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Episode 62- Eating Disorders & Our Complex Relationship With Food
239 Plays2 months ago
Lauren Newman (RD, LD, CDCES, CEDS) brings so much knowledge around the topic of eating disorders and complex relationship to food for those of us living with type 1 diabetes. There are so many tangible takeaways in this episode.
*TRIGGER WARING - eating disorders are discussed in this episode**
Lauren's practice: https://www.laurennewmanrd.com/
IAEDP provider search: https://members.iaedpfoundation.com/search/custom.asp?id=4255
Ellyn Satter Division of Responsibility:https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/
https://www.ellynsatterinstitute.org/how-to-feed/child-feeding-ages-and-stages/
ADA Therapist directory: https://my.diabetes.org/health-directory
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Facebook Group: https://www.facebook.com/groups/typeonetog
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Transcript
Introduction and Trigger Warning
00:00:24
amandacberg
Hi everyone, really fast before we get started. I just want to put a little trigger warning out there. We are going to be talking about eating disorders and type 1 diabetes on today's episode. And let's get right into it.
00:00:35
amandacberg
So I have a very great friend here with us today, Lauren Newman, who I know from college, which is super fun.
00:00:43
amanda
Thank
00:00:44
amandacberg
um But Lauren actually works specifically with
00:00:48
amanda
you.
00:00:49
amandacberg
people living with diabetes who also struggle with relationship to food and eating disorders. And this is something that we've been wanting to cover for a long time on this podcast. So we hope that this conversation is helpful. Welcome to
Lauren Newman's Background and Work
00:01:01
amandacberg
the show, Lauren.
00:01:02
Lauren
Hi, thanks for having me. This is so fun.
00:01:05
amanda
We love that you're here.
00:01:06
amandacberg
I'm so excited.
00:01:08
amanda
Yeah, I'm excited too. there's There's so much to get into already. So can we maybe start with you giving us a little intro about who you are?
00:01:20
amanda
Do you live with diabetes? And how did you get into this line of work?
00:01:25
Lauren
Absolutely. So I am Lauren Newman. I am a dietician, diabetes educator and certified eating disorder specialist. um I do not have diabetes. I grew up with several people in my life who are important to me who have diabetes and that kind of influenced me and gave me a lot of experience and knowledge about type one and I got to see it from the outside in a different way and that, you know, kind of shaped my perspective as I moved through my education and my career. And then also in college, I was friends with Raquel. And so that was obviously a big part of my life and my experience going through school to become a dietitian at the same time as being good friends with Raquel and seeing her live her life and all the nights of being on your you know decks, come follow and getting alerts and all of those things like back in the day.
00:02:22
Lauren
Um, but I now own a private group, private practice.
00:02:22
amandacberg
Yeah.
00:02:26
Lauren
We are a team of dieticians, diabetes educators, and eating disorder specialists. We
Complexities in Managing Diabetes and Eating Disorders
00:02:32
Lauren
specifically work with people with diabetes who have, I'd describe it as a funky relationship with food.
00:02:38
Lauren
So we see some people who have very active acute eating disorders, some people that are just dealing with kind of messy disorder type patterns around food.
00:02:48
Lauren
We work with people who are in, identify as being in recovery from an eating disorder and have like a newer diabetes diagnosis that they're trying to figure out how to navigate and get set up with a treatment plan that makes sense for them that isn't triggering or activating for old habits and patterns. And then we support, you know, families and loved ones who are trying to come up with a care plan that prevents disordered patterns for, you know, the person in their life who has diabetes, if they're just trying to be very aware of that. so We kind of work all across that spectrum. We do see people with all kinds of diabetes, but we ah see a lot of people with type one who struggle with disordered eating and eating disorders. So I think this is a really important conversation for us to be having. And we see people with all different kinds of relationships with food. So
Parental Concerns on Food and Body Image
00:03:39
Lauren
that's what we do.
00:03:41
amandacberg
It's so amazing. Like you're the only one I know of that is doing this work. And after talking in depth with you, it seems like there's a lot of need for help in this area and there's not a lot of people doing it.
00:03:54
amandacberg
So I'm really thankful that you're doing the work that is necessary.
00:03:59
Lauren
no Yeah, I mean, there is such a need for it, you know, I mean, the two of you know so well, like, it is really complicated when you're trying to manage a chronic illness that is affected by food and changes how you feel in your body and around food and about yourself. And there's a lot of expectations and guidelines and, you know, treatment models and everything that kind of put a lot of stress and pressure on the situation.
00:04:29
amanda
Yeah, for sure. And it's so interesting, like, just hearing you talk about it, I'm already getting emotional, classic. Even though my daughter is four, I'm like, that was my first thought when she was diagnosed at two was how do I make sure that her relationship with food and her body um remains quote unquote healthy I guess like because it's just so involved it's so involved and then not to mention the fact that
Understanding Eating Disorders: Causes and Prevention
00:05:00
amanda
like you both rely on food to save you and in scary ways like it could kill you you know so like moving past that
00:05:12
amanda
You also, I feel like have, there's potential in your mind to be like, my body doesn't work. You know, there's part of my body that doesn't work and I don't have control over it. So I'm like desperately seeking control in some other way. And it's, yeah, it's just very, um, I don't know. I'm, I'm so interested in getting into this conversation so I can learn how to best support my girl as she grows up and navigates her life living with this disease.
00:05:46
Lauren
Yeah, absolutely. And I mean, it's just as sad as it is to hear that you're that was one of your first thoughts. And that's something that you're thinking about already so early. That's so terrifying. And as a clinician who sees people on the other side who are like actively dealing with it, I think there's so many of my clients who's hearts would just melt hearing a parent be so concerned about that and so aware of it and wanting to protect their kid in that way like it just it makes me feel so good hearing parents and families and loved ones like be aware of this and want to support the people that they care about and you know not going down that path so major props to you and I absolutely hear how scary it can be
00:06:30
amanda
Yeah.
