Tuesday, June 12, 2007


O is starting to worry me.

I bought a box of stuff that flavours tap water. I'm always trying to get O to drink more water, especially during school and I thought this might help. You add a packet to 22 ounces of water. It only has 15 g of carbs in it, so I didn't think it would mess with her blood sugar that much, if she just sipped on the water all day.

I bought these on Sunday evening. I noticed this morning that they're all gone. It's only Tuesday. This isn't the first time I've noticed this kind of behaviour. If I buy a cereal she likes - and I'm talking Grape Nuts or Life, not Captain Crunch - she'll eat it up in a day or two. Rather than have a sandwich for lunch or get a piece of fruit for a snack, she'll have cereal. It's like she has to consume whatever it is because it might not be there tomorrow and she might never get it again.

I have st0pped buying most snack foods because she inhales them. I do buy Goldfish for the little girls, but I have to hide them. If I buy Kix for them to snack on, O eats them.

I don't get it. I buy fruit. I buy the fruit she asks for - apples and grapes, mostly - I buy other healthy snacks - I cut up peppers and cucumbers, I buy yoghurt, and she will eat them, but if there's anything else in the house, she wolfs that down, too. Even when I ask her not to eat something, she does anyway. I bought myself a pack of gum a few weeks back. I had one piece and she took the rest.

She's almost 13, so she tends to get her own snacks. Short of putting locks on the cupboards and starting a huge power struggle over food, I don't know what to do. She's putting on weight, which embarrasses her, but when I talk to her about it, she gets mad. She's sneaking the food and she almost always gets caught, but she continues to do it. Even when I say "Look, I don't care if you have X food, just TELL me about it." If she does ask, and I know she's already had a not-so-healthy snack, I tell her to get fruit. She never does - she'd rather go pout in her room.

Does anyone have any suggestions? I don't really know how to deal with this. It almost seems like obsessive behaviour, like she has to eat it now because there may not be any food available later.


Kelsey said...

Ohh, that's a tough one.

I'm trying to remember when I was a teenager, what my attitude toward food was like. I was diagnosed at 13, so the diabetes restrictions were all new to me, but I definitely put on weight throughout my teenage years. I hadn't gotten the hang of treating a low without totally overeating, and I fell into the habit of "feeding the insulin" quite a bit.

In a way, I think the worse thing to do would be making a big issue out of her eating. Type 1s tend to have a complex attitude toward food, with all the guilt associated with "bad" blood sugars, and things we "shouldn't" eat.

O's compulsive eating might be that she's stuffing the food in quickly before the thought "I shouldn't be eating this" registers and she starts to feel guilty about it.

Let us know how things go... and good luck!

Allison said...

I'm not entirely sure how to address O's obessive compulsive eating habits, because it sounds serious enough to be bordering on an eating disorder. You have to watch out for those with girls with D. Unhealthy attitudes towards eating manifest in many different ways.

I've always been a big girl. I like to eat and I don't like to exercise. My parents often harped on the fact I would take cookies after dinner, because I was a "diabetic" and "shouldn't" be eating it and why don't I ever eat something healthy? They still harp on it, though obviously not as much since I live a hundred miles away.

I definitely would try to avoid buying the things O really likes except for a special treat, and then just buy it in small portions. If she likes Kix cereal, see if you can't purchase one of those one-serving-only boxes at the store. Limit one per customer. ;-)

Of course, you could take this from a purely economical angle instead of a health/beauty angle. Buying cereal and then eating up quickly means you have to buy more cereal. It's expensive. If O wants to eat an entire box of a cereal a day, she can buy it herself. Otherwise, it's your money, and you should have some control over it. My dad used to make me give him a quarter for every pop can I didn't finish and let go flat. You could do that for cereal and/or other snacks. Just an idea.

Anonymous said...

::plunking down two cents::

It's normal. It's normal as a teenager (with diabetes or without) to be hormonal and moody and to push boundaries. Add diabetes into the mix and the hunger that gets associated with insulin issues, and boom... one human Hoover vacuum.

I ate good things and bad things - and I knew that even good things in excess weren't going to help me in the long run. (It didn't stop me from eating them.) My parents and I would have discussions about my weight (umm...yeah...) and I would end up hiding what I ate from them.

O sounds like a very intelligent individual, so instead of punishing her by not buying foods she likes, could you have her decide what foods she wants in the house - and let her know that you recognize how difficult food choices are as a diabetic? I know you love to cook and have tried to include O in that portion of your life - could you find snacks that she would have to prepare and cook? (If she's hungry, she'll make them. If she's not, she won't.)

Food is often a diversion for larger issues - comfort, stress, boredom... and of course, a teenager never has any of those feelings. Could you ask her (obviously not when she's eating), if she's eating because she's hungry or because she's bored/stressed..etc.?

There are no right or wrong answers for teenager and food. All I can tell you is that she'll grow out of this stage eventually. (Promise.)

