The Intersection of NG Feeding and Hybrid Closed-Loop Insulin Treatment: Finding Balance in Managing Diabetes and Disordered Eating

Trigger Warning: This post discusses topics related to Nasogastric (NG) feeding and hybrid closed-loop insulin treatment for diabetes, including medical procedures and eating disorders. If these topics may be triggering for you, please proceed with caution.

This blog is by no means ment for medical purposes but its my own personal experience of using both a NG tube and a HCL system recently. 

I decided to write this blog to give people an insight into this subject as it is something that I have been going through recently. I wanted to let people know that using a NG tube and a hybrid closed-loop technology to control your Diabeties during eating disorder recovery can work and something we shouldn’t be afraid to try more widely within the NHS. 

Living with Type 1 diabetes is a constant balancing act, and when you add in complications like disordered eating, the challenge can feel insurmountable. Recently, I’ve been thinking a lot about the ways that medical advancements in diabetes management—like hybrid closed-loop insulin systems—are intersecting with more traditional, life-saving measures like Nasogastric (NG) feeding. It’s a complex combination, but for some, it’s the best way to manage both life-threatening physical conditions and the mental health struggles that come with them.

Nasogastric (NG) feeding involves placing a thin tube through the nose, down the oesophagus, and into the stomach to deliver nutrition directly. It’s a method often used when a person is unable or unwilling to consume adequate calories through regular eating. While NG feeding is usually thought of in the context of severe eating disorders like anorexia nervosa, it’s also used for those with conditions that impact the digestive process or require precise nutritional control—such as in cases where diabetes and eating disorders collide.

NG feeding can be both a lifesaver and a lifeline. It allows the body to receive essential nutrients that might otherwise be missed due to restrictive eating behaviors, malabsorption, or other issues that complicate dietary intake. For many people, NG feeding is the first step in stabilising their health when they’re at a critical low point. However, it’s not without its challenges—both physically and emotionally.

A hybrid closed-loop insulin delivery system, combines continuous glucose monitoring (CGM) with an insulin pump that automatically adjusts insulin delivery based on real-time glucose readings. The goal of this technology is to keep blood sugar levels as stable as possible, reducing the rollercoaster highs and lows that come with manual insulin dosing.

These systems are considered "hybrid" because while they automatically adjust basal insulin levels, they still require user input for bolus doses at mealtimes. For someone managing Type 1 diabetes, this can be life-changing. It reduces the cognitive load of constantly calculating insulin needs and offers more freedom and flexibility in day-to-day life.

Combining NG feeding with a hybrid closed-loop system adds a layer of complexity that many within the healthcare system are still navigating. NG feeding delivers a continuous stream of nutrition, which means glucose levels can rise more steadily and predictably than they might with traditional meals. This requires careful adjustment of the hybrid closed-loop settings to prevent hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar).

Here’s where things get tricky: Hybrid closed-loop systems excel at responding to fluctuations in blood sugar levels, but they’re not foolproof. With NG feeding, insulin needs might not fit the standard patterns that the algorithm was designed to handle. Therefore, those using both NG feeding and a closed-loop system often need to work closely with their healthcare team to fine-tune the system's settings for this unique scenario.

While hybrid closed-loop systems and NG feeding both have incredible potential to stabilise physical health, they also come with psychological and emotional hurdles. People who require NG feeding often experience intense feelings of loss of control, shame, or even failure. There’s a stigma attached to needing artificial feeding, which can feel like a step backward in one’s journey to recovery.

For those with disordered eating behaviors, this can be particularly distressing. NG feeding can trigger feelings of guilt or fear around food and nutrition, and using a hybrid closed-loop system on top of that can feel like you’re being micromanaged by technology. The emotional burden of watching your blood sugar levels on a screen and knowing that a machine is deciding your insulin doses can be overwhelming, especially when you’re already fighting the urge to restrict or control your food intake.

Navigating these treatments requires a multidisciplinary approach that includes endocrinologists, dieticians, mental health professionals, and diabetes specialists. Communication and compassion from the healthcare team is crucial. They need to recognise not just the medical necessity of these interventions but also the emotional weight they carry for the patient.

Language is critical. Healthcare professionals must take care to use language that empowers rather than diminishes the person receiving treatment. They should emphasise that NG feeding and hybrid closed-loop systems are tools to help regain control of one's health, not symbols of failure. Acknowledging the courage it takes to pursue these treatments can help patients feel validated and supported.

One of the biggest fears for anyone managing diabetes with a hybrid closed-loop system is losing touch with their body’s cues and signals. There’s a fear that relying on technology might take away the intuitive understanding of what their body needs. This fear can be heightened for those also dealing with disordered eating, as the concept of "trusting your body" feels both essential and impossible.

The truth is, technology and NG feeding can coexist with self-awareness. These tools are not meant to replace intuition but to support it during times when your body is in crisis and needs extra help. They create a safety net, allowing you to focus on healing without the constant worry of survival.

The combination of NG feeding and hybrid closed-loop insulin therapy is not a one-size-fits-all solution. It requires constant adjustments, not just to the equipment but to the expectations, emotions, and mindset of the individual receiving treatment. As technology advances, there is hope that hybrid closed-loop systems will become more adaptable and more seamlessly integrated with various forms of nutritional support, including NG feeding.

But the human element—understanding, empathy, and personalised care—will always be a crucial part of the equation. We must continue to advocate for research, funding, and training to ensure that those who are most vulnerable receive not just the best medical care but also the compassionate support they deserve.

