Please note that this is an Archived article and may contain content that is out of date. The use of she/her/hers pronouns in some articles is not intended to be exclusionary. Eating disorders can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights.
By Quinn Nystrom and Mike Swinyard, MD, FAAP
Dr. Mike Swinyard was diagnosed with type 1 diabetes nearly 50 years ago. He was told that after 10 to 15 years of living with the chronic illness, he’d start to see medical complications. He says, “It doesn’t help anyone to inject fear to motivate someone, to remind them if they don’t do XYZ, these will get XYZ complications. We need hope and encouragement and to know we won’t be constantly judged.”
I met Mike several years ago when I started my work as the National Diabetes Ambassador for Center for Change (CFC). What drew me to CFC was their staff, particularly the ones on the diabetes and eating disorder team that personally lived with type 1 diabetes. There’s just something that you get when you live with the disease every second of your life, as opposed to receiving straight medical training on it. You’ve lived with the ups and downs. You know the feelings and pressures.
What is your diabetes philosophy? How do you explain the disease to others?
Mike Swinyard (MS): This spring was my 47th dia-versary! When I was diagnosed, my doctor told me in 1977, “Doctors can’t have diabetes.” Back in the 1970s, the treatment of diabetes was very different because we didn’t have the advancements we have today. What came next was home blood sugar meters, so we finally got our compass at home.
Hope and insulin need to be combined. This is the way things were in the past. I’m old as dirt; I know what diabetes was like. HbA1c is neutral; I’m glad we have that marker. We don’t have a cure, but we’ve had considerable improvements in insulin and diabetes technology (insulin pumps, CGMs, etc.).
Carl Lewis once said, “Life is about timing.” People with diabetes have to insert insulin into their skin because their pancreas no longer produces insulin. This is where diabetes and the natural world intersect. How do I give my insulin a head start to have a life? Sometimes, they conflict, and sometimes, they collide. We’re a minority on the planet. We’re trying to teach the rest of the world about what it’s about.
What got you interested in treating patients with diabetes and an eating disorder?
MS: Diabetes is not just about learning about blood sugars, complications, carb counting, and types of insulin. We don’t eat weird food or go down the diabetic food aisle (there is no Purina diabetes chow!). That is the beginning of the challenges right out of the gate of diagnosis. We need medical providers not to impose ideas in general. Food is not our enemy. For many of us, it’s more of an issue with timing, not the TYPE of food. What is my glucose? Would I like a Butterfinger? If my blood sugar is elevated, can I postpone eating it so my insulin can start bringing it back down? The diabetes food police is alive and well; ask anyone with diabetes. It’s not helpful or accurate to tell someone with diabetes, “You can’t eat that!” We can celebrate and make peace with food. It’s hard to help the rest of the world understand that. When that misunderstanding is close to home, it can cause a lot of contention, and we see the roots of disordered eating start. Our glucose does not reflect who we are; they’re a condition we have.
Was there something that surprised you when going into ED treatment with people with T1D?
I didn’t know then what I know now. People with eating disorders and diabetes are part of the rest of us in the diabetes universe. They’re trying to make the best out of two tough spots, making peace with food. They’re trying to navigate the perfect storm. When I meet them, it’s not meeting them in the outpatient setting; I meet them at their breaking point; I meet them at a specialized center with experts
in every area. Clients were ready but, of course, still struggling. There can be relapses; there can be triggers.
What do you tell families to give them hope?
They should be patient with their efforts and recognize it’s a journey with diabetes and the ED. These are both lifelong conditions. Sometimes, our outward emotions show up differently, so therapy may show us the root cause of the expression of a parent who is overbearing or angry. Is it fear, sadness, or regret? We’re complicated people with triggers and traumas. And it may not be readily known during the first couple of visits. We’re building a foundation of trust. Sometimes, we don’t get everything in one admission; it’s a long, drawn-out process, and the sacrifices are difficult with clients and families opening up, but it’s worth the effort.
What stands out to you about Center for Change (CFC)?
There is a natural congenial environment at CFC. Diabetes management and eating disorder treatment is TRULY a TEAM effort. We’re their advisors, their coaches. We don’t have the perfect treatment for T1D and EDs. We have treatments that can enhance life with ED and T1D. As an endocrinologist and an understanding of zoning with glucose, we’re trying to avoid extremes. All people with type 1 diabetes may have disordered eating, but we don’t have to compare ourselves to perfection. If I have a low blood sugar, if I have a high with ketones, our team’s goal is to help our clients avoid the extremes. Avoiding binging, purging, and DKA if we don’t have a cure; recovery is about finding balance. Glucose is a vital sign. We need to find a reasonable zone so we can remain healthy. It’s not a zone of perfection! It’s a zone of balancing life with diabetes and ED. I’ve been impressed with the hope that permeates at Center for Change. It’s recovery step by step. Recovery is balancing conditions that we can’t cure.
Learn more about the Eating Disorders & Diabetes Program at Center for Change