00:06:36
amanda
Thank you.
00:06:39
amandacberg
It's hard to know where to exactly get this all started, but I guess like taking it back to the basics or like where these issues are complicated relationship.
00:06:51
amandacberg
I don't know. Like how does it start? Why is it happening? What can we do? I don't know. Like what, what do you think it all comes from?
00:06:57
Lauren
Well, I mean, I think jumping off of that and jumping off of kind of what Amanda was saying, something that I like to remind people is that an eating disorder doesn't just come out of nowhere.
00:07:08
Lauren
um It's a combination of we call eating disorders of biopsychosocial disease.
00:07:14
amanda
Hmm.
00:07:14
Lauren
And so it's a combination of a lot of different factors. And it's not like a one plus one equals two situation. It's a lot of different things just like snowball and come together at once.
00:07:26
Lauren
and it's going to be different for each
Managing Insulin and Food with Children
00:07:28
Lauren
individual person. And so that's what makes it so challenging to like fully, you know, treat and also fully prevent because it is so individualized how that happens. And so the analogy that I like to use is, if we imagine having like a clear glass jar, right, and then we have a whole bunch of ah marbles, let's say, um and When we and we're going to fill up this jar with marbles and each of the different colors of the marbles represent something totally different. um So green might be genetics. So, you know, I might have half my jar full of genetics and Raquel might have like
00:08:08
Lauren
you know, a third of the jar full of genetics. And Amanda might have 90% of the jar full of genetics. It just depends on the person. And what starts to happen is there's all these different colored marbles. There's all these different things that could be going on in any given person's life. And we start to fill that jar as we move through the world.
00:08:24
Lauren
And once that jar overflows, like that's the point where we have an eating disorder. But because it's not a one plus one equals two, we don't all start off with the same amount of our jar full of genetics. So if my jar is only halfway full with genetics, but Amanda's is 90% full of genetics, then, you know, it's going to take significantly more to happen to me for that jar to overflow.
00:08:47
amanda
Mm hmm.
00:08:47
Lauren
and to turn into an eating disorder than it would for Amanda. Amanda might need, you know, two marbles worth of, you know, a yellow, like negative experience in your body that just pushes you right over the edge.
00:09:01
amanda
Right.
00:09:01
amandacberg
Let's move.
00:09:01
Lauren
And so some of those different, quote unquote, colored marbles that might be in there, you know, there's genetics, of course, there's different, um you know, experiences that people can have in terms of like traumatic things that might happen to them, different ways of coping um with all of that. And you know, Amanda, you mentioned um just like how food can be such a like it can hurt you, but it also is needed. And it can see, you know, with diabetes, and that in and of itself can lead to some traumatic situations for people around food, which can definitely be like a whole other color shade of marble that gets thrown in that jar, right? um You know, so so thinking specifically about these marbles that are related to diabetes, like that's a big one for people. um This idea of like,
00:09:53
Lauren
not having a full over your body and wanting to have some say in what's happening or not feeling like things are predictable like that is ah that's a very disconnected experience from your body and that falls within that realm of you know body image body satisfaction like experiences in one's body and that can definitely be a part that comes into it. um There's
Handling Eating Challenges and Low Blood Sugar
00:10:18
Lauren
also other pieces that don't necessarily have to do with type 1 diabetes, but can also be, you know,
00:10:25
Lauren
people with type 1 don't just have type 1 diabetes. You're living your life. You're doing other things. There are different um types of like body-focused sports that we know are put people at higher risk for eating disorders. There's just so many different things, you know bullying, family situations. um There's just so much, right? And so we get to this point where some people can really withstand a lot. They can go through all these really traumatic things. Oh, that's it? OK.
00:10:55
amandacberg
We're good.
00:10:55
Lauren
my
00:10:56
amandacberg
We're good. I don't know.
00:10:57
Lauren
fair
00:10:58
amandacberg
It's my mic, everyone. It's because my fan is on in my room. I'll turn it off, though.
00:11:03
Lauren
Um, but we can get to this point where, you know, there's just so many things that are going on for someone and some people can withstand quite a lot and never spill over into that point of having an eating disorder. And some people, you know, it really, they're just set up in such a way that it's just a couple of drops in the bucket and, you know, we've got, we've got something going on. So.
00:11:28
Lauren
That's kind of how I explain it. And so it is it is challenging, right, to sit with that and to know that, you know, there's some pieces of that puzzle that are within our control and some that aren't. And, you know, some people are definitely like much more protected and some people are not from, you know, some of these situations. But the reality is with with diabetes, you you do have to think about food and you have to think about your body in a way that people that don't have diabetes don't have to.
00:11:56
Lauren
and that automatically puts you at higher risk.
00:11:59
amanda
Yeah, this is such an interesting like visual exercise to think about. it's To me, I immediately was like, okay, the marbles are the risk factors, but it's more complicated than just identifying risk factors. is evaluating ah Speaking from like a mother's point of view, it's evaluating my unique child's risk factors and the concentration of those risk factors in her clear jar and and how full it can get and at what point you know so it's yeah it's it's highly complicated but you just explained it in such a way that made it feel simple where I'm all of a sudden like
00:12:46
amanda
still I will forever be anxious about it until she like I think and until I feel really really super confident that she has a really healthy relationship with her body and food but I am thinking right now like okay i I know the things that I can control to minimize certain marble risk factors that could be poured into her jar and that's really helpful, so thank you.