Kerri. said...

I know that I had some issues with food when I was a kid. Not the kind of issues that made my parents speculate as to whether or not I had an eating disorder, but more of an acute obsession with food. (Versus “a cute” obsession.) Growing up with only Regular insulin and the peaks of NPH, Lente, and UltraLente, the food mantra was part Clean-Your-Plate Club and Part Guilty Eater. I always ate what was in front of me, and I always lied about what I was eating on the side. My poor mother, I definitely put her through the ringer. She was recalculating and tweaking around lies that I was feeding her about the foods I was feeding myself. I just hated being so regimented in my food choices. I wanted cakes and candies and all that garbage that kids eat, and I oftentimes binged on the high-sugar foods in efforts to confirm that I was in control.

Issues like these make sense because so much of a diabetic’s life is centered around food. Every little bit of everything that hits our mouth needs to be calculated into the big, chaotic diabetes equation. I remember finding the stash of E.L. Fudge cookies in my mother’s closet (she was hiding them from me, or maybe she was hiding them from her whole dominantly teenage household, but in my mind, it was just from me) and I devoured almost the whole package. I don’t know why I did it, I knew it wasn’t a good decision diabetes-wise, and yet still I binged. It was sort of like “eat it all now, because later you’ll be paying the proverbial piper.” Healthy? Not exactly. But I admit to doing it, and I also outgrew those tendencies.

Christel’s right in the whole “Add diabetes into the mix and the hunger that gets associated with insulin issues, and boom... one human Hoover vacuum.” That’s spot on. And I can also attest to the fact that despite being food-focused all throughout my life, I have a relatively healthy attitude about eating now. I have always struggled with my weight and have had to work very hard to maintain a level of fitness, and the food obsession thing I’ve mostly outgrown, like Christel said O will. I agree with her all the way around. O will be okay. But this will be a trying sort of time for you guys. I know you’ll be okay, though.

Stay strong.

Anonymous said...

Right now, we don't have this problem, but as she gets older, she will have the control over what she eats. If she asks for a snack and she has just eaten or her BS is high, we try to negotiate with salad, pickles, cheeseburger on lettuce, hotdog, no roll, pastrami and/or cheese, half cup strawberries and whipped cream, low-carb food she can eat. Trying to teach her the difference between true hunger and eating just to eat. We tack a little desert (usually small 15 gram bag of potato chips, popcorn, cheese-its or ice cream)on to the end of each meal, excepting breakfast. We get the individual snack packs so it is easy to control serving size. She has three meals and one large afternoon snack. So far she has accepted these restrictions. We have told her if you do go ahead and eat something after we have said no or without asking us, you are only human, come to us right away and we will cover, no questions asked. But O's eating habits (which I understand, being somewhat of a compulsive eater) are dangerous for her. First of all, I would not buy cereals or any foods that you think will be a "trigger" to cause her to binge. I would have fruits, veggies and low carb snacks that she likes in the fridge ready to eat. I would attend Weight Watchers with or even without her, because they show you how to eat deserts and eat everything you like in moderation and have good speakers to motivate you. You have to train yourself to eat differently. You have to change your attitude about food mentally. This is very difficult, almost impossible, to do without support or help of people who have been there and understand. Sugared waters with 15 grams of carbs in them -- that's like giving her juice. I think there are flavored waters with much less carbs, like maybe 2 grams or five. I would buy those. Minute Maid makes a Splenda sweetened fruit punch and other flavors a lot of kids like, 2 grams for 8 ounces. Packaged individually with the juice boxes or packaged like orange juice in the dairy section. Yes, I am sure the restrictions of diabetes contributed greatly to this. If she really craves cereal, like the other blogger suggested, have a single-serving box on hand for the occasions she must have it. We do not keep more than one box of cereal in the house and cereal is a desert for her, not a food. Consequently, she doesn't request it as she would rather have her other deserts than cereal.

Anonymous said...

I went through the exact same thing as your daughter. I was diagnosed at age 11. I remember finding stashes of food that my parents tried to hide. I always ate much more than I 'should' have. Looking back, I'd say this was because I was going through a denial phase thinking that I was going to control this diabetes; it wasn't going to control me.

Maybe O is feeling very overwhelmed (lots of stuff going on in her teenage mind) by diabetes; and the way she's 'striking back' is my show it who's boss. Just a thought.

Being the baby of my family, I wanted treats (cookies, chips, candy, etc.,) because I felt I should be treated as someone special; simply because I was 'the diabetic' and also because I was the baby. What a scary way to think, I know.

I agree with what everyone else has commented: don't buy the junk type foods, get O more involved in the food prep and education, and most importantly, tell her she's beautiful just the way she is. Self-esteem is so important at her age.


Anonymous said...

Two interesting books on eating disorders are:
Eating by the Light of the Moon
Father Hunger

Be careful about pointing out the weight issue...try to stay focused and model being "healthy", having "energy", "feeling well" as the goals.

