CONDITIONS & DISORDERS
TYPE 1 DIABETES AND INTUITIVE EATING Few studies are available that look at the effects of intuitive eating (IE) on Type 1 diabetes (T1D) management. This article considers the research available on both, demonstrating how traditional T1D management can lead to disordered eating behaviours, and examines how IE could provide a complimentary management option for T1D. T1D is an autoimmune disorder characterised by insulin dependence. Its onset most often occurs in youth and represents about 8% of diabetics in the UK.1 It is typically caused by an unknown trigger, which activates the immune system and leads to the destruction of the insulin-producing beta cells in the pancreas. Insulin is an essential hormone that allows glucose to enter the cells, therefore reducing blood glucose. Insulin can also store excess glucose as glycogen and fat in the liver and adipose tissue, respectively. Without insulin, glucose cannot be taken up by the tissues and remains in the blood, causing high blood glucose (hyperglycaemia), which can lead to a series of health conditions, such as retinopathy, neuropathy and nephropathy. The opposite trend – hypoglycaemia – occurs when there is too much insulin, causing more glucose to enter the cells than needed, severely lowering blood glucose. Hypoglycaemia (hypo, or ‘a low’) is dangerous; it starts with dizziness and fatigue, and if untreated, can lead to convulsions and potentially death. However, this is extremely rare.2 Maintaining blood glucose in the target range is, therefore, essential. Glycaemic status is measured using HbA1c, a marker that determines the amount of glycated red blood cells over three months. Excess glucose attaches to red blood cells during hyperglycaemia, thereby glycating them. The ideal
Eloize Kazmiersky ANut
HbA1c range for an individual with T1D is between 6.5% and 7.5%2 (4858mmol/mol).3 INSULIN ADMINISTRATION
Insulin administration is essential for anyone with T1D. The two main ways of delivering this medication are multiple daily injections (MDI) and the insulin pump. MDI consists of using two different kinds of insulin: 1 a background or long-acting insulin, which releases insulin continually in tiny doses for 8-24 hours depending on the brand; and 2 fast-acting insulin, which acts within 15 minutes to one hour of injecting. Patients with T1D on MDI focus on matching the number of carbohydrates eaten to the correct insulin dose, thanks to ratios previously established by the patient’s endocrinologist.4 This is required as carbohydrate-rich foods get digested into glucose, thereby raising blood glucose. The insulin pump is a small device, which can be tubular or not. Tubular pumps are connected to the body via a tube linked to a catheter and a small infusion kit with a cannula that sits under the skin. Non-tubular pumps often communicate with the catheter via Bluetooth or through a smartphone, or another specialised device, creating a closed-loop system. Fast-acting insulin
Eloize graduated from the University of Nottingham in June 2020 with a BSc in Nutrition. She is further undertaking an MSc in Dietetics at Ulster University, in order to specialise in eating disorders and the psychology behind eating behaviours. eloize_nutritional_ baker EKazmiersky
REFERENCES Please visit: nhdmag.com/ references.html
www.NHDmag.com March 2021 - Issue 161
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