00:13:18
Lauren
Absolutely, yeah, I think there are certain things that we can minimize going into the drawer and then I think part of prevention and like protection in that way is also recognizing when things are kind of building up
Encouraging Open Dialogue About Food
00:13:31
Lauren
and being able to like lessen the load like how can we take a couple marbles out where we can and the way that we take those out is you know moving through some of those situations like if there are things that are happening that are becoming overwhelming or activating for somebody or somebody's having a really hard time dealing with we help them cope with it right and we can move through it and so for example if
00:13:56
Lauren
you know a kid is starting to feel really stressed out around food and we can kind of see that and and see that dynamic starting to play out or maybe they have had some you know scary low situations pop up or just any of that we can really try and work through it rather than pushing it to the side and ignoring it and saying like okay well you know like we'll move through it she's resilient we'll figure it out like it's fine you know I think sometimes it's easy to blow past it and not realize that it's building up in that jar. And that's why I always describe that analogy as like a clear jar. Like we can see
Recognizing and Addressing Disordered Eating
00:14:31
Lauren
through some of it. And if we, you know, if you know your kid and you know your loved one and you can kind of work through it and help to take a couple of things out or, you know, undo some of those situations and get to a better place with it, that certainly lessens the load and can definitely help with prevention.
00:14:50
amandacberg
Do you have any tips around language and discussions that parents can have with their kids when it comes to food? Because I know like a huge topic, especially in our community that consists of a lot of parents of young kids with type one, it's really challenging for them to be able to dose and to pre-dose, especially when you don't know how much your kid is going to eat. So it's like, as they get older, are you asking them like, what do what do you want to eat? What are you not? Like, how is that helping or hurting their relationship? All of those things.
00:15:16
Lauren
I absolutely I mean, that's such a huge topic in and of itself.
00:15:19
amandacberg
Yeah.
00:15:19
Lauren
And I think it's, I think it's twofold, because I think it's about the food in and of itself.
00:15:19
amandacberg
yeah
00:15:25
Lauren
And then it's also about the medication and like the management of the insulin. And those are obviously related in so many ways. um But it's also kind of two separate pieces for me, because one side of it is about like, what is the dynamic that's going around going on around food anyway, as you know, a kid grows up, and of course, as an older child or even a, you know, an adolescent or a teenager, the responsibility that a kid has around food looks really, really different than when they're young, right? And their ability to think through things and reason, like, as you, you know, grow up, you're that, like, age appropriate and developmentally appropriate.
00:16:06
Lauren
um engagement with food and those conversations changes. And so that's a whole thing in and of itself that even people without diabetes are dealing with, right? And so that's why I also think about that as being kind of a separate thing when we're talking about anybody, any kid, you know, any family dynamic around food, we're talking about, you know, how do we instill that like healthy relationship with food? How would how do we make sure that this kid is getting what they need? And also, they're able to communicate with us about
00:16:37
Lauren
what they want, what's working for them, how they're feeling, how much food they want, you know, all of that. That's something that a lot of families are working through. And then on the flip side, it's the, you know, well okay, how are we managing the insulin? What is the, you know, what is the game plan here? What are we even doing with any of this? And again, as they mature and age and things change,
00:16:58
Lauren
How do we continue to move through that and kind of pass some of that responsibility off to the kid as well? And how does that, you know, how do we know when we're ready for those things and how do we shift? And I know that is like the age-old question in the diabetes world.
00:17:12
amanda
Hehe.
00:17:13
Lauren
We're always talking about that. um But I think it's important to remember that at times that those two things are separate but related because If we try to think about it all as one, then I think we wind up putting the diabetes first rather than putting the kid first.
00:17:29
amandacberg
Yep.
00:17:29
Lauren
And at the end of the day, they're a kid, and we're just trying to figure out, you know, are we hungry right now or are we not, right? And so I think trying to come back to baseline as this is a kid first, not diabetes first, um and we're on the same team here.
00:17:47
Lauren
Right? This is not like me versus the kid. This is not, you know, me versus anybody. Like it's all of us working together to get to this end goal of, you know, in the short term, kids feeling well, parents feeling well.
00:18:01
amanda
Yeah.
00:18:03
Lauren
And then at the, you know, long term, everybody kind of having a like staple and healthy relationship with food and with their diabetes management.
00:18:13
amanda
Can I give you a real life example that happened yesterday morning and help guide me because I knew what I was doing in the moment, but I was also like, Oh my God, we are on the third attempt.
00:18:17
Lauren
Yeah.
00:18:26
amanda
You have so much insulin in your body, you know, and I wasn't saying that stuff out loud, but in my head, I was just like, I'm so like panicked but so she um we're we're super big proponents of letting her try anything and everything and she leads the charge on what she chooses to eat we always include fruits and vegetables at every single meal and encourage let's try it you know if you want or you can just leave it if you know you don't want it whatever so all that
00:18:34
Lauren
Totally.
00:18:57
amanda
just to put it out there. We took her grocery shopping earlier in the week. She picked out a cereal that she hadn't had before. And I was like, great, put it in the cart.
00:19:08
amanda
Just didn't even like pay attention to it, you know. um And then yesterday morning, she decided she wanted cereal and cereal really affects her blood sugars like it does for almost every single other type one diabetic.
00:19:21
Lauren
Uh-huh.
00:19:23
amanda
And so I pre-bolist after measuring everything knowing like oh she even this pre-bolist with like a good amount of insulin in the morning is she's still gonna go high and whatever she takes one bite and goes this is gross and puts this entire like two cup worth of cereal and milk into the sink and I was like
00:19:48
Lauren
Oh no.
00:19:50
amanda
okay and I go okay what else do you want because I gave you the insulin for it we have to eat something because you've got lots of insulin in your body so what else do you want she goes oh I'll try that yogurt one bite this yogurt is also gross and I was like Hattie like just started to get frustrated you know and she's like okay I'll try this yogurt instead that one was also gross after one bite and so now I'm sitting here as like a parent who's stressed because we have to leave for school in 12 minutes like ah trying to think like okay now I have to do the parenting teaching of like wasting food is also not okay but like
00:20:11
Lauren
Yeah.
