Diabetes dietitian Helen Gibbs explains the link between emotions and over-eating.
Karen was tearful from the start of her appointment.
She had gained 12 kg after starting on insulin for her type 2 diabetes six months earlier. She was taking 120 units of insulin a day, but her HbA1c remained high.
The 62-year-old carer choked up with tears when I asked what she wanted from the appointment. After time, tissues, and a glass of water, she began to tell me her story. “I had such good intentions to have breakfast before I came today but I ran out of time. I realised I was going low, so I pulled in at a petrol station and picked up a sandwich, which is OK, but I also bought lollies and a soft drink, you must think I am such a bad person.”
Through tears she told me about the last 18 months. Her diabetes wasn’t under control, which meant she had to move onto insulin to control her blood sugar levels.
She was struggling at home too because she had finally agreed her intellectually disabled son, Tane, should go into supported living. “Everyone said to me I would have plenty of time to look after myself – but I can’t stop binge eating every night. I used to do it when he was there, but only on bad days. Now it’s almost every night. I said I would stop when I started the insulin, but I couldn’t. Look at me now, I am a failure.”
I didn’t think she was a bad person or a failure – just sad, tired and hurting. I told her it was natural to be struggling with such a big change in her life but that perhaps she hadn’t made space for the grief she felt after Tane left home, she hadn’t processed this huge decision.
We didn’t talk much about nutrition at Karen’s first session but she agreed to keep a food, mood and hunger diary. I also referred her to a colleague for brief intervention therapy (see panel).
Two weeks later I asked her if she had seen any pattern in her food and mood diary. She thought about it and said: “I start every morning saying I am going to be the perfect diabetic and only eat healthy food. But by the afternoon I’m feeling hungry and I start snacking. Once that happens I get upset and eat more because I am feeling upset, does that sound silly?”
These are the classic symptoms of a binge-fast cycle. Luckily there are techniques Karen could use to reduce the likelihood of it happening in the future. We worked through a typical day and she set the following goals:
• Eat a breakfast that includes whole grains and protein foods and a serving of fruit or vegetable. • Plan snacks if going longer than six hours between meals • Have her main meal at midday • Walk for 10 minutes after each meal to help bring down her blood glucose.
This helped Karen break her binge-fast cycle during the day. However we identified that she was still in the habit of nighttime eating. I asked her why she thought she was doing this? On reflection Karen realised that she was bored, without her son there in the evenings. I asked her to think about how she could fill that space with something positive.
On her final visit Karen was full of news. She had found the brief intervention counsellor very useful. He had suggested she return to the parent support group she left when her son had to go into supported accommodation. Karen had been asked if she wanted to train as a peer supporter for other parents. “I’m working with two families with small children. I’m like a grandma and coach rolled into one. I’m either on the phone or writing in the evening. The parent support coordinator says I should write a blog of my experiences, to help other parents.”
I asked how she was feeling. “I am sometimes still sad, I miss Tane, especially after our Sunday visit but I am so happy I can help others. I feel like I have a purpose again.”
Although Karen’s 3 month HbA1c was far from perfect it was much improved. Before meal tests were under 8 and some close to 4, which meant she could reduce her insulin. Karen had got stuck because she was experiencing difficult emotions and needed support dealing with those feelings.
When you are stuck you may feel that nothing can help you but there are many ways of getting support, including brief intervention, support groups, and online resources. The main challenge for Karen, who believed she lacked willpower, was to identify the emotions and/or situations that drove her to overeat. This helped her find ways to overcome these and bring her eating back under control.