In the end, it’s about finding balance. Balance between the technology that sustains us, the medical interventions that save us, and the inner strength that drives us to keep fighting. No one should have to face this journey alone, and no one should be left feeling like their life is anything less than worth fighting for.

The Heartbreak of Being Told You Don’t Matter: A Reflection on the State of Type One Diabeties & Eating Disorder Care

Trigger Warning: This blog contains discussions around eating disorder behaviours, mental health, and language used by healthcare professionals. These are my personal experiences and reflections. This post is not intended as an attack on any individual or organisation but as an expression of the deep frustration and helplessness that I—and many others—feel.

I’ve struggled with how to begin this post, not because I didn’t have anything to say, but because this topic is deeply personal. It’s one of those things you don’t want to talk about—but not talking about it makes everything worse. So, here I am, diving into a conversation that desperately needs to be had.

Recently, people in the Type 1 Diabetes (T1D) community have been receiving devastating news: many are being discharged from T1DE (Type 1 Diabetes with Disordered Eating) services due to a lack of funding, and in some cases, the services are closing altogether. This is a shocking and harsh reminder that healthcare is too often dictated by budgets and bottom lines rather than the needs of the people it’s supposed to serve.

I’ve also heard stories of others being denied access to treatment because they don’t meet the rigid criteria for what a T1DE diagnosis entails. For many, insulin omission is just a small part of their eating disorder, not the whole picture. Yet T1DE services often can’t support those whose symptoms go beyond insulin omission. Meanwhile, traditional eating disorder services tend to turn away patients who are in a “normal” weight range due to limited resources and strict guidelines.

So, what happens to those who fall between the cracks? They stay there. Passed from one service to another like a problem no one wants to deal with. They’re told they’re not “ill enough” or don’t need help “just yet,” because their behaviors don’t fit the available treatments. These people are left in no man’s land, stuck in their illness far longer than necessary—and in some cases, they never find their way out.

I’m not naive. I understand that the NHS is stretched thin and that difficult decisions have to be made. Red tape is everywhere, and career advancement often means more than patient care. But the fact remains: people are dying from eating disorders complicated by Type 1 diabetes, and this shouldn’t be happening in 2024.

I consider myself fortunate to have access to both a T1DE team and an Eating Disorder Service, but this came at a tremendous personal cost. I had to lose a significant amount of weight to be deemed “sick enough” for treatment from my local Eating Disorder team. Now, on top of my T1DE diagnosis (often referred to as diabulimia), I also have a diagnosis of anorexia and am on the verge of being admitted to an Eating Disorder Unit.

In the T1D and eating disorder community, there’s often this unspoken assumption that the responsibility for recovery falls entirely on the patient. You’re expected to be ready, to trust the healthcare professionals (HCPs) who make you feel like your very existence is wrong. We’re told to “go with our gut,” to trust our instincts. But what happens when the very instincts we’re being told to ignore are the ones we’ve relied on for survival? What do you do when you’re told that everything you thought was healthy is actually killing you, one step at a time?

Since 2020, when my T1DE began to rear its ugly head during the COVID pandemic, I’ve been fighting for adequate treatment—not just for myself but for others who struggle with this awful complication of diabetes. I’ve been told that to be a “good diabetic,” food is something that must be policed, not enjoyed, and that it’s better to be underweight than overweight.

I want to send a message to all healthcare professionals, whether you work in diabetes or not: your language matters, every single day of the year. Whether it’s a check-up with a GP, an appointment with a dentist, or a follow-up with a Diabetes Specialist Nurse (DSN), the words you use can have an impact far greater than you realise.

We’re all aware that resources are scarce and research is underfunded, but what about the people who are left feeling hopeless? The ones convinced that the only way out of the hell they’re living in is an early death—or worse, taking their own life? This isn’t okay. No one should ever feel that suicide is the only option. Yet, for many battling T1DE, that’s the grim reality.

At a recent parliamentary inquiry supported by Breakthrough T1D UK (JDRF) into T1DE, I had the honor of meeting the parents of Megan Davison. Megan took her own life after struggling with T1DE, and it wasn’t until a second inquest—one her parents fought tirelessly for—that T1DE was acknowledged as a major factor in her death. Sadly, Megan’s story is not unique. People have been dying from T1DE-related complications for years, across the world. So why are we pulling funding for treatments that could save lives? It’s like stopping funding for cancer treatments.

Sitting in that room, listening to others share their stories—of being refused care, told they weren’t “sick enough,” or battered from fighting for treatment—I realized something: T1DE is like an infection that spreads, consuming every part of your life. You’re lost in the chaos, with no one reaching out a hand to help. The six people who shared their stories that day are warriors. They survived, despite the odds. But what about the hundreds—thousands—who don’t?

There’s an uncomfortable truth that many of us feel but rarely say aloud: to the system, we cost too much money. I recently read a quote from a diabetes consultant: “Those of us who battle T1DE cost the NHS too much money through DKA admissions, complications, and the sheer time it takes to treat us. It feels like, in the eyes of the system, our lives just aren’t worth the expense.” As harsh as this sounds, this is how thousands of people feel every single day.

But we do matter. Every life matters. And it’s time we start demanding better. It’s time we stop accepting funding cuts and budget constraints as valid reasons to let people die. It’s time we start valuing the lives of those with T1DE just as much as anyone else’s. Because at the end of the day, every single one of us deserves the chance to live, to hope to be heard, and to recover.