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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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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Why looking for aliens is good for society (even if there aren’t any)

Professor Ian Crawford from the Department of Earth and Planetary Sciences writes on the significance of astrobiology for the benefit of society. This article was originally published on The Conversation.

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Shutterstock

The search for life elsewhere in the universe is one of the most compelling aspects of modern science. Given its scientific importance, significant resources are devoted to this young science of astrobiology, ranging from rovers on Mars to telescopic observations of planets orbiting other stars.

The holy grail of all this activity would be the actual discovery of alien life, and such a discovery would likely have profound scientific and philosophical implications. But extraterrestrial life has not yet been discovered, and for all we know may not even exist. Fortunately, even if alien life is never discovered, all is not lost: simply searching for it will yield valuable benefits for society.

Why is this the case?

First, astrobiology is inherently multidisciplinary. To search for aliens requires a grasp of, at least, astronomy, biology, geology, and planetary science. Undergraduate courses in astrobiology need to cover elements of all these different disciplines, and postgraduate and postdoctoral astrobiology researchers likewise need to be familiar with most or all of them.

By forcing multiple scientific disciplines to interact, astrobiology is stimulating a partial reunification of the sciences. It is helping to move 21st-century science away from the extreme specialisation of today and back towards the more interdisciplinary outlook that prevailed in earlier times.

Earth rising above the surface of the moon, as seen from Apollo 8 in December 1968.
NASA

By producing broadminded scientists, familiar with multiple aspects of the natural world, the study of astrobiology therefore enriches the whole scientific enterprise. It is from this cross-fertilization of ideas that future discoveries may be expected, and such discoveries will comprise a permanent legacy of astrobiology, even if they do not include the discovery of alien life.

It is also important to recognise that astrobiology is an incredibly open-ended endeavour. Searching for life in the universe takes us from extreme environments on Earth, to the plains and sub-surface of Mars, the icy satellites of the giant planets, and on to the all-but-infinite variety of planets orbiting other stars. And this search will continue regardless of whether life is actually discovered in any of these environments or not. The range of entirely novel environments opened to investigation will be essentially limitless, and so has the potential to be a never-ending source of scientific and intellectual stimulation.

Sand dunes near to Mars’ South Pole.
NASA

The cosmic perspective

Beyond the more narrowly intellectual benefits of astrobiology are a range of wider societal benefits. These arise from the kinds of perspectives – cosmic in scale – that the study of astrobiology naturally promotes.

It is simply not possible to consider searching for life on Mars, or on a planet orbiting a distant star, without moving away from the narrow Earth-centric perspectives that dominate the social and political lives of most people most of the time. Today, the Earth is faced with global challenges that can only be met by increased international cooperation. Yet around the world, nationalistic and religious ideologies are acting to fragment humanity. At such a time, the growth of a unifying cosmic perspective is potentially of enormous importance.

In the early years of the space age, the then US ambassador to the United Nations, Adlai Stevenson, said of the world: “We can never again be a squabbling band of nations before the awful majesty of outer space.” Unfortunately, this perspective is yet to sink deeply into the popular consciousness. On the other hand, the wide public interest in the search for life elsewhere means that astrobiology can act as a powerful educational vehicle for the popularisation of this perspective.

Indeed, it is only by sending spacecraft out to explore the solar system, in large part for astrobiological purposes, that we can obtain images of our own planet that show it in its true cosmic setting.

The Earth photographed from the surface of Mars by the Mars Exploration Rover Spirit, March 2004.
NASA/JPL/Cornell/Texas A&M

In addition, astrobiology provides an important evolutionary perspective on human affairs. It demands a sense of deep, or big, history. Because of this, many undergraduate astrobiology courses begin with an overview of the history of the universe. This begins with the Big Bang and moves successively through the origin of the chemical elements, the evolution of stars, galaxies, and planetary systems, the origin of life, and evolutionary history from the first cells to complex animals such as ourselves. Deep history like this helps us locate human affairs in the vastness of time, and therefore complements the cosmic perspective provided by space exploration.

Political implications

Alexander von Humboldt, 1843.

There is a well-known aphorism, widely attributed to the Prussian naturalist Alexander von Humboldt, to the effect that “the most dangerous worldview is the worldview of those who have not viewed the world”. Humboldt was presumably thinking about the mind-broadening potential of international travel. But familiarity with the cosmic and evolutionary perspectives provided by astrobiology, powerfully reinforced by actual views of the Earth from space, can surely also act to broaden minds in such a way as to make the world less fragmented and dangerous.

I think there is an important political implication inherent in this perspective: as an intelligent technological species, that now dominates the only known inhabited planet in the universe, humanity has a responsibility to develop international social and political institutions appropriate to managing the situation in which we find ourselves.

The ConversationIn concluding his monumental Outline of History in 1925, HG Wells famously observed: “Human history becomes more and more a race between education and catastrophe.” Such an observation appears especially germane to the geopolitical situation today, where apparently irrational decisions, often made by governments (and indeed by entire populations) seemingly ignorant of broader perspectives, may indeed lead our planet to catastrophe.

