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July 18, 2008

Behavior, Complications

Question from Melvindale, Michigan USA:

I have a lot food issues (disordered eating) and, in fact, have been diagnosed with EDNOS (eating disorder not otherwise specified). I’ve gone through bouts of restricting, purging, and compulsive eating to the point of qualifying for and having gastric bypass. I was also a “pioneer diabulimic” long before it had any given name, or even much thought. Now, after a 130 pound weight loss, I’m finding myself in a position I’ve been in before (it’s at least in part, what lead to a lot of original weight gain). I feel best when my stomach is pretty much empty and my blood sugar is between 70 mg/dl [3.9 mmol/L] and 90 mg/dl [5.0 mmol/L]. My current problem is that when I eat anything, I immediately feel too full and end up bolusing what usually ends up too much insulin in an effort to get my stomach to at least feel empty rather quickly. While I do have some mild gastroparesis (caused from two major stomach surgeries within the last eleven months or so), it expected that this will heal in time. In the meantime, do you have any suggestions on something I can do, other than purging or using an insulin bolus that usually leads to a too low blood sugar in an hour or two, in order to get the food moving so as I’m not so uncomfortable and also (very important to me) so I don’t gain the weight back? By the way, I purge because it actually gets painful, not so much because I want, or am returning to purging as a means of weight control. History has well taught me how much that doesn’t work.


From: DTeam Staff

You have a very difficult problem and one that should probably be referred to an eating disorder specialist. I am interested to know why you bolus insulin for a full stomach. Do you find it increases the emptying in your stomach? That might not be the case and would be a source of hypoglycemia you need not expose yourself to. I have worked along side our bariatric surgery dieticians and they work very carefully with patients on the content of the food and how digestible the food may be. I would pay a lot of attention to the texture and content. Find out what works and doesn’t work. Under no circumstances is it really acceptable to purge. If you find yourself doing this, you need to work with your healthcare team to address this. It reinforces the problems you had previously.