The Dangerous Intersection of Fatphobia and Type 1 Diabetes

Living with Type 1 diabetes is challenging enough, but when you add the pervasive influence of Fatphobia into the mix, it creates a toxic environment that can be both physically and mentally damaging. Fatphobia can present as humiliating or derogatory words, actions, or suggestions. and it permeates many aspects of society, including healthcare. When it intersects with Type 1 diabetes management, the results can be devastating.

So lets talk about the Impact of Fatphobia on Diabetes Management. There are two issues here that i have experienced. Firstly there is the stigma of weight and secondly there is the misconception of Weight and Control.    

So i have talked about the issue around the stigma of weight not only with diabeties care but in healthcare in general many time before in my blogs. However from this issue I have a unique perspective of this after being obese for a long period of time, also being underweight and suffering with a Eating Disorder. So what are some of the things that comes with the stigma of weight?

People with Type 1 diabetes are already tasked with managing their blood glucose levels, insulin intake, and overall health. But when Fatphobia comes into play, it adds an additional layer of stress. Individuals may feel pressure to maintain a certain weight to avoid judgment from healthcare professionals, family, or even themselves. This can lead to unhealthy behaviours, such as under dosing insulin to prevent weight gain or adopting restrictive eating patterns that harm both mental and physical health.

The next issue i want to talk about is the Misconception of Weight and Control. Fatphobia often perpetuates the dangerous myth that weight is entirely within an individual’s control and that losing weight will automatically lead to better health outcomes. This ignores the complexities of Type 1 diabetes, where weight can fluctuate due to factors beyond one’s control, such as insulin resistance, hormonal changes, or even the body’s response to treatment. The obsession with weight loss can distract from what truly matters: maintaining stable blood sugar levels and overall well-being. we as diabeties deal with numbers all the time but quite often are scolded for the numbers on the scales when we go to clinic. I have never understood why HCPs need to know what i weight in terms of treating my diabeties which has nothing to do with those pesky numbers on those scales.  

Next thing i want to talk about is the healthcare bias and misdiagnosis that can come with the presence of Fatphobia within healthcare. So the Dismissal of Symptoms that the presence of Fatphobia can lead to, is where symptoms are overlooked or misattributed to weight rather than being properly diagnosed and treated. For someone with Type 1 diabetes, this can mean that signs of complications, such as diabetic ketoacidosis (DKA) or neuropathy, are ignored because a healthcare provider is more focused on weight than on the underlying condition. This can delay critical interventions and worsen health outcomes. There is also the misdiagnosis of many people as Type 2 diabetic rather than Type 1 due to the bias within healthcare based not only on weight but age. I have spoken to a number of people who have had this experience and it delays treatment and ultimately can affect someones health long term.

The bias doesn’t stop at diagnosis. Fatphobia can also create barriers to receiving proper treatment. For example, a healthcare provider might be hesitant to prescribe certain medications or treatments that could potentially lead to weight gain, even if they are necessary for managing Type 1 diabetes. This can leave patients without the best tools to manage their condition, all because of a misplaced focus on weight.

The Psychological Toll that is impacted by the Intersection of Fatphobia and Type 1 Diabetes can be a daily challenge. For me this started at a rather young age and also was impacted by my late T1D diagnoses. i didnt recieve my diagnoses until i was in my early adulthood.  Something i experienced is the Internalisation of Fatphobia. Living in a society that stigmatises larger bodies can lead to internalised Fatphobia, where individuals begin to believe the negative stereotypes about their own bodies. For someone with Type 1 diabetes, this can manifest as guilt, shame, or self-blame for their weight and condition. The constant pressure to conform to an unrealistic standard of thinness can erode self-esteem and contribute to mental health issues such as depression, anxiety, or eating disorders.

And while we are talking about Eating Disorders we cant go by without mentioning Eating Disorders and Type 1 Diabetes (T1DE). The intersection of Type 1 diabetes and disordered eating, sometimes referred to as T1DE, is a serious and often overlooked issue. Fatphobia can exacerbate this problem, as individuals may engage in dangerous behaviours like insulin manipulation (omitting or under dosing insulin) to lose weight. This not only puts their physical health at risk but also deepens the psychological distress they experience. The focus on weight over health creates a breeding ground for these destructive patterns.

So what can we do to Break the Cycle of Fatphobia in Diabetes Care i hear you ask?

Well these are just some ideas that i have found useful and of course are not an extensive list. First there is the provision of more Education and Awareness within all areas of healthcare. It’s crucial to educate healthcare providers about the dangers of fatphobia and the importance of focusing on overall health rather than weight. By shifting the conversation away from weight and towards holistic diabetes management, we can create a more supportive and effective healthcare environment for people with Type 1 diabetes.

Next i would say get comfortable with Advocating for Yourself. For those living with Type 1 diabetes, it’s important to advocate for care that prioritises your health and well-being, not just your weight. Don’t be afraid to challenge Fatphobic comments or seek a second opinion if you feel your concerns are being dismissed. Remember, you are the expert on your own body, and your health is more than a number.

