Diabetes, Baby!
A welcome guide to diabetes for fat folks with disordered eating.
Recently, several friends and acquaintances have been newly diagnosed with diabetes. I had my diagnosis in 2012 and it’s been a rocky road navigating my diabetes alongside medical providers’ fat bias and their neglect of my disordered eating recovery. I want to share advice and experiences I’ve had; I hope they can help other people have a less troublesome journey to well-managed diabetes.
From one peer to another, here are things I’ve learned that have helped me along the way. Please know that this article contains descriptions of emotional abuse, diet culture, disordered eating, and some specifics about food nutrients. This article is for informational and educational purposes only, isn’t a substitute for individual medical or mental health advice. I also want to make sure I state how much privilege in access I have; I know that some of this advice will not be possible for many folks, which I fucking hate. I keep working for everyone to have more access like I’ve had, just as I will continue to work against fat abuse in medical settings.
This is not your fault.
When I got my diagnosis back in 2012, I was in shock and very upset. I’d been searching for three years for an answer to why I was so sick, but doctors I saw at the time did not give meaningful care. I also had a lot of old verbal and emotional abuse in my past that centered around fatness being a surefire road to diabetes and an early death. My endocrinologist took the time to really figure out what had been making me so sick, and as I sat, in shock and open-mouthed in her office, she looked me in the eye and said, “this is not your fault.” It’s true, despite popular and even medical confusion of correlation with causality. Diabetes is a genetic propensity that for some, can be triggered by high stress physical circumstances. Hearing from the very beginning that diabetes was not my fault helped set me up for so much better health outcomes in the future, so I am forever grateful that my endocrinologist said it to me. However, even if you can’t believe that yet, you deserve good care and treatment that helps you rather than hurts you in the long run. You deserve to have your disordered eating recovery, fat body, and diabetes management too! This is not your fault, dear reader!
If you are in the midst of or in recovery for disordered eating, you can prioritize your recovery while also treating your diabetes.
Your doctor will likely suggest the first steps for you. Many folks are told to diet and exercise to achieve weight loss before they try medications, which sets most people up for failure, as restriction and weight loss is not possible or sustainable for a great majority of people. It’s also common for doctors to recommend diabetes education and restricting carbohydrates either before or in conjunction with common first line-medications.
Unfortunately, a lot of me doing better with my diabetes management has also been pretty linked with active disordered eating treatment, learning intuitive eating skills, getting in touch with my body, and working to release body trauma through somatic experiencing therapy. I’ve had so much privilege in the kinds of care I’ve been able to access; I wish everyone could have it and me writing this article is part of spreading what I can to others who don’t have that access.
Diabetes education through hospitals and offices can be predictably terrible.
My first experience with diabetes education left me in tears, but the treatment for my disordered eating was with a provider who also did diabetes management, and they were wonderful! There’s a great variety in what kind of diabetes education is available from any one provider. Pamphlets and lectures will inevitably list weight loss or carbohydrate restriction, so if you choose to utilize diabetes education available through your local hospital or insurance, prepare yourself for weathering or setting boundaries around harmful conversations that are often mandated by someone besides the dietician teaching it. Also, diabetes education changes from person to person and has changed over time. The information your grandparent or friend got for their diabetes may differ, both due to when they got their diagnosis and what their individual cases need.
If counting carbs will trigger your ED, or starts to, your doctor can and should develop a treatment plan with you that doesn’t involve it.
Common first-line medications often do not require carb counting to work, but even with insulin, you can ask your doctor to give set dosages of insulin for each meal time you usually eat. You may need assistance from a dietician; if you describe a variety of typical meals you eat to them, they can help estimate carbohydrates that they can send to your diabetes care doctor. You could also use a lay person you trust to support you by looking up carb estimates online so that you don’t have to. Your doctor can also prescribe without this kind of estimate; the process usually involves measuring blood sugar a lot to see where you’re at on average. Most doctors work to prescribe as little insulin as needed, so they may start very low.
The key to this sort of development will not be eating the same types of foods all the time, but utilizing these other methods of gathering data: the support of others, and listening to what your body tells you, including blood sugar checks. This process might be easier the more healed you feel from ED, but as we all know, recovery isn’t linear. There will be bumps in the road.
If your diabetes can be managed by medications, that is AWESOME.
Please utilize them when you need to. Sometimes doctors will not want to put you on insulin when you need it because it can cause “weight gain.” The weight gain from popular diabetic treatments is usually something like 5–10 pounds for the people studied. While this could be a hurdle for an individual’s ED recovery, depending on your circumstances, it may not be a reason to avoid a medication. One of the best pieces of advice I received from a dietician was to let the doctor decide if I need medication or not, and focus on my ED recovery.
Many of the newer classes of diabetes medications come with promises of weight loss due to an appetite suppressant effect.
