I am an 18 year old college student, and I am suffering from severely uncontrolled type�1 diabetes as well as anorexia nervosa. At the present time, my weight is somewhat stable but tends to fluctuate depending on my eating habits. I take Lantus at bedtime and NovoLog during the day to try to control my blood sugar, but because of my inconsistent eating habits, it is difficult. My blood sugars are either extremely low or run in the high 300s- 400s [mg/dl, 16.7-22.2 mmol/L]. I am not sure what to do because I refuse to get an insulin pump due to body image issues. Any suggestions?

Food problems coupled with diabetes make both already difficult issues, even more complicated. The best advice I could provide would be to work honestly with a good therapist and also with your diabetes team so that they can help you. Try to find out the basis for your anorexia. If you come to the basis about such issues, a long and difficult struggle to be sure, then you will have the emotional energy to tackle such issues.

Sometimes anti-depressants and mood stabilizing medications will be very helpful. You should review this with your therapist as well. Sometimes this may take changing therapist to find exactly the right person for your personality and needs. Similarly, you need to work with your diabetes team to figure out a system (either an insulin pump or basal/bolus regimen) that makes sense while your eating is still not consistent, and more importantly, working with your therapist and with you on these issues together. It can be overcome but will take some honest therapy work.

SB