Eating Disorders in Type 1 Diabetes

Jacqueline Allan, PhD candidate and Associate Lecturer in Psychology, at Birkbeck discusses the little known but extremely dangerous prevalence of eating disorders in Type 1 Diabetics, and her charity Diabetics with Eating Disorders.

In 2014 I was lucky enough to be granted a Bloomsbury scholarship to undertake a PhD focussing on Eating Disorders in Type 1 Diabetes, including one known as ‘Diabulimia’, at Birkbeck. I’ve worked in this area since 2009 when I founded the registered charity Diabetics with Eating Disorders.

First, let me explain what Type 1 Diabetes is.

Type 1 Diabetes is an autoimmune disorder where the insulin-producing beta cells of the pancreas are mistakenly destroyed, making sugar in the body impossible to process. Insulin is one of the most vital hormones in the body – it ferries energy we consume in the form of carbohydrates to our muscles, organs and brain, so it is essential for every bodily function. For this reason, those with Type 1 must check their blood sugar every few hours and administer synthetic insulin to keep themselves safe. There are two main ways for administering insulin – Multiple Daily Injections using both long acting and short acting insulin, or Subcutaneous Infusion using an insulin pump.

Most of us utilise a carbohydrate-counting approach, whereby we know how many insulin units we need for every 10 grams of carbohydrate consumed and what our general background levels should be. If it sounds like a simple equation, it’s not.  Everything affects blood sugar – not just the obvious stuff like sports, illness or alcohol but stress, the weather, sleep, menstruation – its educated guesswork.

When it goes wrong, we are in immediate danger of death. Too much insulin and we can’t think as there is not enough fuel in the cells of the body. We shake, seize, our bodies have a fight or flight reaction and if not treated with sugar in a timely manner we risk falling into a coma and/or dying. Too little insulin and the body has to find other ways to get rid of sugar and provide energy for itself; sugar escapes into the bloodstream and is excreted in the urine while the body starts burning fat and muscle for fuel. The calories consumed can’t be processed and are not utilised, so the body is forced to cannibalise itself for energy. This process is called Diabetic Ketoacidosis – it is a life-threatening condition and the main symptom is massive weight loss. In this sense, we are borne into a world where everything is about food, injections, the looming threat of complications, hospitals and numbers with the knowledge that ignoring it all results in a substantial reduction in body size.

For decades, research has shown that those with Type 1 Diabetes have higher levels of eating disorders that their non-Diabetic counterparts. Anorexia, Bulimia and eating disorders not otherwise specified (EDNOS) are twice as prevalent, and insulin omission is present in around 40% of female patients. The statistics for men are not as clear but levels have been rising steadily since the early 90s.

My research looks at risk factors for the development of Eating Disorders in Type 1 Diabetes. I started my PhD in 2014 and found that there is a psychological vulnerability which, when combined with Diabetes-specific distress predicts higher eating disorder symptomology and higher levels of blood sugar. Having modelled these risks, I developed a multidisciplinary intervention delivered online to address them. I am in the process of writing them up at the moment, but initial results are positive.

I am also looking at another important question – are we measuring the right thing? One common feature of standard eating disorder questionnaires is that they ask questions which could directly relate to diabetes regimen, rather than eating disorder symptomology – for example, questions like ‘do you avoid specific food groups?’ Many Type 1 Diabetics deliberately avoid carbohydrates in order to control blood sugar as a lifestyle choice rather than an eating disorder. Similarly, many people investigate this population by asking these standard questions that are fundamentally flawed, without acknowledging the issue that insulin omission leads to weight loss.

We have made substantial inroads into treating Eating Disorders in Type 1 Diabetes and it has been a privilege to be involved centrally with that research. The National Institute for Health and Care Excellence (NICE) guidelines published earlier this year marked a watershed in recognising the issue, as did the documentary and radio piece with the BBC. There are now two NHS Trust programmes that deal with diabulimia which is more than when I founded the charity in 2009. We still have a long way to go.

The next big hurdle is recognising that Eating Disorders in Type 1 Diabetes is fundamentally different due to the nature of the illness itself and that insulin omission and diabulimia are unique. Hopefully, my research will help with that.

Watch: Diabulimia: The World’s Most Dangerous Eating Disorder

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Assessment, feedback and technology

In a new open access book from the Bloomsbury Learning Environment, Sarah Sherman and Leo Havemann look at the role of technology in educational assessment and what looks set to change.

Assessment lies at the heart of formal learning, and therefore at the heart of our work as educational technology practitioners. For our students in higher education institutions throughout Bloomsbury and the wider sector, undertaking coursework typically involves the use of online services and software to research and produce digital documents which are then submitted via a virtual learning environment (in our case, Moodle). Increasingly, marking and feedback also takes place online. These changes to assessment practices have been brought about through dialogue, collaboration and investment of precious time by academics, administrative staff and learning technologists, and by and large, the results appear to be welcomed by both students and staff. Yet this is not the full story of the role technology already and potentially plays in assessment. Online submission and marking of digital documents represents a digitisation of offline practices, which brings various new affordances (and of course removes others), but is not necessarily transformative.

