Wednesday, November 25, 2015

Understanding Diabulimia

By Michel Harris, MS, RD, LDN, CDE
Imagine a mother watching her five-year-old daughter (we'll call her Lisa) wasting away, despite eating larger than usual amounts of food, and experiencing frequent urination. Unfortunately, those were symptoms of undiagnosed Type I diabetes. While this was not desirable, after receiving education, Lisa was able to return to a healthy state because of daily, multiple insulin injections, a well-balanced meal plan, and participation in sports activities.

Ten years later, Mom noticed that once again, Lisa was consuming larger than usual amounts of food, but she assumed it was just a growth spurt. However, when Mom was changing the sheets on Lisa's bed one morning, she found several vials of unused insulin under the mattress. At this point in time, Lisa had been fully responsible for administering her daily insulin injections and monitoring blood glucose levels. When Mom approached Lisa, she got very defensive but then broke down in tears and admitted that she was only taking one-fourth her usual amount of insulin, and sometimes skipping it altogether.

People with diabetes experience burnout in performing daily self-care to manage their condition. But after much discussion, Lisa admitted that she was not taking her insulin to help control her weight. As a teenager, not only was Lisa having to deal with a chronic condition that required a significant amount of attention each day, but she was also faced with the discomfort of normal weight increases during puberty and the pressure to be thin.

You may have heard of bulimia, a condition in which one eats large quantities of food, then purges the calories via self-induced vomiting, laxative use, excessive exercise, and/or diuretics. Lisa is suffering from a form of bulimia called Diabulimia, and her chosen method of purging is controlling her insulin doses. Without going into too much detail, insulin is a hormone produced by the pancreas that is vital in shuttling glucose (sugar) from the blood into body cells after nutrients are digested and absorbed into the bloodstream. Those with Type I diabetes must inject insulin at meals, snacks, and on occasions when their blood glucose levels may be too high. Failure to do so results in weight loss because the cells cannot use glucose for energy and other vital body functions; that excess of glucose is eliminated in the urine and also builds up to potentially life-threatening levels in the blood.

Diabulimia is a serious condition that requires a treatment team including a psychotherapist, psychiatrist, registered dietitian, medical doctor, and endocrinologist. Symptoms to be aware of are

  • Frequent urination
  • Weight loss despite eating large quantities of food
  • Abnormally high blood glucose levels
  • Excessive thirst
  • Weakness
  • Fatigue
  • Inability to concentrate
  • Hiding insulin/purposely not taking insulin

In severe cases, the person may develop diabetic ketoacidosis, a potentially fatal condition in which blood glucose levels become dangerously high. People with Type I diabetes are already at risk for several long-term complications that include neuropathy (numbness and tingling of the extremities), cardiovascular disease, retinopathy, kidney disease, and gastroparesis. Since Diabulimia elevates blood glucose levels, this further increases the risk of developing these complications if treatment is not immediately sought.

While most therapists who specialize in eating disorder treatment are equipped to deal with the behaviors associated with Diabulimia, a registered dietitian with eating disorder experience, and who is also a Certified Diabetes Educator (CDE), should be sought after as part of the treatment team.

Michel Harris is the nutritionist at The Awakening Center and believes in the mindful approach to develop a peaceful relationship with food and exercise in the recovery process of eating disorders.

Monday, November 9, 2015

Meditation Monday: Opening the Heart

 By Nancy Hall, MA, NCC, LPC
In an effort to take the “manic” out of “Monday,” this weekly post explores techniques, issues, latest research, and other thoughts on meditation. Nancy facilitates a weekly meditation group at The Awakening Center. For more information, contact her at 773.929.6262, extension 17 or

Meditation often brings relaxation to the body. Jaws and fists unclench; brows become smooth. And something new experiences can happen when the shoulders loosen--the heart opens up.

We often carry our burdens in our shoulders. Without even realizing it, they creep closer and closer to the ears. This tension-related shrugging also pulls the shoulders forward, drawing the area around the heart back. The shoulders bear our burdens and protect the heart.

At the weekly meditation group at The Awakening Center, before embarking on any guided imagery, I take participants through a progressive relaxation of the body. This is so important because if the body is held in a state of “readiness” and hypervigilance, the meditation experience becomes very narrow. We cannot allow our awareness to expand if we’re in a defended posture. Additionally, important information can be gathered by noticing which body parts don’t soften so easily. What is being communicated? What needs extra kind attention?

When we get to the shoulders, I usually instruct participants to allow them to gently drop down and back. Allowing the shoulders to loosen down releases the burden. Slightly back opens the heart area. While this opening of the heart might be challenging and sometimes downright unsafe in the “real” world, I hope that the group is a safe place to experiment with the experience.

Folks who have experienced hurt and trauma heal through building a sense of safety. Within the group, they can practice opening the heart—even just a little bit—without worrying that it will be stomped. They learn to trust their instincts and can begin opening the heart to loved ones—and even to themselves.

Enjoy your practice.

Monday, November 2, 2015

Meditation Monday: Listening

By Nancy Hall, MA, NCC, LPC
In an effort to take the “manic” out of “Monday,” this weekly post explores techniques, issues, latest research, and other thoughts on meditation. Nancy facilitates a weekly meditation group at The Awakening Center. For more information, contact her at 773.929.6262, extension 17 or

The human brain is a wonder. With it, we can do algebra, learn to drive, and figure out how to make cauliflower palatable. But so much of our energy is taken up by the thinking part of the brain. Rumination. Worry. Obsession. Thinking becomes a dream-like state. A trance.

This trance can become a barrier that isolates. Our ability to take in data becomes impeded. Our bodies from the neck down seem separate from our minds.

Meditation can help us awaken from that trance. By breathing and intentionally connecting to the sensations in the body, we begin to gather new information. Your thinking part may tell you that going on that second date is a good idea, but in the meantime, your stomach is in knots.

Psychologist and meditation leader Tara Brach teaches that the first step in opening up the experience is to listen. Listen not only with the ears but with the whole body. Allow yourself to receive the information that is churning through your body from the inside out. 
  • Listen to sensations: Is there twisting, tightening, loosening, fluttering, and so forth?
  • Listen to emotions: Happy, sad, afraid, angry? How are these emotions expressed in the body?
  • Listen to the sounds actually present: What sounds are in the room? Outside the room? Notice the space between sounds. Receive sounds that are actually present instead of listening to the chatter in your head. 

We have so much information available to us if we just listen fully. This is not easy, I know. Thinking and ruminating can be a defense mechanism for some. Trauma or intense emotions can make listening to the body feel unsafe. It’s OK to go at your own pace—start small by checking in with one neutral part of your body. Feel your feet against the floor. Listen to the sounds outside for 60 seconds.

Take these steps with gratitude.

Enjoy your practice.