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A love letter to my fellow clinicians

Dear Clinicians: Just because diabetes is on the diagnosis list doesn't mean your patient needs to change their eating.

That’s kinda all we were taught in school, huh? Decrease carbs. Adjust eating. Plate method.

Even in HAES, non-diet, and eating disorder spaces, the knee-jerk reaction for a new diabetes diagnosis is to adjust food and carbs. Sure, there’s some cognitive dissonance that goes on for us, and a general feeling of “ick” when that comes up, but in our training and education, we honestly haven’t been given much else to work with when it comes to diabetes management.

At a recent training I gave on the intersection of diabetes and eating disorders to a group of eating disorder clinicians, this came up a lot. “OK, yeah, but don't people with diabetes need to decrease carbs? Aren’t we doing a disservice by not adjusting the meal plan for a new diagnosis or for someone whose A1c is above goal?”

Short answer: No! By restricting carbohydrates or making other "adaptations" to meals while in active ED treatment, we are colluding with the eating disorder and doing harm. period.

Long answer:

Remember that there are SO. MANY. THINGS. THAT AFFECT BLOOD SUGAR! A wonderful and fun example is a study I stumbled upon yesterday (Hayashi, et al). The authors gave people with diabetes a meal and then separated them into two groups. One group went to a comedy show after eating, and the other group went to a boring lecture. They found that the comedy group had blood sugar that was an average of 50 mg/dl lower than the group that went to the lecture. Friends. Laughing can literally make as big of an impact as food on blood sugar.

Other life factors that affect blood sugar:

  • stress

  • hormones

  • medications (including being under-medicated)

  • medication timing

  • sleep

  • family and social pressures

  • stigma

  • movement

  • reactions, mindset, and decision-making

If all of these affect blood sugar, why is so much focus on food? (My answer: diet culture. Diet culture’s influence on our training and education is deep, and it is extremely apparent in diabetes research - that’s a whole other post.)

When we’ve been doing great work with a patient and they receive a new diagnosis of diabetes, that feeling of “oh shit, I must be doing something wrong in my work with this patient” is not uncommon. But again, that’s diet culture and fatphobia sneaking (scratch that, bulldozing) into our lives.

Because if someone is already feeling chaotic about food and eating, adding more restrictions and rules around food isn’t going to help. You know this already. It’s the rampant fatphobia in our training, education and diabetes research that is making you second guess yourself.

So the next time you’re working with someone with diabetes and that knee-jerk reaction to make changes to food comes up for you, take a moment to pause, reflect, and get curious. What is making me have this automatic reaction to make changes to food? Where else can we focus our energy to help steer us in the direction of healing?

If we are just focusing on food, we are doing a disservice to everyone with diabetes.


Hayashi, Keiko, et al. "Laughter lowered the increase in postprandial blood glucose." Diabetes care 26.5 (2003): 1651-1652.



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