Some of these medications are prescribed for weight loss in higher doses. If you struggle with restrictive eating, it’s really important to be clear with your doctor about the effect restriction and lack of appetite have on your recovery. It has also been hard for me to encounter ads for medications I’ve been on when they’re being used for weight loss. Everyone is different, but I wish I’d had a heads up on this issue, so I’m giving it to you.
Be honest with your doctor.
I know from experience that this is very difficult; doctors can be hostile, disrespectful, and dangerous in their bias, stigma, abuse, and neglect towards fat people. But — if you can practice being vulnerable and speaking openly about the effects, a good doctor will respond to that. There are a LOT of bad doctors out there, and I know it is truly exhausting to find a doctor, and depending on your area, you may have very limited options.
I understand this may be the hardest part for you; I have a lot of traumatic personal experience from this process. Finding a medical practitioner who is both an expert in diabetes care and will not harm you with weight stigma and ignoring your ED recovery is extremely hard. I usually think that being as honest as possible is both best for my mental health and for chances of a doctor listening and respecting me and my care, even if they think I am wrong
Once you find one doctor that you trust, you can also ask them for help in contacting other medical care providers who will treat you without (or with less) harm.
I carry a medical “passport” with me to doctor visits that list all my medications, conditions, letters of recommendation from my therapists, dieticians, and sometimes just my own letters stating what I NEED for health care that isn’t damaging. There are also sometimes pre-written letters available from online dieticians and activists that cover common misconceptions about weight and health, and I include those as well.
On eating: if you have access to registered dieticians that use a Health At Every Size (HAES) or fat-positive ED framework, please avail yourself of them.
They can help when you feel stuck. I am not a registered dietician — but my experience as a patient has been that dieticians recommend adding foods to your diet rather than restriction, ie add protein, fats, and fiber to your meals and snacks rather than trying to restrict carbohydrates or sugars. We need every food group to fuel our bodies.
Net carbs isn’t really a thing.
It’s mostly a diet culture advertising thing, and I was frequently confused and frustrated over this when I first was diagnosed. Your body treats carbs as carbs, whether they are from cane sugar, bread, Brussels sprouts, etc. Changes in absorption are caused by other nutrients that go with them, plus your individual human body cocktail. Protein, fiber, and fat all slow digestion down and help regulate blood sugar. If you consume animal products and can tolerate dairy, I recommend whole fat dairy because it’s the closest I’ve found to an even carb:fat:protein ratio, and my body really does well with it. You can do this without dairy, however; I usually do better with meals and snacks that combine macro nutrients and food groups rather than just one.
Your lows are real lows.
This is excellent advice my endocrinologist gave me years ago. When you feel low, your body is giving you the clues that it needs fuel. Listen to it! As a recently diagnosed diabetic, your blood sugars may have been high for a while before diagnosis. If you start medications, you may feel like you’re having low blood sugar as the medication starts to kick in, but the actual number isn’t dangerously low. Your body is used to higher numbers being low — it takes time for your body to adjust. If you feel shaky, faint, sweaty, nauseated — treat the low blood sugar feeling.
Checking blood sugar can be very triggering and painful, as it links health with numbers.
I decided that a helpful reminder for me was, “This is a message, not a judgment.” I taped that on my blood sugar meter. It helped a lot, over time. Most of the messages from our bodies help us understand what we need better if we can listen to them. The numbers are a message that your body needs support of some kind, whether it’s medication, food, or something else.
Pre-diabetes is often introduced without supports.
The people I’ve known who are told they’re prediabetic are not actually offered any resources or supports, so they’re left guessing and typically somewhat panicked. These folks also experience surges in disordered eating. If you are diagnosed with pre-diabetes (or ANYTHING) and not offered supports, I’m sorry. That’s not fair to you.
The advice I have for this situation is trying to advocate for yourself more, which obviously sucks. But it does get easier with practice, like most things. So hang in there — learn what you can about your body. Talk to diabetics about their experiences and try out their advice to see if it works for your body. And recognize that diabetes is primarily genetic, so if you become diabetic, it’s not your fault.
Just a few resources that help me:
The Love, Food Podcast by Julie Duffy Dillon, RDN (this is my letter!) https://juliedillonrd.com/lovefood217/
The diabetes specialist in this episode: https://www.laurennewmanrd.com/
Christy Harrison, RDN is author of Anti-Diet and creator of the Food Psych podcast, and I especially love Harrison’s newsletter, Food Psych Weekly, which offers a well-written dose of disordered eating science and social reminders that always pumps me up in making decisions about food and my blood sugar.
I also enjoy Lindley Ashline’s Body Love newsletter and blog, which often has pretty good personal thoughts on diet culture in general.
I also find that any body liberation and anti-diet resources help me stay up to date on research and emotional skills for self-advocacy; books like Anti-Diet by Christy Harrison RDN and Body Respect by Dr. Lindo Bacon help a lot. I also like following fat-positive dieticians online.