Student attainment and satisfaction are sector-wide concerns, leading to calls from influential agencies such as the HEA and Jisc to enhance and transform assessment practices. The Bloomsbury Learning Environment (BLE) agreed in 2014 to focus the consortium’s shared activities on the ways in which learning technologies can enhance and support assessment and feedback. We wanted to gain an overview of current practices throughout Bloomsbury, and at the same time uncover and share examples of people making use of learning technologies in ways which go beyond the norm of digitised offline practice. Over the two subsequent academic years, we organised a programme of online and face-to-face events, conducted research, and collected case studies highlighting good practice.

In our experience, teaching staff often do not have much opportunity to find out what their peers are doing. Therefore, we have now published the written outputs of our enhancement theme as a freely available, open access ebook entitled Assessment, Feedback and Technology: Contexts and Case Studies in Bloomsbury. The ebook contains three research papers, which capture macro-level snapshots of current practice across the BLE partner institutions, as well as a wide range of pedagogic and technical case studies. These chapters have been contributed by academics, learning technologists, administrators and consultants, bringing a variety of perspectives to the topic. In developing this collection, our aim is therefore to offer an overview of current assessment practices, and hopefully some inspiration and ideas for making better use of technology.

The research presented in the first three chapters of the book include specific examples of practice at the BLE partner institutions from which broad recommendations have been drawn to help inform wider practice. These papers focus on:

  1. The use of technology across the assessment lifecycle
  2. The roles played by administrative staff in assessment processes
  3. Technology-supported assessment in distance learning

The first chapter introduces the assessment lifecycle model, developed by Manchester Metropolitan University and Jisc, which helps to contextualise the Bloomsbury landscape. The chapter was prompted by a wide-ranging survey conducted by each partner member to gauge how assessment practices were delivered and supported with technology. The second chapter offers administrative perspectives of the processes involved in assessment, and the research provides insight into how course administrators manage their responsibility in the workflow. We explore their pain points and consider improvements. Finally, the third chapter describes the assessment and feedback practices in the Bloomsbury programmes which offer distance learning (DL). Although it specifically considered DL, the findings and recommendations in this chapter are applicable for all teaching models.

The subsequent chapters are case studies of digital assessment and feedback practices, which operate at the micro-level of specific modules, offering an understanding of the pedagogy underlying the adoption of particular tools, and the associated benefits and challenges. The practice described does not simply replicate standard offline practices in a digital way, but extends the role of assessment and feedback. The case studies are categorised into five themes:

  • Alternative Tasks and Formats
  • Students Feeding Back
  • Assessing at Scale
  • Multimedia Approaches
  • Technical Developments

The final section contains three case studies of technical developments, which have been undertaken locally to support or enhance aspects of practice. The book acknowledges the inspiring work of our colleagues but also contributes to the wider discussion in the education community regarding improvements to assessment and feedback. Most of all, we hope this collection will be of interest to academics throughout Bloomsbury and beyond who are curious to learn about and develop new assessment approaches.

Further information: http://www.ble.ac.uk/ebook.html

Authors:
Sarah Sherman, BLE Service Manager, Bloomsbury Learning Environment @BLE1
Leo Havemann, Learning Technologist, Birkbeck, University of London @leohavemann

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What will it take to stop extreme climate change?

Birkbeck graduate Leo Barasi discusses his new book, The Climate Majority: apathy and action in an age of nationalism, which confronts the reality of climate change and the need for ordinary people to take action. 

You could look at the news and think climate disaster is now inevitable. Each of the last three years has, one by one, been the hottest on record. A consequence of that was visible with Hurricanes Harvey and Irma, which were made more destructive by oceans that had been warmed by human emissions. All of this has happened with the world only having warmed by perhaps a third of what it will this century if emissions don’t fall.

But you could also look around and think the world is finally dealing with climate change. For the first time, global emissions have stopped increasing, not because of a recession, but because of efforts to deal with the threat. Nearly every country has committed to limit their emissions, in an agreement that anticipates national commitments will strengthen over time.

Both views are right. Climate change is now here and is killing people. And the world is dealing with it more seriously than ever before. But which path will win out? Will the world eliminate emissions within a generation as it should if it is to prevent dangerous warming? Or will its efforts falter, emissions continue at their current rate (or even increase), and the planet respond with increasingly ferocious storms, heatwaves and droughts?

My book, The Climate Majority: apathy and action in an age of nationalism, looks at one of the factors that could make the difference – and how those of us who are worried about climate change could swing the balance.

While the world has done better than many predicted in halting the increase in emissions, its progress has depended on changes that have imposed little burden on most people. The most important of these has been the closure of coal power plants, and cancellation of new plants, which are increasingly being replaced by lower-carbon sources like gas and renewables.

