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An entire chapter of The Smart Woman’s Guide is dedicated to eating disorders and women with diabetes. In the chapter, I highlight 3 treatment centers that have specialized programs for women with diabetes. One of these is The Center for Hope of The Sierras in Reno, Nevada. Executive Director, Brandon Keppner agreed to talk with me about the center. Here is our conversation:

Tell me about the Center’s specialized approach to women with diabetes and eating disorders. And how is this different than the treatment you offer women without diabetes? 

 We focus on working toward an end goal of Intuitive Eating.  In order to reach that, we start with our patients being “portioned” by staff according to a menu plan developed between the patient and our Nutrition Therapist.  As they progress with treatment, we gradually allow them to start portioning their own snacks, and then one meal a day, etc. until they are on full self-portioning for all snacks and all meals.  This allows them to eat in a family style setting and with appropriate amounts to match their body’s needs.  We also have staff focusing and assisting each person with the mental stress and fears that come with this type of progression.

This is a standard practice for all.  For those with diabetes, we practice a similar method with their insulin.  We have 24 hour nursing staff that will begin by “portioning” the insulin according to the carb ratios dictated by our Endocrinologist.  As treatment and comfort with this progresses, we gradually work with the patient to start counting and calculating their own insulin doses.  Our end goal is to have women comfortable not only with appropriate food intake, but also appropriate insulin dosing.

We also work with the patients to become free with their food choices and not let the eating disorder dictate what foods they are “allowed” to eat or not eat.  We practice this same philosophy with our diabetes patients.  Specifically we help them break free from the myth that there are good and bad foods for diabetes patients as well.  Sometimes according to blood sugar levels at a given time there are more appropriate choices to be made, but when blood sugars are appropriate, freedom of food choice is highly encouraged with the appropriate insulin dosing.

What are the most common issues for women with diabetes? (thinking about food all the time? managing lows and eating when not hungry?)

As far as food and eating, they are surprisingly very similar to any other women suffering with an eating disorder.  The added struggle comes with their fear of insulin.  They tend to see the insulin as a direct correlation to gaining weight.  Once they begin dosing appropriately, they tend to function more clearly and as we say, “awake from the fog.”  We hear repeatedly that they feel so much better and maintain a similar weight shortly after treatment begins.

Tell me about your team of experts, why is it important to have all these people involved in the patient’s care?

We work with many outstanding doctors.  Endocrinologist, Medical Internist, Medical Director and Psychiatrist, Registered Dietician, Director of Nursing, Clinical Director, and many other therapists and various staff that have all been specifically trained on warning signs and care for diabetes.

Many other centers also state that they will work with diabetes, but we have not found anywhere else that coordinates that treatment with an Endocrinologist and the staffing we use.  We believe there are far too many items that need oversight by professionals at this level.  If the insulin dosing and counting is left to the patient, the trend that led them to the need of treatment will be much harder to break and not allow them to focus on the treatment needed as clearly.

What is the cost, is financial assistance available and is this treatment covered by insurance? 

We do have a daily fee that we can negotiate with individuals with according to their needs.  We have sought after a few outside companies for loans and financial assistance, but have not found strong results.  This is the key to the work we do.  98% of all our patients utilize treatment payments through their insurance plans.  We have a strong record of being able to gain authorization and payment days through insurance plans and are in network with over 24 current providers at this time.

If someone is in danger and she can’t get to your program, what is the next best thing?

We will coordinate or recommend a higher level of care to an In-Patient facility if they need more help than we can offer.  This will help them stabilize in a safe manner so they can step down and when ready, hopefully come to our treatment once appropriate.  If they can’t get to our program for other reasons, we have dedicated staff that will find a way to get them the help they need anyway we can.

How can friends and/or family help this person?

•           Communicate your concern in a caring, non-judgmental manner

•           Ask your friend to consult with a professional to help explore your concerns

  •       Offer to help find help and/or come to an appointment with your friend.

•           Avoid conflicts or a battle of the wills and continue to be a supportive listener.

•           Avoid placing shame, guilt, or blame. Try not to use “you” statements.

•           Avoid giving simple solutions.

•           Express your continued support.