00:20:35
amanda
I certainly don't want to say you have to eat anything. Like absolutely not. I don't believe in that. And also like you have so much insulin in your body. We have to leave in five minutes. I need to make sure that you have carbs to cover that insulin because your school does not remotely monitor your CGM. They just rely on alarms. So if you have a ton of insulin and you're alarming at under 75, like you're gonna drop to 50 the next number, you know? So I'm just, all these things are going in my head. So I'm saying out loud to her, Hattie, I need you to be, like, I need you to focus. You have to eat something, you have to figure something out. And she's like, toast, I'll do toast. I'm like, okay, thank you. And I'm like, sit down, please focus on eating your toast. And I just, the entire morning I was like, I could have been so much better. I could have been,
00:21:26
amanda
more calm, more gentle, maybe less food focused. Should I even bring up the fact that I gave her the insulin? So now it's her responsibility to consume food. Like I'm the one who pressed start on the insulin. It was my decision to give her the insulin. So help me.
00:21:43
Lauren
Okay, I mean, first of all, like, give yourself so much grace, because I also think it's incredible for you sharing that story, because there's probably so many parents listening that have been in that exact same situation.
00:21:54
Lauren
And honestly, probably a lot of people with type one that have done that to themselves too.
00:21:58
amandacberg
oh yeah
00:21:59
Lauren
It happens, right? And so like, first of all, give yourself so much grace, that is a stressful situation to begin with, trying to get, you know, a four year old to eat and get out the door on time.
00:22:01
amanda
Yeah.
00:22:10
Lauren
And then you know, to try and navigate all of that at once. I mean, it's, it's, that's hard, right? So, so much grace, you did nothing wrong. It's the stuff that happens, right?
00:22:21
Lauren
And these are not like, these one-off situations, I think, especially at her age, like are so much more stressful for you than for her.
00:22:24
amandacberg
Oh yeah, yeah.
00:22:28
Lauren
um You know, I don't think that she, ah fortunately or unfortunately, probably doesn't have a concept of exactly like how stressful and how big that situation felt for you in that moment.
00:22:39
Lauren
And so I think like, you did such a great job in offering other options and trying to move through it with her. And she ate something and it was okay. um I think coming back to all of it, I think there's always like a, we try to present to the families that we work with this idea of When you're feeding a kid, what are, you what is the family responsible for around food and then what is the kid responsible for and so how do we work together as a team to like make that happen and of course it doesn't always work out perfectly.
00:23:10
amanda
Mm.
00:23:17
Lauren
um But generally, in our practice we like to follow the model. from Ellen Satter and she calls this the division of responsibility. And it's this idea of, okay, parents and you know caregivers are responsible for the what and the when around food. So like, what are we eating? When are we eating? um And then the kid is generally responsible for if they're going to eat and how much they're going to eat.
00:23:43
Lauren
I know that sounds really scary when we're trying to manage blood sugar in a situation like yesterday. And so with diabetes, there's obviously like very specific ways that we kind of move and adapt with that, but also ways that we move and adapt on the parent side um with the what and the when that kind of makes sense. And so generally what this means is parents take like a leadership type role in the food.
00:24:07
Lauren
so What are we eating? When are we eating? Okay. When are we eating? We have set meal times. We know it doesn't need to be exactly the same time every day or anything like that, but it's setting that expectation for the child of like, okay, no, this is breakfast time. We're eating now. If you don't eat now, that's, you know, you can decide if you're going to eat or how much of it you're going to eat. But the next time we're eating is like, so kind of setting that framework for here's when food is going to happen.
00:24:32
Lauren
throughout the day. And then providing the what. So like what are we eating, right? So parents are you know doing the grocery shopping and of course bringing in the kids and bringing in their preferences and what we know they like and letting them make decisions about what we buy at the store.
00:24:46
Lauren
But at the end of the day, like you don't necessarily have to open up the floor to everything being available all the time for every single meal and snack of the day.
00:24:55
amanda
Hmm. Hmm.
00:24:56
Lauren
And so for example, if you know that cereal is really challenging for blood sugar and it kind of freaks you out a little bit to deal with that in the morning on the way to school is cereal maybe like you know an afternoon snack option or like maybe something that we have at a different point during the day when you feel more able to deal with it or maybe it is like a weekend thing when you have her at home and you feel like you can navigate that a little bit better and so it doesn't mean that you're restricting cereal or never allowing cereal it's just hey at this point like I'm making the decision about what we're gonna eat and
00:25:31
Lauren
here are the options that you have right now and that's not one of the options for breakfast today and so it kind of takes some of that stress out of those situations at moments and we always redirect with language around you know if she's like what I want the cereal right now cereal is not an option right now it's not oh we're never having cereal cereal is not allowed cereal so bad for you like none of that it's just
00:25:50
amanda
Yeah.
00:25:52
amandacberg
And it's not because of diabetes. I like that you're not saying that.
00:25:54
Lauren
And it's not because of diabetes. It's just because this is just not what we have available right now. This is not an option in this moment. And that gives you a little bit of, um, a little bit more ability to kind of take the lead in a way that you feel comfortable with in those moments as a parent. And so it's, that's kind of where we go with that. And then on the flip side, it's, you know, okay, here are the options that the kid has for breakfast or for lunch or whatever. And they,
00:26:24
Lauren
as a parent, you put the food down, we say, here's what we're having, and they get to decide, you know, if they're going to eat how much they're going to eat, that's hard with diabetes. And so, you know, we always aim to pre bolus, that's really hard with some kids.
00:26:33
amanda
Mm hmm.
