How Much Insulin You Take in a Day Doesn’t Define You

You're absolutely right: how much insulin you take in a day doesn’t define you. This is such an important message for anyone managing Type 1 diabetes, especially if they're grappling with feelings of self-worth, body image concerns, or societal pressures.

Here’s why insulin needs don’t define you and some thoughts on embracing this mindset:

Living with Type 1 diabetes means that insulin is a crucial part of your daily life. It’s the lifeline that keeps your blood sugar in check and allows you to live a full life despite the challenges of the condition. However, for many people with diabetes, the amount of insulin they need each day can become a source of anxiety, guilt, or even shame. 

Insulin is a Tool, Not a Judgment

No two bodies are the same, and this is especially true for those managing Type 1 diabetes.

• Insulin as a Tool: Insulin is a life-saving medication that helps you manage your blood sugar, no matter how much or how little you need. The amount you take isn’t a reflection of your effort, health, or value as a person.
• Everyone’s body is different:  Factors like age, weight, activity level, hormones, and stress all influence insulin requirements. Comparing your insulin dose to others isn’t helpful because it’s not a one-size-fits-all equation.

Your Insulin Dose Reflects Your Body’s Needs

It’s also important to recognise that your insulin requirements can change over time. This is a normal part of diabetes management, not a reflection of failure.

• Insulin Requirements: Needing more or less insulin simply shows how your body processes carbohydrates and responds to external factors. It’s not “good” or “bad”; it’s just a biological response.For example:
• During growth spurts, illness, or periods of high stress, your body may need more insulin.
• Increased physical activity or changes in food intake may lower your insulin needs temporarily. Both are normal.

Shame Around Insulin Can Be Harmful

• Feelings around insulin: Feeling shame or guilt about taking insulin can lead to dangerous behaviours, such as skipping doses or under-dosing to reduce perceived weight gain. This puts your health at serious risk.
• Thinking about insulin: Reframing insulin as a positive part of your health care can help reduce this shame. Insulin allows you to live, thrive, and enjoy your life to the fullest.

You Are Not Defined by Numbers

Diabetes management often revolves around numbers—blood sugar readings, carb counts, insulin doses. But these numbers don’t tell the full story.

• More Than a Number: The amount of insulin you take is just a number. It doesn’t measure your character, your resilience, or your ability to manage your diabetes. It’s easy to get caught up in the numbers, but it’s crucial to remember that they don’t define who you are.
• Avoiding Self-Judgment: It’s natural to feel frustrated or even guilty if you feel like you’re taking more insulin than you “should.” But self-judgment only adds to the stress. Instead, focus on the fact that you’re doing what you need to do to take care of your health.

Insulin Amount ≠ Your Effort or Willpower

• Managing Type 1 diabetes is incredibly demanding, but the amount of insulin you take isn’t a reflection of your success or how “in control” you are.
• Blood sugar fluctuations are affected by countless factors, many of which are outside your control. Taking more or less insulin to adapt to those fluctuations is a sign of strength and responsibility, not weakness.

Insulin Is Not the Enemy

In a world where diet culture often demonises carbs and insulin, it’s easy to develop a negative attitude toward insulin.

• Insulin Is Essential, Not Optional: Insulin isn’t something to be feared or avoided; it’s a necessary and life-saving treatment. Whether you need a little or a lot, insulin is what keeps your body functioning properly.
• Combatting Stigma: Unfortunately, there can be a stigma attached to needing “too much” insulin, perpetuated by misconceptions about diabetes. But needing more insulin doesn’t mean you’re doing something wrong. It simply means you’re taking care of your body’s needs.

Embrace Body Positivity and Self-Compassion

• Body Image: If body image concerns are influencing how you feel about insulin, remember that your body is doing its best to function under unique circumstances. Insulin supports your body in staying strong and healthy.
• Self-Compassion: Practice self-compassion by reminding yourself that your worth is not tied to your appearance, your numbers, or your insulin doses.

Focusing on Overall Health

Instead of fixating on insulin doses, shift your focus to your overall health and well-being.

• Holistic Health: Good diabetes management isn’t just about insulin doses. It’s about balancing blood sugar, staying active, eating a balanced diet, managing stress, and taking care of your mental health. Your insulin needs are just one piece of the puzzle.
• Listening to Your Body: Pay attention to how you feel, both physically and mentally. If you’re feeling good, energised, and healthy, that’s a more accurate measure of your diabetes management than how much insulin you’re using.