But eventually, the world will exhaust relatively painless changes like this. At some point, the only remaining emissions cuts – which will be crucial for avoiding dangerous warming – will be from activities that directly affect many people in their day-to-day lives.

Two of the most challenging of these are flying and meat-eating. The world is going to have to radically cut emissions from both – but in the two areas, emissions look set to increase. Without action, either could effectively make it impossible for the world to prevent dangerous warming.

Achieving these harder, but essential, emission cuts won’t be possible without public support. Yet, at the moment, that support wouldn’t be forthcoming. It’s not that many people deny climate change: no more than 20% do, even in the US. The more important problem is that many people, perhaps half the population, understand that climate change is real and a threat, but just don’t think about it very much and don’t understand why they would need to change their lives to deal with it. Without their support, crucial emission-cutting measures will fail.

My book looks at the people who are apathetic about climate change and investigates why they think what they do. It explores how human psychology and the ways climate change is often described have made the problem seem distant, unthreatening, and a special interest of left-wing liberals.

And the book looks at what we can do to overcome apathy. There’s no magic word that will make the world act on climate change, but there are ways we can persuade those who are apathetic that it is worth making the effort to deal with the threat. It’s still possible to tip the balance away from disaster.

The Climate Majority: Apathy and Action in an Age of Nationalism by Leo Barasi is published by New Internationalist on 21 September

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Building a hive mind through immersive art

Lily Hunter Green, Birkbeck’s next Artist in Residence, discusses the project she will be undertaking during her tenure: Bee Composed Live. The residency supports collaboration between academics and artists and will culminate in May with an exhibition of Lily’s work and a symposium.

I first began my work with honey bees in 2014. At the time I was working as a Sound Artist, exploring resonant and sustained sounds within different structures and spaces. As a pianist, I was anatomising the inner workings of my piano. By chance, a bee flew inside. The sound produced was resounding and alveolated, unlike anything I had heard before. I immediately began researching the bees. I was surprised that I didn’t know more about the pollination crisis, especially given the severity of the problem.

My previous piece, Bee Composed (2014), involved transforming a piano into a working beehive in which bees dwelled while an installed audio-visual recording device captured the harmonics of their interaction with the piano strings. One of the central aims of Bee Composed was to raise awareness about the human-caused threat to the honey bees and, as a result, to us too, if we don’t do something to stop their decline. I have since begun to develop Bee Composed Live, the work that my residency at Birkbeck will be focused on: that is, a live performance piece that combines music, dance and original audio-visual compositions in a bid to explore the ways in which we can artistically and critically draw attention to our rapidly changing ecology, and our role within it.

I believe that the role of the artist is to present an alternative way of experiencing the subject. One that provokes new ways of thinking, feeling and responding. Art as a creative transformer, as a catalyst for change, if you like. My primary objective in terms of Bee Composed Live is to present audiences with an alternative way of experiencing and interacting with nature via a series of immersive creative strategies. This will include the creation of a simulacrum ‘hive mind’, a unique microcosmic space, or ‘super-organism’, that enables audience members to experience the inner dynamics and scientific happenings of the hive. The concept of the ‘collective consciousness’ or ‘hive mind’ is itself an appropriation of how the worker bees administrate the hive.

As such, Bee Composed Live is dynamic collaboration. It represents togetherness, the power of collective thinking and action, and the importance of community.

This residency provides a unique opportunity for me to develop my creative thinking and practice within a new and challenging environment. To develop Bee Composed Live, I will work closely with the Birkbeck Centre for Contemporary Theatre, a space in which theatre makers, critics and audiences gather to share knowledge, ideas and practices.  I also hope to explore collaborative opportunities with other academic departments that intersect with my work, such as the Department of Earth and Planetary Sciences, the Department of Film, Media and Cultural Studies and Birkbeck Research in Aesthetics of Kinship and Community. As someone who usually works in isolation, I am hugely excited at the prospect of working with such a range of creative practitioners and academics.

Most of the 10-month residency will be spent within The Centre for Contemporary Theatre. During this time students will have the opportunity to engage with a range of creative activities extending from inter-disciplinary workshops, digital screenings and seminars, through to the final performance and exhibition. My ambition is to inspire students and academics of all ages and disciplines to think ‘outside of the box’ and consider new ways of working with artists and creative forms, potentially creating new opportunities and collaborations across a range of disciplines, and thereby transforming complicated, often ‘dry’ scientific fact and theory, into a more accessible, digestible and dynamic form.

Another dimension of the residency will be to involve local communities and the wider public in Bee Composed Live: whether as active participants or as passive observers. Diversity is at the heart of my creative practice. As such, I am keen to ensure that as many people as possible are able to engage with this project in some way. As a consequence, every effort will be made to create a piece of work that can eventually go out into the community, by physically in a touring capacity, and/or, via a digital platform.

Collaboration and participation will be key to the success of this residency. I hope as many people as possible will become part of this creative hive mind.

 

 

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