00:26:39
Lauren
ah And so we always in our practice work with people around, okay, if we're gonna wind up in that situation, where maybe we know we have pickier eater or we have somebody who's kind of in that stage of development where they're like, I like this. No, I don't. At least I do. No, I don't. And they're kind of moving through that. um Sometimes we suggest, you know, doing something like a pre-bolus for half of the meal or half of the carbs and then doing the rest of it later, just that we get a little something in before and we can manage blood sugar that way.
00:27:10
Lauren
um Sometimes we have situations where it is just easier given the child to dose after eating. um And then for some people, we like to recommend just having almost as like thinking about it as a medical alternative, but like, okay, we try and eat the food and if we can't get it done, then we have just carbs that we treat as medication to just match the insulin and move on with our day.
00:27:34
amanda
Hmm.
00:27:37
Lauren
They're not gonna finish eating. They're not gonna eat. It's just, you know, whatever the kid is able to deal with, if it's juice, if it's glucose tabs, if it's something else, I don't really care. But whatever they're willing to do and just match the insulin and move on.
00:27:50
Lauren
um Because that was before.
00:27:51
amandacberg
What about kids that are oh sorry um that are realizing that if they don't eat their food, they'll get to have a low snack?
00:28:01
Lauren
So I think that that's part of the way that we talk about um lows and low snacks in general that we want to avoid. We don't want kids. And of course, like, you know, kids are drawn towards things that are really exciting and taste really good. But we also want to make sure that they keep a very neutral perspective on around all foods. And so you know, if they are the kind of kid that really loves apple juice, then maybe that's not like the best thing to be using for a low, because then you will wind up in a situation where a kid is like, Yeah, well, if I want some juice, then if I go low, I'll get some juice, right? They're they're really smart in that way. And so um we want to try and keep a very neutral perspective around food for everybody, and especially with around kids. And so we prefer to
00:28:53
Lauren
encourage families and encourage even just people who type one to take a very neutral perspective. And so all foods are allowed at all points. And if we do need a particular food that we're just going to rely on for a low snip, for like a low treatment in that kind of moment, we treat it as just like a medical thing. And so, you know, of course you find that balance between something that the kid will actually want, right? We don't want to be forcing them to eat something that they absolutely hate and don't want to deal with, but we try to reserve um a like perspective of this is a medical treatment. It's you know a balance to the insulin. It's medical carbs right now. It's not like fun food, let's eat something yummy. it's you know This is a medical thing that we're dealing with right now. And moving through it that way.
00:29:40
amanda
So as you're explaining this, I'm trying to like think through real life scenarios.
00:29:44
Lauren
Yeah.
00:29:45
amanda
So my girl loves gummies, like the Welch's gummies, right? And we can almost always get her to have gummies if she's going low.
00:29:56
Lauren
Mm hmm.
00:29:58
amanda
I try really hard not to encourage seeking out gummies if she's not low just because she gets them so often and it's not the healthiest choice. But I never say flat out no, if she's really like, I really want some gummies right now. And so is that Like if you're, if, if gummies are in the house and they're just kind of like, uh, yeah, sure.
00:30:33
amanda
Across the board, depending on the time of day, depending on how many, just like where we're at, you know, cause of course I'm not the mom that's just like, yeah, a hundred packs of gummies a day. Sure.
00:30:43
amanda
Whatever. Like there has to be balance in that way too.
00:30:44
Lauren
Right.
00:30:47
amanda
When I am giving her gummies for a low, does it make sense to identify the gummies that are for a low as like, this is, these are because you're low right now.
00:30:58
amanda
You definitely need these for being low. And then in other situations, if she's like at a birthday party and she's like, Hey, there's gummies. Can I have some like, Oh yeah, let me dose you.
00:31:09
amanda
Go ahead.
00:31:09
Lauren
Yeah.
00:31:10
amanda
Like is, is that an okay way to handle it? Or how do you recommend?
00:31:13
Lauren
I mean, I think for her, that probably makes sense. I think, you know, it depends on the age of the child and if they're able to understand what that actually means and how much awareness they have around like, what is a low?
00:31:25
Lauren
Why do we treat it? What does that mean? You know, um and so that's that's that place that as we move through development, that can kind of shift a little bit.
00:31:27
amanda
Yeah.
00:31:33
Lauren
ah But I definitely think if we're if we're treating a low blood sugar, providing the kid with like an explanation that is age appropriate of, hey, like this is what we're doing right now and here's why I'm asking you to do this, is super reasonable. And then I think it also comes back to, yeah, like she loves gummies. Let's have gummies at certain points. um And bringing it back to that like what and when and the parent kind of leadership responsibility piece and saying, you know i would what I would encourage is,
00:32:03
Lauren
you know offer gummy is as part of like a snack here and there or part of a meal here and there but don't offer it all the time every single day right and so kind of rotating things in and out of what we're offering to the child and saying here's what we have to eat right now you can make a decision based on what these options are but here are the options that I'm actually providing you with to choose from right now and so you don't need to open up the you know, at that age, the pantry to every single thing that we have in the house right now, you can choose from for a snack. It's, hey, we're having a snack, right? You know, we're doing the when, it's snack time, it's snack time, let's have a snack. Here's what the options are. You can have this, or you can have this, or you can have this. And then they can have that autonomy to make that decision if we're in an age, like an age group where that's developmentally appropriate for the kids to be making a decision about it.
00:32:54
Lauren
And then move on, and as a parent, you can continue to rotate options in and out. Sometimes gummies aren't options, sometimes they aren't. And when somebody's low, and if we're treating it with gummies, hey, we're having some you know glucose because you're low.
00:33:06
Lauren
We're having some sugar because you're low. We're having some gummies because you're low.
00:33:09
amanda
Mm hmm.
00:33:10
Lauren
And that's different then.
00:33:11
amanda
Mm hmm.