Building a Positive Relationship with Your Treatment

It’s important to cultivate a healthy, positive relationship with your diabetes treatment.

• Trusting Your Care Plan: Trust that your healthcare team has prescribed the insulin regimen that’s right for you. They’ve taken into account your unique needs and are working with you to manage your diabetes as effectively as possible.
• Acceptance and Self-Compassion: Accepting that you may need more or less insulin than others—and being compassionate with yourself about it—is a crucial step in reducing the emotional burden of diabetes. You’re doing the best you can, and that’s what matters most.

Connect with Support

• Support Groups: Join online or in-person communities of others living with Type 1 diabetes. You’ll often find shared experiences that reinforce the idea that insulin amounts are personal and variable, not a measure of worth.
• Professional Support: Seek support from healthcare providers who emphasise a holistic approach, focusing on mental and emotional health alongside physical care.

Celebrating Your Strength

Living with diabetes requires resilience, discipline, and self-care—all of which are far more important than any number on a vial or a syringe.

• Recognizing Your Effort: Every day, you make countless decisions to keep your blood sugar in check and manage your diabetes. Those decisions, and the effort you put into your health, are worth celebrating.
• Focusing on What You Can Control: While you can’t always control how much insulin your body needs, you can control your attitude and approach to managing your diabetes. Focusing on the positives and taking pride in your self-care can help you maintain a healthier perspective.

Conclusion

How much insulin you take in a day doesn’t define you. It’s just one aspect of managing Type 1 diabetes, and it’s one that varies from person to person and from day to day. You’re a whole, multifaceted person with strengths, talents, and so much to offer beyond this one aspect of your health. What truly matters is how you care for yourself, how you adapt to your body’s needs, and how you approach your diabetes with resilience and self-compassion. Embrace your journey, trust in your treatment, and remember that your worth is not measured by numbers, but by your strength, courage, and commitment to living well with diabetes.

Day patient treatment for an eating disorder (ED) while managing Type 1 diabetes

Starting day patient treatment for an eating disorder (ED) while managing Type 1 diabetes presents a unique set of both positives and challenges, as the two conditions are deeply intertwined. The goals of treatment are often to balance physical and mental health, improve eating patterns, and stabilise blood sugar levels.

Positives of Day Patient Treatment for ED with Type 1 Diabetes

1. Specialised, Integrated Care:

   • Day treatment programs tailored to both EDs and Type 1 diabetes provide holistic care. These programs often include a team of professionals, such as endocrinologists, dietitian, and mental health specialists, who understand the relationship between food, insulin, and emotions.
   • Individualised care plans focus on both the eating disorder and diabetes management, ensuring that blood sugar levels are consistently monitored and adjusted as needed.

2. Structured Meal Support:

   • The structured environment of day patient programs encourages regular meals and snacks, a critical aspect for both ED recovery and diabetes management.
   • These meals are often tailored to help restore a healthy relationship with food, reduce the anxiety around eating, and maintain stable blood sugar levels.

3. Emotional and Psychological Support:

   • Psychological support in these programs addresses the emotional connection between diabetes and disordered eating, especially the concept of diabulimia, where insulin is restricted to lose weight.
   • Patients have access to therapy, both group and individual, helping them deal with body image issues, fear of weight gain, and the impact of diabetes on daily life.

4. Peer Support and Community:

   • Being part of a day program allows individuals to connect with others facing similar challenges, reducing feelings of isolation. Peer support is crucial for understanding shared struggles and celebrating progress.

5. Focus on Long-Term Coping Skills:

   • The day patient approach typically focuses on teaching patients how to balance insulin use, carb counting, and maintaining healthy eating habits over the long term. Learning sustainable strategies for managing both the eating disorder and diabetes can lead to long-lasting health improvements.

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Challenges of Day Patient Treatment for ED with Type 1 Diabetes

1. Complexity of Managing Two Conditions:

   • Balancing the treatment of an eating disorder with Type 1 diabetes is highly complex. Both conditions involve careful monitoring of food intake, which can exacerbate anxiety about food, insulin, and blood sugar levels.
   • The emotional stress of managing diabetes can also trigger ED behaviours, leading to a cycle that is difficult to break.