At least she's taking the insulin for what she eats.

Did you see this news item today?

Like many teenage girls, Lee Ann Thill was obsessed with her appearance. A diabetic, she was already suffering from bulimia - forcing herself to throw up to lose weight. But it wasn't enough, and she'd recently put on 20 pounds.

Then one day at a camp for diabetic teens, she heard counselors chew out two girls for practicing "diabulimia" - not taking their insulin so they could lose weight, one of the consequences of uncontrolled diabetes.

Don't you realize you could die if you skip your insulin? the counselor scolded. Don't you know you could fall into a coma or damage your kidneys or your eyes?

But that's not what registered with Thill, who has Type 1, or juvenile diabetes. Instead, she focused on this: Skipping insulin equals weight loss. For the next 17 years, diabulimia was her compulsion.

"I took just enough insulin to function," said Thill, now 34, of Magnolia, N.J.

Today, she worries about the long-term damage that may have come from her weight obsession. At 25, a blood vessel hemorrhage in her eye required surgery. At 28, doctors told her she had damaged kidneys.

"I'm fearful for the future," Thill said. "I feel very strongly that had I taken care of myself, I could have lived as long as anyone without diabetes. I don't think that's going to happen now."

Diabulimia is usually practiced by teenage girls and young women, and it may be growing more common as the secret is exchanged on Internet bulletin boards for diabetics and those with eating disorders. One expert who has studied the phenomenon estimates that 450,000 Type 1 diabetic women in the United States - one-third of the total - have skipped or shortchanged their insulin to lose weight and are risking a coma and an early death.

"People who do this behavior wind up with severe diabetic complications much earlier," said Ann Goebel-Fabbri, a clinical psychologist at the Joslin Diabetes Center in Boston.

The American Diabetes Association has long known about insulin omission as a tactic to lose weight. But "diabulimia" is a term that has only cropped up in recent years and is not a recognized medical condition, said Barbara Anderson, a pediatrics professor at Baylor College of Medicine in Houston.

Type 1 diabetes is a disorder in which the body's own immune system attacks insulin-producing cells in the pancreas. People with this disease produce little or no insulin, so they take shots of the hormone daily.

It differs from Type 2, the form associated with obesity and which accounts for about 90 to 95 percent of all diabetes.

Insulin is vital for delivering glucose from the bloodstream to the body's cells. Without insulin, cells starve even while the bloodstream becomes burdened with too much glucose.

When Type 1 diabetics skip or reduce their insulin, they risk falling into a coma or even dying. Blindness, amputations and kidney failure are some of the long-term complications that can develop.

Warning signs for diabulimia include a change in eating habits - typically someone who eats more but still loses weight - low energy and high blood-sugar levels, Goebel-Fabbri said. Frequent urination is another signal. When sugars are high, the kidneys work overtime to filter the excess glucose from the blood.

This purging of sugar from the body through the kidneys is similar to someone with bulimia, who binges and then purges, or vomits, Anderson said.

Studies show that women with Type 1 diabetes are twice as likely to develop an eating disorder. Ironically, good diabetes management, which requires a preoccupation with food, counting carbohydrates and following a diet, may lead some to form an unhealthy association with food, Goebel-Fabbri said.

Jacq Allan, 26, of London, is a diabulimic. When recently interviewed, she said she had not taken her insulin shots for two weeks and rarely takes them regularly. She weighs 42 pounds less than she did a year ago.

Allan is stuck between two fears: taking insulin, which may lead to weight gain, and the damage her destructive compulsion is doing to her body.

"I'm terrified of insulin," Allan said. "Every morning I wake up and think maybe I should go to the hospital."

Diagnosed with Type 1 diabetes nearly three years ago, Allan said she can feel the constant, sky-high sugar in her blood. Her list of ailments - chest pain, heart palpitations, muscle cramps, bacterial infections and lower back pain - are not the usual health problems of a twenty-something.

"I'm constantly worried that my eyes are going to go, but they seem relatively OK for the moment," she said. "I always wonder if this will be the day that some major organ fails. I kind of want something to happen because then maybe I'll stop."

Gwen Malnassy, 21, of Santa Monica, Calif., detailed her struggle with diabulimia for three years in a diary she posted on the Internet.

"If you don't think it will happen to you, don't fool yourself," writes Malnassy, diagnosed with diabetes at 9, in her final entry 11 months ago. "I believed the same."

Doctors diagnosed Malnassy with both anorexia and bulimia at 13, she said.

"I would look at magazines and think that if I looked like the models, I would have more friends and be more popular," Malnassy said in a recent interview.

She began withholding insulin at 17 after learning of the practice during a doctor's visit and continued withholding insulin off and on until last year.

Malnassy continues in her online diary: "I will say it again. Reach out; get help. Do not fall; do not let the disorder consume you. It's a miserable way to exist."

Copyright 2007 by The Associated Press. All Rights Reserved.