00:33:11
Lauren
it's It's not snack time. We're low. It's a medical situation.
00:33:16
amanda
Cool. Okay.
00:33:17
Lauren
Yeah.
00:33:18
amandacberg
Oh my gosh, I have so many questions running through my head. Hopefully we have time. We have to have you back on. Um, trying to decide which direction to go in. Okay. Let's, that's like a short, quick one.
00:33:28
Lauren
Yeah.
00:33:28
amandacberg
Siblings related to all of this because the, if you have anything on that, the type one's getting low snacks, the sibling wants to listen or, you know, just all that, anything there.
00:33:39
Lauren
I mean, I think that, you know, it depends on the situation. If it's like, we're all in the car and kid is going low and all the kids are around and whatever, like, okay, if we have gummies for everybody, fine.
00:33:51
Lauren
But I think it's also depending on the age of the other siblings, it can sometimes be developmentally appropriate to say like, Hey, it's actually not snack time for you right now. And this is again, a medical situation for this one sibling.
00:34:01
amanda
Mm.
00:34:02
Lauren
And so again, coming back to like, this is a medical intervention, this is a medical treatment, this isn't just like a fun, spontaneous snack time, it's not time for food yet for everybody. um So it kind of depends on the age of the other siblings and how we approach that conversation.
00:34:18
Lauren
If we're at home and like there's a lot of other food around and it could theoretically be snack time, we can make that snack time and say, like okay, cool, let's you know have some food, right? um But I totally and understand and appreciate that there are situations like that where it's not going to work out perfectly.
00:34:36
Lauren
And we just do the best that we can and move on, right?
00:34:36
amanda
Yeah. yeah
00:34:40
Lauren
I think as much as people with type one can be very perfectionistic about things at times, I think the parents sometimes fall into that as well and and pick up on that, like high stress, high pressure from the medical system to be really like excellent and perfect about all of this all the time. And that's just not the reality. So, you know, we do the best we can in any given situation and just move on, right?
00:35:04
amanda
Yeah, <unk>s ah it's so funny.
00:35:08
amandacberg
All right.
00:35:08
amanda
Thank you for bringing that up, Raquel, because our three-year-old actively, daily, searches the nooks and crannies of drawers and behind Hattie's bed and under her pillows for any potential straggler gummies that were left in the pack from the lows overnight.
00:35:28
amanda
And she knows she's not supposed to eat them because we say like they're yucky. There's lots of germs on them now. They've been open for too long. Like it's not the time to do it. You know, like gummies are for when Hattie is low. We need to treat the low, whatever. You can have gummies sometimes, not all the time. It's not healthy to eat them all the time. That's how we like phrase it to the three-year-old. And she will go around and be so quiet when I'm like doing dishes, right? My mind's just not on like where is Summer and what is she doing?
00:35:58
amanda
And then she'll come to me and be like, mom, I ate the gummies.
00:36:02
Lauren
That's so cute.
00:36:02
amandacberg
the I love that she comes and tells you though. She is so cute, like ultra cute, yeah.
00:36:07
Lauren
like cute
00:36:09
amanda
ah It's just like, it is funny, but they're, you know, back in my mind, I'm like, oh my gosh, how, what am I doing wrong for her now?
00:36:10
Lauren
i think
00:36:19
amanda
yeah
00:36:20
Lauren
I think it all comes back to again that like developmentally appropriate kind of conversation and also remembering that at all stages of development and it obviously you know gets more intricate as kids get older but at all stages of development there's kind of that that piece of it where kids are learning how to I don't know, like lie about things or not lie about things and how to push boundaries in different ways.
00:36:46
amanda
Yep.
00:36:51
Lauren
And I think that it's it's, that's a really great example of seeing her in like a very cute way, kind of push the boundaries around some of it.
00:36:57
amanda
Yeah.
00:36:58
Lauren
um and you know There's there something that I think if we can appreciate and understand and like zoom out a little bit to see that that kind of makes sense and where she's at in that stage of development, it's just coming out in this particular way that feels very stressful because of the whole situation at large.
00:37:16
Lauren
I think we can appreciate what's happening and you know just make sure that we're continuing to say, okay, cool, she likes gummies. Maybe you know coming back to that what and when, Can we offer some gummies for her at other points?
00:37:27
Lauren
And just continuously redirect and remind her, like, thank you so much for telling me that you did that, because we don't want, like, that to turn into a very secretive type thing.
00:37:35
amanda
Yeah.
00:37:36
Lauren
But, you know, thanks so much for telling me. Sounds like you really want some gummies. Let's try and get some later in the day or something like that, you know?
00:37:42
amanda
oh That's so helpful.
00:37:43
Lauren
And just offering that reminder to her, which at three, you know, she might remember, might not remember, but just kind of providing that as, hey, like, I totally see you.
00:37:44
amanda
Yeah.
00:37:55
Lauren
totally understand what's going on here. You really like gummies. Let's validate that. Let's make sure you get some gummies at a different point in the day and just, you know, appreciate that.
00:38:01
amandacberg
Ah.
00:38:05
Lauren
She's <unk>s pushing some boundaries a little bit.
00:38:07
amanda
Oh, she sure is. That's so funny. um Okay, that's really helpful. I'm gonna try introducing gummies here and there for her, just as part of our daily snack routine. um Okay, should we get into maybe the conversation surrounding the actual like,
00:38:27
amanda
disordered eating and what that might look like. And obviously we will rely on your professional take on how to talk about it, but just so that those of us who are listening have an idea of what to look out for and how to support our children as they get older and potentially enter a space where disordered eating could be, you know, more than you like.
00:38:50
amandacberg
Can I ask or add like a second part to that question? um Do you believe that parents should be introducing the idea of eating disorders with or without type 1 diabetes to kids at any point? Because I know like I learned about diablimia specifically from searching Facebook groups. and Honestly, looking up how to lose weight with diabetes and seeing the topic of insulin causes weight gain and that whole thing.