2. Fear of Weight Gain:

   • Insulin use can lead to weight gain, which is a significant concern for many people with EDs, especially those with diabulimia. Adjusting insulin levels to manage blood glucose appropriately can be psychologically challenging for patients who associate insulin use with changes in body image.
   • The emotional conflict between needing insulin for diabetes and fear of its impact on weight can lead to resistance in treatment.

3. Blood Sugar Fluctuations:

   • During the early stages of recovery, the body is adjusting to new eating patterns, which can cause blood sugar fluctuations. High blood sugars (hyperglycemia) and low blood sugars (hypoglycemia) are common as the body adapts, and these can be frustrating or scary.
   • These fluctuations can sometimes reinforce unhealthy thoughts or habits (e.g., skipping insulin to avoid low blood sugar or restricting food to prevent highs).

4. Hyper-Focus on Food and Numbers:

   • Managing diabetes requires constant attention to food, carbohydrates, and insulin dosing. For individuals with EDs, this focus on food can sometimes perpetuate obsessive thoughts and behaviors, making recovery more difficult.
   • It’s a challenge to work on repairing one’s relationship with food while still needing to track every meal for diabetes management.

5. Physical Symptoms of Diabetes Complicating Treatment:

   • Untreated or poorly managed blood sugar levels can cause fatigue, irritability, mood swings, and other physical symptoms that can make it harder to engage in therapy or adhere to the treatment plan.
   • Dealing with both the physical complications of diabetes and the psychological aspects of an ED can feel overwhelming at times.

6. Fear of Judgment or Misunderstanding:

   • Patients with Type 1 diabetes may feel a sense of guilt or shame about their eating disorder, worrying that healthcare providers or peers won’t fully understand the pressures of living with both conditions. This fear can make it difficult to fully open up and engage in treatment.

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Key Strategies for Success

• Education on Diabetes and ED Overlap: A critical part of treatment is educating the patient about how their diabetes management impacts their eating disorder and vice versa. Understanding this connection can reduce fear and anxiety around food, insulin, and weight.

• Gradual Adjustment to Food Intake and Insulin: Treatment usually involves a gradual reintroduction of balanced meals and appropriate insulin use to avoid drastic blood sugar changes and reduce psychological distress.

• Regular Blood Sugar Monitoring: Frequent monitoring helps to identify patterns and manage fluctuations, providing immediate feedback that can be used to adjust treatment plans.

• Focus on Non-Weight-Related Goals: Instead of focusing on weight changes, the emphasis is placed on improved energy levels, stable blood sugars, mental health improvements, and overall quality of life.

• Long-Term Support: After the day program, ongoing therapy and support are essential to help maintain recovery and manage diabetes in a way that promotes mental and physical well-being.

Conclusion

While day patient treatment for eating disorders with Type 1 diabetes presents challenges, it offers significant benefits in terms of specialised care, emotional support, and structured meal plans. With a comprehensive and patient-centered approach, individuals can make strides in recovery, balancing their physical health with the psychological components of both conditions.

The Challenges of Being Treated for an Eating Disorder in an Acute Hospital: A Waiting Game for the Right Care

Trigger Warning: This blog contains discussions around eating disorder behaviours, mental health, and care received by healthcare professionals. These are my personal experiences and reflections. This post is not intended as an attack on any individual or organisation.

Managing an eating disorder is challenging enough on its own, but when it's combined with Type 1 diabetes, the complexities multiply. Many people with these dual conditions find themselves in acute hospitals while waiting for a bed in a specialised eating disorder unit. Although acute hospitals offer essential medical stabilisation, they often lack the specialised care required to treat both the eating disorder and diabetes effectively. In this post, we’ll delve into the difficulties of managing these conditions simultaneously in an acute hospital setting and the impact it has on patients' well-being.

The Complex Interplay of Eating Disorders and Diabetes

When Type 1 diabetes and an eating disorder occur together, they create a unique set of challenges that complicate both diagnosis and treatment. Managing diabetes requires precise monitoring of blood sugar levels, consistent carbohydrate intake, and careful insulin administration. On the other hand, eating disorders are often characterised by an unhealthy relationship with food, severe calorie restriction, or binge-purge cycles.