Finally build Support Networks. Building a support network of friends, family, and healthcare providers who understand the complexities of Type 1 diabetes and reject Fatphobia is essential. Surrounding yourself with people who focus on health and well-being rather than weight can help you maintain a positive relationship with your body and your diabetes management.

I want to say that the intersection of Fatphobia and Type 1 diabetes creates a dangerous and harmful environment that can impede proper care and exacerbate both physical and mental health issues. It’s time to dismantle the harmful myths that equate thinness with health and to advocate for a healthcare system that treats the whole person, not just their weight. By recognising and addressing the impact of Fatphobia, we can ensure that everyone with Type 1 diabetes receives the compassionate, comprehensive care they deserve.

Navigating Eating Disorder Recovery with Hybrid Closed-Loop Insulin Pump Therapy

Living with Type 1 diabetes presents a host of daily challenges, from monitoring blood glucose levels to administering insulin doses. For those also recovering from an eating disorder, these challenges can be even more complex. The advent of hybrid closed-loop insulin pump systems offers new hope for managing diabetes more effectively, but integrating this technology into an eating disorder recovery plan requires careful consideration and support.

Hybrid closed-loop insulin pumps, often referred to as “artificial pancreas” systems, combine continuous glucose monitoring (CGM) with an insulin pump to automatically adjust insulin delivery. These systems aim to maintain blood glucose levels within a target range, reducing the burden of constant monitoring and manual insulin adjustments.

For many people with diabetes, hybrid closed-loop systems have been life-changing. They offer more stable blood glucose control, reduce the risk of hypoglycemia, and provide a significant psychological relief from the relentless task of diabetes management. However, the interplay between diabetes technology and eating disorders can be delicate and requires a nuanced approach.

Eating disorders can complicate diabetes management. These conditions often involve a distorted relationship with food, body image issues, and harmful behaviours that can disrupt blood glucose control. In this context, managing diabetes can become even more challenging and emotionally fraught.

The use of a hybrid closed-loop system during eating disorder recovery presents unique advantages and challenges. On one hand, the automation of insulin delivery can relieve some of the stress associated with constant glucose monitoring and insulin dosing. On the other hand, it requires a degree of trust in the technology and oneself, which can be difficult for someone recovering from an eating disorder.

Benefits of Hybrid Closed-Loop Systems in Recovery

1. Stabilized Blood Glucose Levels: Hybrid closed-loop systems can help stabilize blood glucose levels more effectively than manual management, which is particularly beneficial during eating disorder recovery when inconsistent eating patterns can cause fluctuations.

2. Reduced Cognitive Load: The automation of insulin delivery reduces the mental burden of diabetes management, allowing individuals to focus more on their recovery process without the constant worry of managing blood glucose levels.

3. Improved Quality of Life: Many users report improved quality of life with hybrid closed-loop systems due to better sleep, fewer diabetes-related disruptions, and overall peace of mind.

4. Support for Nutritional Rehabilitation: Consistent insulin delivery can support nutritional rehabilitation by helping to manage blood glucose spikes and drops that may occur with refeeding or changes in eating patterns.

Challenges and Considerations

1. Trust in Technology: Transitioning to a hybrid closed-loop system requires trust in the technology, which can be challenging for individuals with a history of eating disorders who may struggle with control issues.

2. Behavioral Triggers: The data provided by CGMs, such as real-time blood glucose levels, can be a double-edged sword. While it offers valuable information, it can also become a source of anxiety and potential trigger for disordered behaviors if not managed carefully.

3. Personalization and Support: Recovery is highly individual, and the integration of diabetes technology should be personalized. Regular consultations with healthcare providers, including endocrinologists, dietitians, and mental health professionals, are crucial to tailor the use of hybrid closed-loop systems to individual needs.

4. Monitoring and Adjustment: Continuous monitoring and potential adjustment of the hybrid closed-loop system settings are essential to ensure it meets the unique needs of someone in eating disorder recovery.

Strategies for Successful Integration

1. Comprehensive Care Team: Assemble a multidisciplinary care team that includes endocrinologists, diabetes educators, dietitians, and mental health professionals. This team can provide holistic support and ensure all aspects of health are addressed.

2. Education and Training: Ensure thorough education and training on the use of the hybrid closed-loop system. Understanding how the system works can reduce anxiety and improve confidence in its use.

3. Regular Check-Ins: Schedule regular check-ins with healthcare providers to monitor progress, address concerns, and make any necessary adjustments to the treatment plan.

4. Emotional Support: Engage in therapy or counseling to address the emotional aspects of both diabetes management and eating disorder recovery. Support groups can also provide a sense of community and shared experience.

5. Mindfulness and Self-Compassion: Practice mindfulness and self-compassion techniques to manage stress and anxiety related to both diabetes and eating disorder recovery. Being kind to oneself during this challenging time is crucial.

