the other thing too, talking about the type one and type two, and the stigma around that, there's a lot of stigma that, hey, type one, people with type one diabetes are skinny.
Dr. Karen Nelson 27:19
Yes, good point.
Gina Patnoe 27:21
And so I think there's this pressure and this thought of, hey, you need to be.. if I have type one, I'm supposed to be skinny. And that also, a lot of messages from from doctors or from society are, hey, it's going to be easier to manage diabetes, if you're in a smaller body. And again, I tell patients every day, hey, we can manage diabetes, regardless of the shape or size your body wants to be in, we're going to do that and figure that out together. But that can be really challenging for someone if they know they've required less insulin when when they might have been in a different size body than they are now.
Dr. Karen Nelson 27:51
How do you help your patients discern the wide variety of information that is available on social media, regarding maybe bodies, you know, diet culture, all those images that they're seeing? Tell me about that a little bit.
Gina Patnoe 28:04
Oh yes. It's such a challenge the number of type one diabetes accounts, you know, that that are there. And I think, I think, first, the type one diabetes is small, and having support is huge. And so really, I will encourage patients, hey, go where you need. Often social media provides a wonderful community. But yes, being discerning, being discerning about that, and what that content is, is so important. I would caution anyone who is being told, you know, they can only have a certain amount of carbohydrates at a meal. We're not listening to that. That is not true. You know, again, just like all foods fit at Melrose with any type of eating disorder, all foods still fit when you have diabetes, right? Any type of diabetes, all foods still fit. And so I think, being discerning about that content and the you know, the food messaging and certainly not being black or white with those, those food rules, like some accounts may want to be.
Dr. Karen Nelson 28:55
How do you help other family members, as they're attempting to support their loved one who has a diagnosis of both type one diabetes and an eating disorder.
Gina Patnoe 29:06
This is so challenging, you know, to again like any eating disorder, seeing that person suffering, and especially when we add the diabetes, seeing that they are not taking the medication they need every single day to keep them alive, can be so distressing. So a few recommendations, you know, again, that compassion, trying to trying to really connect with the complexity of the type one diabetes with the eating disorder, you know, understanding that this is such a challenging disease to manage when it's again, when it's separate or when it's together.
Dr. Karen Nelson 29:37
Right.
Gina Patnoe 29:38
One thing I would definitely say and what patients will continually tell me avoid threatening complications. I can promise you, a patient who is not taking their insulin is well aware of what those long term complications will be and the eating disorder doesn't care. So that has shown to just be not not helpful, but I think focusing on What are the short term ways that resuming that insulin might be helpful, and I think that's how someone's feeling, you know, having that energy level, being able to stay awake, not feeling nauseous, those small day to day things that might give them give them a little energy and hope are much more important to focus on then, than the long term threats of, of what they're doing. And the last thing I'd say is praising for baby steps, yeah, okay, you know that, hey, if all we're doing for a while is taking insulin for breakfast, and not for lunch and dinner, we'll take it. Okay. So little by little working back towards that comfort level of covering every single carbohydrate, of course is our goal, but knowing that we can take those baby steps and praise along the way,
Dr. Karen Nelson 30:41
For sure. I love that you brought up, you know, not, you know, as a family member, our urge, especially out of fear might be to kind of do some threatening, don't you know, that, you know, you're going to get really sick, often, right? That that kind of talk doesn't do much to shift the behavior. That's just my family member expressing their fear at me.
Gina Patnoe 31:01
Even without the eating disorder at all. I can't tell you how many patients and just with type one that will tell me, oh, yeah, doctors or, you know, family members, or people will tell me all the time, oh, you know, you're going to lose a limb or uncle so and so lost a limb. And you know what, that that doesn't help.
Dr. Karen Nelson 31:16
Right. Absolutely. Absolutely. Well, I say all the time, shame, you know, that that often can trigger shame, or some resistance, and that isn't going to help me, you know, shift the behavior in a positive way.
Gina Patnoe 31:28
And hopelessness, right?
Dr. Karen Nelson 31:29
Right.
Gina Patnoe 31:30
If you have this messaging in your mind that no matter what you're going to do, you're going to develop this complication or lose a limb. Let me tell you that that is not motivating. Mm hmm.
Dr. Karen Nelson 31:39
Good point.
Gina Patnoe 31:40
Again, like, like we've said before approaching with compassion, not with judgment or accusations. You know, I think starting it and getting it on their side, right, asking, Hey, how have you been doing lately? How are you doing in school? You know looking at those bigger picture, things that might be being affected first. You know, encouraging them to eat with you to take their insulin with you. And that can be challenging too, because someone, someone with diabetes doesn't want to be, to be babysat. Or to be told, Hey, are you taking your insulin right? So asking what they need. And again, those questions about, hey, you know, might you be struggling with taking your insulin or, Hey, I've been noticing this, I'm worried about you. And then certainly encouraging them to get specialized treatment, whether that's talking to you know, a diabetes educator, an endocrinologist first, getting connected to a specialized care
Dr. Karen Nelson 32:28
For sure, starting the conversation, we say it all the time,
Gina Patnoe 32:31
Why we're here, right?
Dr. Karen Nelson 32:32
That's right. Like literally, I it, sometimes it feels like brand new information to people of like, Oh, I could bring it up? Absolutely, you can. And that we don't have to know all the right words, or know exactly what to say. But sometimes the expression of that concern, can, you know, start an appointment or start a conversation with your endocrinologist, and then that can lead you to more specialized care.
Gina Patnoe
Exactly, Karen.
Dr. Karen Nelson 32:34
I love that. I love that.
Gina Patnoe 32:41
And yeah, and I mean, the last thing I would just want want to say is, again, that recovery from this co-occurring diagnosis is possible. I've seen it we see it.
Dr. Karen Nelson 33:08
That's right.
Gina Patnoe 33:09
So having hope with that. I just thank you for for letting me be able to share about this and to bring awareness to this because it's you know, it can feel really isolating for someone who who has this particular eating disorder.
Dr. Karen Nelson 33:21
Thank you so much for joining me today. It was an absolute delight to chat with you, Gina.
Gina Patnoe 33:26
My pleasure. Thanks, Karen.
Dr. Karen Nelson 33:27
(Piano Music Starts) That's it for today. Thanks for joining me, we've covered a lot. So I encourage you to let it settle and filter in. And as I tell my patients at the end of every session, take notice. Pay attention, and we'll take it as it comes. I'll talk to you next time. Melrose Heals a conversation about eating disorders was made possible by generous donations to the Park Nicollet Foundation.