In a specialised unit, treatment teams have a deep understanding of this interplay and know how to tailor care to address both conditions simultaneously. In acute hospitals, however, the focus is often on immediate medical stabilisation without considering the complex ways in which diabetes management and disordered eating behaviours interact. This lack of integrated care can lead to insufficient treatment, where each condition is addressed in isolation rather than as part of a broader, interconnected problem.

Lack of Specialised Knowledge and Diabetes Expertise

Acute hospitals typically have teams that are well-versed in managing diabetes and teams that focus on general eating disorder care, but few have experts who understand how these two conditions overlap. The treatment approach for someone with both conditions is not as straightforward as for someone dealing with just one. For example, individuals with this dual diagnosis might engage in "diabulimia," or T1DE as it is now known behaviours. This is where they intentionally reduce or skip insulin to lose weight—a behaviour that is extremely dangerous but not always recognised in non-specialised settings.

It is also possible to be diagnosed with a ‘traditional’ eating disorder such as Anorexia or Bulimia as a diabetic, where there is NO manipulation of insulin in order to loose weight. This also required a nuanced understanding of both the psychological and physiological aspects involved. 

In an acute hospital, the focus is often on stabilising the physical symptoms rather than addressing the underlying mental health needs. Without expertise in this area, medical professionals in acute hospitals may focus solely on normalising blood glucose levels without addressing the underlying eating disorder behaviours. This narrow focus can lead to a cycle where patients are stabilised physically only to relapse quickly, as the psychological drivers of their disordered eating and insulin misuse remain unaddressed.

Most staff in these settings are not specialised in eating disorders, and they may not fully grasp the intricacies of these conditions. This can lead to a narrow approach that focuses on weight gain or symptom control without delving into the emotional, cognitive, and behavioural aspects that drive the disorder.

The lack of specialised training can also lead to misunderstandings and stigmatisation. Patients might encounter healthcare professionals who unintentionally minimise their condition, seeing it as a problem of self-control rather than recognising the deep-seated psychological struggle involved. This misunderstanding can feel isolating for patients, leaving them feeling misunderstood and dismissed.

The Risks of Inconsistent Blood Sugar Management

For those with Type 1 diabetes and an eating disorder, managing blood sugar levels is a tightrope walk, balancing insulin doses with nutritional intake. In an acute hospital, where the goal is often immediate stabilisation, the rigid treatment protocols can inadvertently cause more harm than good. Standardised meal plans and insulin dosing might not take into account the individual’s specific relationship with food, fears, or behaviours related to their eating disorder.

Acute hospitals are not typically equipped to provide the kind of nutritional and psychological support that patients with both diabetes and an eating disorder require. The lack of a personalised approach can lead to severe fluctuations in blood sugar levels, increasing the risk of life-threatening conditions like diabetic ketoacidosis (DKA) or hypoglycemia, while also reinforcing unhealthy behaviours around food and insulin use.

Psychological Distress and Fear of Insulin

For many individuals with both an eating disorder and Type 1 diabetes, insulin itself can become a source of fear and anxiety. The misconception that insulin leads to weight gain is a common barrier to treatment adherence among this population. In a specialised eating disorder unit, mental health professionals work closely with patients to reframe their thinking around insulin, help them understand its necessity for survival, and address body image concerns in a compassionate way.

However, in an acute hospital setting, where the focus is on physical stabilisation rather than psychological support, this nuanced aspect of treatment is often overlooked. Medical staff may lack the training to address these fears in a therapeutic manner, leading patients to feel unsupported and misunderstood. This disconnect can make patients more resistant to insulin treatment and deepen their ambivalence toward recovery.

Rigid Medical Protocols vs. Individualised Treatment

One of the most challenging aspects of being treated in an acute hospital is the rigid, protocol-driven approach to care. While necessary for many medical conditions, this standardisation often fails to address the unique needs of eating disorder patients especially ones who also have type 1 Diabeties. These rigid medical protocols might involve discontinuing the use of technology like Continuous Glucose Monitors (CGMs), insulin pumps (IPs), or Hybrid Closed Loop (HCL) systems. As a result, patients may be required to revert to Multiple Daily Injections (MDI), which can significantly increase their anxiety levels, making an already stressful situation even more overwhelming.