This article was originally published on The Conversation. Read the original article.

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What’s in a face? Birkbeck researchers delve into what facial expressions reveal

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Birkbeck scientists in residence at the Science Museum have recently run a live experiment with members of the public, to discover how much we understand about people simply by looking at their faces. Two members of the team report on their experiences.  

Ines Mares, postdoctoral research assistant in the Department of Psychological Sciences: As humans, we possess the remarkable ability to extract a wealth of information from even a brief glance at a face: we can identify people, judge the emotion they are feeling, assign character traits (rightly or wrongly), and in doing so, continue to thrive as a social species. Because faces are so interesting and processing them well is so important to us as humans, they made an ideal topic to explore in the context of the Science Museum’s ‘Live Science’ initiative.

In the Science Museum we ran a series of experiments to understand what factors make faces more rewarding or appealing – such as how attractive they were, the emotions they were displaying or how old the faces were. We were especially interested to see how these judgements related to our ability to recognise faces, and to see how our results would change for younger and older participants (our experiments tested children from five years of age to adults of almost 90!).

Dr Ines Mares explains the experiment to a participant.

Dr Ines Mares explains the experiment to a participant. 

“This was a great opportunity for us to engage directly with people and discuss the type of research we do and the questions that motivate us. It is also a unique chance to reach out and test a much more diverse set of people than we are conventionally able to do, with anyone aged from five to 105 invited to take part in our studies.”

Dr Marie Smith, Senior Lecturer, Lead Scientist with Dr Louise Ewing (UEA) and Professor Anne Richards (Birkbeck)

Conducting this type of study, in which we focused so closely on individual differences with such a broad audience was outstanding.  It was a unique opportunity to interact with people from very different backgrounds and ages – something that can be challenging to do in the university labs.

To begin with, we were concerned about people’s willingness to take part in our experiments, but after the first day at the museum we understood that people were interested in being involved and actually wanted to know more about our hypothesis and what motivated us to do this type of work. It was an amazing chance to discuss these topics with members of the public and get feedback on our work directly from them. Initially this idea seemed quite daunting to me, but I ended up loving it, since the majority of people who took part in our experiments (and we had almost 2500 participants) were really motivated and interested to know more – not only about face processing, but also about other aspects of science in general.

Being part of a team running experiments in the Science Museum was an amazing opportunity.  Without a doubt, I would repeat this experience, not only because of the amazing breadth of data we were able to collect, but also because of the opportunity it gave us as researchers to disseminate our work and discuss science in general.

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Professor Anne Richards explains the purpose of our study to an interested volunteer. 

Michael Papasavva, PhD student in the Department of Psychological SciencesEven when working in a hub-science such as psychology, lab life can become monotonous. Surrounded by friends and colleagues who share similar views and challenges, it’s very easy to lose yourself in the bubble of academia.

Michael Papasavva signs up another keen volunteer!

Michael Papasavva signs up another keen volunteer! 

I was thrilled when presented with the opportunity to get out of the lab and be a scientist in residence at the London Science Museum. This prospect invoked childhood memories of navigating this huge and stimulating environment on school trips and family days out; I knew that the experience was going to be awesome (in the nerdiest way possible).

Working as part of a team of 12 researchers, we ran experiments in the ‘Who Am I? Gallery.’ This is perhaps one of the more interesting areas of the museum; the space houses visiting scientists from various disciplines and facilitates their research. Members of the public are free to wander over and volunteer to participate in experiments (or query the location of the toilets or dinosaurs). Our team conducted a range of different face processing experiments that examined the role of development and individual difference on face memory and emotion processing. By the end of the residency, almost 2500 people had participated (832 children, 1487 adults), creating masses of data for us to explore once we were back in the lab.

In addition to generating novel information, it’s the responsibility of a scientist to disseminate that knowledge to the wider public. Our residency provided us with an opportunity to engage with a very wide demographic. I must admit, it was heart-warming to see our younger participants having so much fun with the masks and games we had set up to help draw in the crowds and that so many of our  older participants chose to stay back to discuss our project with us. People genuinely enjoyed giving back to science.

I would strongly recommend the Live Science project.

Photo credits: Science Museum Group Collection

The full science museum team: Dr Marie Smith (Senior Lecturer, Birkbeck), Professor Anne Richards (Birkbeck), Dr Louise Ewing (Lecturer, University of East Anglia), Dr Ines Mares (Post-doc, Birkbeck), Michael Papasavva (PhD Student, Birkbeck), Alex Hartigan (PhD Student, Birkbeck), Gurmukh Panesar (PhD Student, Birkbeck), Laura Lennuyeux-Comnene (RA, Birkbeck), Michaela Rae (RA, Goldsmiths College), Kathryn Bates (MSc student, Birkbeck), Susan Scrimgeour (MSc student, Birkbeck), Jay White (Intern, UCL Institute of Education).

Further information:

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