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July 29, 2000


Question from North Carolina, USA:

Since a low blood sugar episode, I have developed a fear of bolusing insulin in large amounts and tight control. I have also since become bulimic in order to enjoy normal amounts and types of foods. I do not eat sweets and I exercise normally. I am a 23 year old certified personal trainer, martial artist and graduate student. I know better than to do this. I was taking Prozac when the bulimia started to help with depression caused by losing an internship with a federal law enforcement agency due to the diagnosis. I have called many treatment centers for eating disorders, but none seem like they can help someone with type 1 also. They assume I use exercise to purge and some don’t want me to carry juice and glucose for lows, or use my pump! What is the best hospital for a type 1 with bulimia?


From: DTeam Staff

First, I want to commend you on your wanting to find help and support. It sounds as though a lot is going on and you need to be able to put all of the pieces of the puzzle back together with some help and support from a good team. You obviously have a physician that has been working with you in regard to your diabetes. You have some options here. One, you and your physician can team up with a clinical psychologist and a dietitian. Both the clinical psychologist and the dietitian should have experience working with individuals who have eating disorders. In addition, the dietitian should also be pump-educated. A team approach is a good bet.

If you and your doctor are not able to come up with these two pieces of the support team (a clinical psychologist and a dietitian who is trained in eating disorders and pump educated) you and your physician may want to sit down together and contact the many ADA recognized education programs located in North Carolina. These programs meet the standards for excellence in diabetes education. Both you and your physician need to mutually agree on the best suited program that meets your complex and individual needs. Again the diabetes education program needs to be able to give you the support of an endocrinologist, a clinical psychologist, and a dietitian, and even a diabetes educator. This is a team approach where all of your support is found in one program.

Here is the web site address where the education programs are listed: http://www.diabetes.org/education/eduprogram.asp. This web site is a part of the American Diabetes Association. It lists the facility, program name, address and telephone number of the facility. You have so many issues that need to be addressed and a team approach may make you feel comfortable and safe.

Additional comments from Dr. Donough O’Brien:

I can’t help feeling personally that this very complex problem requires a very personal knowledge of you and that it would be best served initially if your present diabetes doctor would team up with a clinical psychologist that he/she knew and trusted. Starting all over again at a new center might not be a success.