Navigating eating disorder recovery while managing Type 1 diabetes is a complex journey, but the use of hybrid closed-loop insulin pumps offers a promising tool to ease this path. By providing more stable blood glucose control and reducing the cognitive load of diabetes management, these systems can support recovery efforts. However, their integration must be approached with careful consideration, personalized support, and a comprehensive care team to address the unique challenges at the intersection of diabetes and eating disorders. With the right strategies and support, individuals can find a balanced approach to managing their health and achieving recovery.

The True Cost of Having T1DE That No One Talks About

Living with Type 1 diabetes (T1D) is a complex and demanding journey. When an eating disorder is added to the equation—referred to as Type 1 Diabetes with Disordered Eating (T1DE)—the challenges become exponentially greater. While much is said about the physical and medical aspects of managing T1D, the true cost of T1DE is often overlooked. This cost is multifaceted, affecting not just the body, but also the mind, relationships, and overall quality of life.

There are many COSTS to T1DE some more spoken about than others here are a few i would like to talk about. Firstly i want to talk about the Emotional and Psychological Toll. The emotional and psychological burden of T1DE is profound.

• Constant Fear and Anxiety: Managing T1D requires constant vigilance, and when disordered eating behaviours are added, the fear of losing control intensifies. Every meal becomes a battleground, and the anxiety over blood sugar levels, weight, and body image can be paralysing.
• Guilt and Shame: Individuals with T1DE often experience intense guilt—guilt for eating, guilt for taking insulin, guilt for not being "perfect" in their diabetes management. This is compounded by shame, particularly when society and HCPs fail to understand the complexity of their struggle.
• Depression and Isolation: The mental strain of T1DE can lead to depression and feelings of hopelessness. Many people with T1DE feel isolated, believing that no one understands what they’re going through, which can push them further into their disordered behaviours.

Next is the Physical Health Consequences. The physical toll of T1DE extends beyond the typical complications of diabetes.

• Long-Term Complications: Insulin manipulation or omission, a common behaviour in T1DE, can lead to severe complications such as diabetic ketoacidosis (DKA), neuropathy, retinopathy, and kidney damage. These complications can shorten life expectancy and significantly reduce quality of life.
• Nutritional Deficiencies: Disordered eating patterns can lead to malnutrition, which exacerbates the physical stress on the body. Over time, this can weaken the immune system, impair wound healing, and contribute to further complications.
• Chronic Fatigue and Weakness: The combination of fluctuating blood sugar levels and inadequate nutrition can lead to chronic fatigue, making daily activities a struggle and reducing the ability to engage in normal life.

Another consideration is the Financial Burden/cost of T1DE, this is significant and often underestimated.

• Lost Income: The emotional and physical toll of T1DE can make it difficult to maintain regular employment. Frequent doctor appointments, sick days, and hospitalisations can result in lost income.

There is also the impact on Relationships both personal and professional. T1DE doesn’t just affect the individual; it also takes a toll on relationships with family, friends, partners, and work colleagues.

• Strain on Family Dynamics: Family members may struggle to understand the complexity of T1DE, leading to frustration, misunderstandings, and tension. The constant worry about their loved one's health can also cause emotional burnout.
• Isolation from Friends and Social Activities: Social events often revolve around food, which can be anxiety-inducing for someone with T1DE. This can lead to social withdrawal, further deepening the sense of isolation and loneliness.
• Relationship Stress: Romantic relationships can suffer as partners may feel helpless, frustrated, or even resentful. The secrecy and guilt associated with disordered eating behaviours can create emotional distance and mistrust.

Another aspect is the difficulty with Cognitive and Academic/Work Performance. T1DE can also impact cognitive function, affecting academic and work performance.

• Difficulty Concentrating: Fluctuating blood sugar levels can lead to brain fog, making it difficult to concentrate or make decisions. This can affect academic performance or job productivity.
• Memory Issues: Poorly managed diabetes and nutritional deficiencies can lead to memory problems, making it harder to retain information or learn new skills.
• Missed Opportunities: The need to prioritise health over other aspects of life can lead to missed opportunities in education, career advancement, or personal growth.

Finally there is the Loss of Joy and Passion. One of the most profound yet unspoken costs of T1DE is the loss of joy and passion in life.

• Hobbies and Interests Fade: The overwhelming focus on managing T1D and the disordered eating can cause people to lose interest in hobbies and activities that once brought them joy.
• A Life Consumed by Numbers: Life becomes consumed by counting carbs, monitoring blood sugar, and managing insulin, leaving little room for spontaneity or enjoyment.
• Disconnection from Self: T1DE can create a disconnect between the individual and their true self, as their identity becomes entangled with their illness.

The true cost of T1DE goes far beyond the physical and financial aspects—it permeates every corner of a person’s life, affecting their mental health, relationships, career, and overall sense of self. It’s a burden that many carry in silence, often feeling misunderstood and unsupported. Acknowledging these hidden costs is the first step towards providing more comprehensive care and support for those living with this dual diagnosis. It's essential to approach T1DE with empathy, understanding, and a commitment to addressing not just the physical, but also the emotional and psychological needs of those affected.