In a specialised eating disorder unit, treatment is holistic and personalised, involving dietitian's, therapists, psychologists, and medical doctors who collaboratively create an individualised care plan. Acute settings typically lack this multidisciplinary approach, limiting the effectiveness of treatment and potentially leading to a cycle of physical stabilisation without real progress on the mental health front.

There is an important and frustrating issue here that highlights a gap in the otherwise valuable care provided by specialised eating disorder units. While these units excel in offering holistic treatment for the psychological and emotional aspects of eating disorders, their lack of understanding and support for diabetes technology often undermines effective diabetes management. This disconnect can force patients to abandon their familiar, personalised tools like Hybrid Closed Loop (HCL) systems, Continuous Glucose Monitors (CGMs), or insulin pumps, and revert to Multiple Daily Injections (MDI), which disrupts their routine and control over their condition.

My experience of being forced back to MDIs, despite proven success with the HCL system, raises a critical question about whose safety is truly being prioritised. The decision to move me away from advanced diabetes technology seems to be based on the staff's lack of knowledge or comfort with these tools, rather than what’s actually best for my health. When your Time In Range (TIR) drops from 97% to below 50% due to this change, it's clear that your diabetes management has been significantly compromised by a system that should be designed to support your overall well-being, not hinder it.

 Its understandable to question how this approach can be justified, especially when the aim of treatment should be to optimise both your mental and physical health. It’s crucial for specialised units to close this knowledge gap and integrate diabetes technology into their care plans so that patients like me can maintain the best possible control over both their diabetes and eating disorder recovery. Without this integration, it’s hard to see how the current approach serves the patient’s best interests.

Triggering Interactions with Food and Nutrition

The way food is handled in acute hospitals can be another significant issue for individuals with eating disorders. Meals in these settings are often standardised, with little to no flexibility or consideration for the specific needs of someone with an eating disorder. Without proper meal planning and therapeutic support, eating can become even more stressful, and the process of weight restoration can feel punitive rather than healing.

Moreover, without guidance from specialised dietitian's trained in eating disorders, patients may feel overwhelmed and unsupported during mealtimes. Staff in acute hospitals may not understand the anxiety, guilt, or fear that patients experience around food, leading to interactions that inadvertently reinforce negative emotions and behaviours.

Emotional Distress and Increased Anxiety

Being in an acute hospital without a clear timeline for transfer to a specialised eating disorder ward can cause significant emotional distress. The uncertainty of not knowing when they will receive appropriate care can amplify feelings of hopelessness, frustration, and anxiety. Patients often feel like they are in limbo, physically present in a hospital but mentally waiting for the moment when their true recovery journey can begin.

This sense of waiting can be demoralising, especially when patients see their physical symptoms being treated while their psychological needs remain unmet. The lack of progress in their mental health care can lead to a feeling of being stuck or even worsen their condition, as they may feel misunderstood and unsupported in their current environment.

Disruption of Continuity of Care

Continuity of care is crucial in treating eating disorders, as consistent therapeutic relationships and a stable environment foster trust and promote progress. Unfortunately, when patients are in an acute hospital, they often experience a fragmented approach to treatment. They may see a revolving door of different healthcare professionals, each with varying levels of understanding about their condition.

This discontinuity can break the therapeutic alliance, causing setbacks in the patient’s emotional and psychological healing. When a bed finally becomes available in a specialised unit, the transition itself can be difficult, as patients must adjust to new routines, expectations, and a different team of professionals. This shift can be unsettling, making it harder to build trust and fully engage in the therapeutic process.

Conclusion: A Call for Better Integrated Care

While acute hospitals play a crucial role in managing immediate health crises, they are not ideally suited for the nuanced needs of eating disorder patients. The lack of specialised care, a supportive environment, and individualised treatment can make the recovery process more challenging and can even set patients back in their journey toward healing.

For meaningful recovery, it's essential that individuals with eating disorders receive care in settings designed specifically to address the complex interplay of psychological and physical aspects of these conditions. The current system needs to improve its transition processes and ensure that patients aren't left in limbo in acute hospitals while they wait for the right care.

Increasing the availability of specialised beds, enhancing training for acute hospital staff, and developing clearer pathways for transitioning to eating disorder units are crucial steps in bridging this gap. Only then can we provide patients with the environment and support they need to recover fully and live healthier, more fulfilling lives.