00:39:16
amandacberg
So like, I don't remember if my doctor ever talked to me, it's possible she did, but like, should parents be bringing that up in a healthy way before the issue comes up?
00:39:27
amandacberg
Yeah.
00:39:27
Lauren
oh That is such a good question um And I have such a reaction to that because so much of me wants to say like no that's not a parent's job it's the job of the like doctors and medical professionals to be screening for things and like appropriately catching things as they pop up and
00:39:29
amanda
Haha.
00:39:48
Lauren
Most don't know how to do that. And so I think it's such a complicated question. And oh my god, I love that question so much. I it's so I think that is so many things are coming to my mind right now. It like absolutely catches the nuance of what this experience is for so many people because so many people that are dealing with things are you know I don't think that maybe parents recognize that something is happening or don't know if they should say something or even like friends and loved ones in general like not maybe picking up on weird vibes but like not knowing quite what to do about it and then trusting that medical professionals will catch something if it is there and the reality being that most
00:40:32
Lauren
medical professionals like don't really know what they're looking at when it's happening. um Don't know how to appropriately screen for it. And there also aren't really um adequate assessment tools for this population. And so I think my gut reaction this is to say, Oh, I really wish that parents didn't have to be the ones kind of on the lookout and having those types of conversations. But I do think that in reality, like whoever is closest to the person with diabetes, should maybe not necessarily like preemptively talking about it, but like keeping an eye on certain pieces of what they're seeing and what they're experiencing and knowing you know where those lines are between what's maybe normal and expected and what's not. Gosh, that's such a good question.
00:41:26
amanda
Yeah, well, it's, it's, it's very interesting.
00:41:26
amandacberg
Okay.
00:41:31
amanda
Cause yeah, as the parent right now, I'm kind of thinking about, I don't know that I would want to sit her down at 10, 11, 12 and like have a heavy conversation about disordered eating and like how to avoid it.
00:41:47
amanda
Even though that's like technically the prime age, right? For, for the thoughts to start creeping in.
00:41:51
Lauren
So.
00:41:55
Lauren
I mean, we see thoughts start to creep in kind of at all different points. um I don't know that any of this needs to be like, let's sit down and talk about this.
00:42:04
amanda
really
00:42:04
Lauren
I think it's more so for a parent and a caregiver, like being aware of what some red flags might be or keeping an eye out for things and knowing what to do when that happens.
00:42:17
amanda
Okay, so can we dive into that?
00:42:18
amandacberg
Yeah, what are those?
00:42:19
Lauren
Absolutely. Yeah. So the way that I like to talk about this is that you know, this kind of all of this idea of like disorder dating eating disorders, it all kind of sits on a spectrum where on one end, we have somebody with like a very normal, healthy, appropriate relationship with food with their body, their diabetes management. And then on the other side, we have somebody with like a full on acute diagnostic eating disorder.
00:42:19
amanda
Yeah.
00:42:46
Lauren
And in the middle is just kind of some like disordered patterns, some funky stuff that might come up here and there. And honestly, the reality in our society is that most people kind of sit in that slightly disordered middle gray area, right? We live in a society that's very hyper focused on weight and body size and, you know, the way that we look and the way that we eat and and There's lots of meaning that we draw from that and whatnot. And so it's most people kind of live in that ah like disorder type middle ground um in some way. And that's not to say that that's necessarily a negative thing, right? Especially when we're dealing with a chronic condition that involves being aware of food in your body in a different way than the general population. And so I want to be so clear that like,
00:43:32
Lauren
Yeah, we want to keep an eye on disorder type things that might pop up, but we can't label something just inherently as a problem without knowing the intention behind it and how much distress it might be causing the person. And that's really the line where we see it start to cross into like a more acute, like diagnostic eating disorder situation is where that person who is experiencing things is starting to feel like a high level of distress around what's happening and how they're engaging with food in their body and where they it's it's taking up a lot of time and attention in their life in a way that doesn't quite match or is maybe affecting their ability to show up and
00:44:16
Lauren
you know, other situations, life, family, friends, social, school, etc. um And so, you know, those kind of disorder type behaviors are things that, you know, are kind of more like obsessive or extreme around food or body. So, like,
00:44:36
Lauren
counting calories, counting carbs in a very like unexpected or obsessive way, because of course with diabetes, we do need to count carbs, but you know when it starts to get to a point where it is you know more rigid or more extreme, and maybe causing some distress for that person, or they're feeling overwhelmed by it, or it's getting in the way of them being able to you know engage in their life, that's that's where we start to see it becoming a problem. right It's not the particular behavior in and of itself,
00:45:07
Lauren
the intention behind it, it's the distress that comes with it. So any kind of extreme patterns around food, so could be related to carbs, could not be related to carbs, um restrictive type things, so people pulling out, you know, different food groups, different amounts of food, people having um a lot of thoughts around weight loss or their body, their body size, body shape, kind of hyper fixation on that.
00:45:36
Lauren
we see a lot of people that kind of fall into this like obsession and awareness of health in a way that can sometimes become really extreme. And so sometimes that that's not necessarily about like calories in the way that we would generally think about with eating disorders, but it can be about health and lead to people taking kind of more intense or or extreme action to,
00:46:02
Lauren
quote unquote care for their body or their health. We see people who, you know, might be engaging with activity or exercise in a way that starts to become more frequent or more intense. We see people, you know, starting to play with maybe different types of like engagement with medications or not medication. So that could be insulin, that could be other types of medications, you know, for the purpose of affecting their health or their body or their weight in some capacity. And so you know we see a lot of that kind of stuff happen. And so all of those things, if you pick one of those things out as an individual behavior, sure, we could label it as somewhat disordered in this weird gray area. But that in and of itself doesn't make an eating disorder. I think where we keep an eye out is, do we have a lot of those things going on?
