How to Have a Successful Conversation about Diabulimia


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How to Have a Successful Conversation about Diabulimia

Treating Diabulimia is only possible when clinicians and therapists communicate well.

[Download this FREE pamphlet to learn more about ED-DMT1 signs and symptoms.]

Lyn Goldring, BN, RN, CEDRN, Chief Nursing Officer for Alsana and co-architect of Alsana’s new Diabulimia Program, shares her nurse’s perspective on how how to have a successful conversation about Diabulimia with a client’s primary care physician or endocrinologist.

1. Do your homework

Just as many clinicians may have to do some catching up to do in educating themselves about eating disorders, you, too, may have to spend some serious time learning more about diabetes before initiating a conversation with a member of your client’s health care team. Informed advocates are the best advocates. Some great resources include:

  • Diabulimia Helpline
  • Diabulimia: What It Is and How To Treat It by Grace Shih, RD, MS
  • Diabulimia: Towards Understanding, Recognition, and Healingby Aarti Esther Sharma
  • Prevention and Recovery from Eating Disorders in Type 1 Diabetes: Injecting Hope by Ann Goebel-Fabbri
  • We Are Diabetes

Last but not least, you can definitely consider Alsana and our team to be a resource for you. We have produced multiple blog posts and webinars on the topic. These can also prepare you to have a successful conversation about Diabulimia

The Co-Occurrence of Diabetes Mellitus Type I & an Eating Disorder
Dr. Marghertia Mascolo, MD, CEDS
ED-DMT1: A Nurse Perspective
Lyn Goldring, BN, RN, CEDRN


There is almost always a learning curve when figuring out the nuances of communicating about eating disorder. As you might expect, there are even more complexities in navigating conversations about diabulimia and diabulimia patients As your client’s advocate, you do a great service by helping their clinician understand this subtle shift in language.

There are also some unique particulars to learn about communicating with diabulimia clients. Keep these things in mind:

  • In general, we want to develop inclusive language that reduces shame and judgment.
  • We do not “control” diabetes. We manage diabetes.
  • Find out how the client likes to be identified; we are not treating “diabulimics.” We are treating humans who have diabulimia, a misunderstood, life-threatening illness that they did not choose.
  • Talking about numbers is unavoidable for diabulimia patients, but it is helpful to talk about reasonable ranges rather than rigid targets.
  • Talk about HOW to live with chronic illness; clients will not recover from diabetes or become the “perfect diabetic” but they can recover fully from their eating disorder.
  • Remember: diabetes doesn’t follow the rules, even if the patient does. Reacting to the numbers is not helpful. Blood sugar doesn’t tell the whole story. There are many factors to consider.
  • Remember: your client has probably already experienced biases related to their diabetes and possibly their eating disorder as well. This could cause them to feel defensive and/or ashamed.
  • Remember: the client will not remember everything you say, but they will remember how you made them feel (Based off of my favorite quote by Maya Angelou, a quote I live by).

Try to be patient with clinicians as they work to incorporate these language modifications. At the same time, remind them that the language they use with their patient is a significant part of that individual’s recovery environment, and that eating disorder clients can’t heal in an environment of judgment and shame.


The tone of this conversation ought to be quite urgent. The mortality rate for people with diabulimia is much higher than that of any other eating disorder, and higher still than the mortality rate of diabetes alone. Your client will not be well unless the mental health component of their eating disorder is treated in concert with the physical component of diabetes, and it is important that the clinician understands this.  


When you have these conversations, it’s as much an opportunity for learning as it is for teaching and advocating for your client. Come prepared to ask some questions of your own. For example:

  • Ask about the client’s history, like how often they’ve ended up hospitalized for Diabetic ketoacidosis (DKA).
  • How “brittle” is the client?
  • Ask the clinician how much they have struggled with this patient; have they been difficult to work with?
  • Are they aware of any manipulative or dishonest behavior?
  • What is the patient’s frustration level?
  • Ask them if there are topics they’d like you to bring up in your sessions.
  • Ask the clinician what will happen if your client continues on their current trajectory; when should you expect to see serious physical consequences if things don’t improve soon?

Last but not least, ask how you can support them.

The whole point of these conversations is to strengthen your client’s recovery team. For the team to be successful, each team member needs to be supportive and collaborative. And remember, your client will absolutely notice if your messaging differs significantly from what their clinician is saying which could erode trust. You must try to be on the same page and approach your client’s treatment as a united front.


Don’t leave this meeting without discussing next steps and scheduling a follow-up conversation. This ongoing arrangement will help you and the client’s medical team remain alert, supportive, and able to act quickly if the client’s condition worsens and suddenly requires a higher level of care.

Clinicians, of course, will all react differently to a therapist’s insistence on being involved and collaborative. But as your client’s advocate, it is your responsibility to do all you possibly can to help build your client’s recovery team.


Lyn Goldring, BN, RN, CEDRN

Lyn Goldring, BN, RN, CEDRN

It is extremely fulfilling to see our Diabulimia Treatment Program come to fruition. Knowing that Alsana is now empowered and qualified to be opening our doors to a new population- a population that isn’t currently receiving care or understanding- makes me feel tremendously happy and proud of my team and the work we have been doing.

I have a passion for this because I walk this path, too. This work resonates with me on a very personal level. In 2017, I was diagnosed with type 2 diabetes. I recognized the biases in how people spoke to me and noticed how that made me feel.

I am a nurse. I carry empathy and compassion by trade. But I developed even more compassion after receiving my own diagnosis. Before that, I suppose I never really thought, “Wow. They will have this the rest of their lives and they are so misunderstood.” Alsana’s Diabulimia Program, is something I truly believe in. As a test I often ask myself, “Would I admit my child-or myself- to this program?”

And the answer is, “yes.”

At Alsana, our primary objective is to provide quality healing for full eating disorder recovery to as many humans as possible, while empowering caring professionals just like you to connect those who are struggling with life-saving treatment. Please connect with us if we can be of service.


Additional resources:


The health consequences of co-occurring eating disorders and diabetes are serious and can be life-threatening. The risk of death for ED-DMT1 is 17x more likely than type-1 diabetes alone, and 7x more likely than anorexia alone.


We Are Here to Help

If you or someone you love is currently struggling with Type 1 diabetes, treatment options are available to work with the delicate nature of this condition. It’s important to be informed about the complexity of the disease, and ask for help if struggling with any issue surrounding how to care for and love your body.


At Alsana, we believe that all individuals with an eating disorder deserve holistic care adapted to their unique needs. For individuals with co-occurring eating disorders and diabetes mellitus type I, a safe, inviting environment with professionals who specialize in both diagnoses is vital…

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