00:46:55
Lauren
Do we have you know an extreme frequency or intensity around some of those things? Are we noticing that it's picking up speed and and whatnot compared to how this person was, you know,
00:47:09
Lauren
five months ago, a year ago, etc. Do we notice that if the person doesn't do this thing, they are behaving differently than how they normally are? Do we notice um that this person is highly distressed by doing or not doing any of these things? um That's kind of where we keep an eye out for some red flags and say, whoa, like,
00:47:34
Lauren
hey, what's going on with this? you know like I'm noticing that this is happening, and I just want to check in about it. ah you And so that's that's how I think about it, and that's how we kind of move through it in the world that I live in.
00:47:50
amandacberg
Okay, I know we do have to wrap up in a second, but that was a super helpful list, I think, for parents to start to look out for.
00:47:55
amanda
Yes, very.
00:47:58
amandacberg
um And then in terms, if you could really quickly go into what people should do if they see this, obviously have the conversation. If it seems to be more of a drastic thing, um are they able to work with you?
00:48:10
amandacberg
Any suggestions there? We of course can link all your stuff as well.
00:48:14
amanda
Yeah, like what's the first step?
00:48:14
Lauren
um
00:48:15
amanda
Like my thought would be to reach out to my daughter's endocrinologist first and or her primary care physician.
00:48:23
Lauren
Yeah, I mean, I think first step would probably ideally, assuming that there's enough of a relationship between the caregiver and the, you know, the kid who's struggling, my first step would be, can you, you know, talk to the kid about it?
00:48:37
Lauren
right and just say like you know exactly how I said before him noticing this is happening you know can we just check in about it like how are we feeling about this you know.
00:48:47
Lauren
um am I, you know, am I interpreting this correctly? What's happening here? And so being able to so try and have that conversation and see what the kid is actually thinking about, because I also know, and it can be really scary as a parent to start to see some of those things. And I also want to be really clear that some of those types of behaviors, first of all, might not actually be a problem, might not actually be an eating disorder. And Or could also be related to other kinds of mental health struggles, right? Maybe we're just really, really anxious and we have an anxiety situation on our hand and it's not an eating disorder. It's just anxiety that's manifesting around a particular food thing. Maybe there's
00:49:29
Lauren
you know some OCD budding or something else like that that might be coming up. Maybe there's you know a whole other situation that's going on that we just don't know. So let's check in with the kid first and see what they have to say. I think after that, if we are picking up on like, hey, maybe this is kind of a disordered eating, eating disorder type situation. you I think reaching out to a professional is definitely a good next step.
00:49:55
Lauren
um I would love if all endocrinologists and pediatricians knew what to do. Some of them are really excellent and some of them don't quite have a handle on what they're looking at or what to look for. And so I think at a bare minimum, reaching out to an endocrinologist is a pretty good first step because, especially if you have a good relationship with them, because most endocrinologists at a bare minimum have a referral list of therapists that they like working with who they know understand diabetes.
00:50:25
Lauren
and so that's always a great place to start if you can't find somebody in your area or somebody who's a network that's like you know exactly what we do like an eating disorder, dietitian, diabetes like specializes in this right there's not so many of us but at least if we can start somewhere with you know getting a name of a therapist or a dietitian who like actually understands diabetes or actually understands
00:50:33
amandacberg
Thank you.
00:50:47
Lauren
eating disorders. And so going to an endocrinologist and kind of reaching out trying to get a ah name or a referral is a great first step. Reaching out to A like eating disorder focused therapist or dietician is also another good step. The credential that I hold of certified eating disorder specialist is through the Association or the International Association of Eating Disorder Professionals. That's IADEP, I-A-E-D-P. They have a list on their website of all other credential or all other clinicians who hold this credential. So that's another place
00:51:24
Lauren
get some names. Our practice is also happy to be a resource if we can and we support people individually. We are licensed in 36 states at the moment I believe and we are also more than happy to just kind of be a resource and help find a referral for you even if we're not the best fit for you or for your kid.
00:51:45
Lauren
We know a lot of people were happy to ask in any networks that we're in to find somebody who would be a good fit for anybody. So we're happy to be that resource if we can be.
00:51:56
amandacberg
Amazing.
00:51:56
amanda
Love it. Yeah.
00:51:57
amandacberg
Okay. This was such a good conversation.
00:51:58
amanda
Such a helpful talk. Yeah.
00:52:00
amandacberg
Like seriously, one of my favorite, probably podcast episodes we've recorded, um, to everyone listening, Lauren and I have talked about different ideas of things we can do together, including a possible masterclass or other resources.
00:52:12
amandacberg
We want to hear your feedback. If there are certain things you want from Lauren or, you know, just on this topic, definitely send us a message and let us know so we can try to create that. Um, we'll link all of her info in the show notes. And we just can't thank you enough. Seriously, this was so incredible.
00:52:29
amanda
Yes, truly.
00:52:29
Lauren
Thank you so much.
00:52:31
amanda
Yeah. What you're doing is amazing work and the people you work with are super lucky to have you.
00:52:36
amandacberg
Yes.
00:52:37
Lauren
Thank you so much. I appreciate that. And y'all are doing such a great job with all of this. And Amanda, you're doing such a great job with your daughter. You're welcome.
00:52:45
amanda
Thanks. that we'll We'll check in in 14 years or in 20 years or 30 years after she processes her childhood.
00:52:49
Lauren
We'll see what goes. We'll see what you have to say.
00:52:55
amandacberg
All right, we will see you all next week.
00:52:55
amanda
We'll see.
00:52:59
amanda
All right, bye.
00:52:59
amandacberg
Bye