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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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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Animating medieval manuscripts

Professor of Medieval Studies Anthony Bale discusses his work with Birkbeck’s artist in residence, animator Shay Hamias. Together, they are developing a new interface between contemporary digital animation and medieval studies.

This year Birkbeck received one of only 19 prestigious Leverhulme Trust Artist-in-Residence awards. The residency is supporting animation artist Shay Hamias to work with me in Birkbeck’s School of Arts. Hamias is an animation director, with experience working on short and feature films, advertisements, and the museum and heritage sectors. Hamias’ work creatively explores the visual possibilities of design, motion and narrative, seeking new ways to interpret the medium. Hamias had long been fascinated by the artistry of medieval manuscripts, their combination of the written word and visual effects, and their engagement with religious belief. So the Leverhulme Artist-in-Residence award provided a superb opportunity to develop a completely new interface between contemporary digital animation and medieval studies.

Hamias and I share an interest in the meanings of images and symbolism, in particular, the religious symbolism in Christianity and Judaism. Our project has sought to put modern design in conversation with medieval artefacts in a bold new way. We have tried to test that idea, proposed by many scholars of medieval culture, that the pages of medieval books are ‘alive’ and animate, full of ‘active’ visual and mnemonic effects for the reader. Can contemporary animation engage in a fruitful and stimulating encounter with the often perplexing but beautiful images we find in medieval manuscripts? In medieval manuscripts, design and illustration are provided as tools for the viewer/reader to enable them to decode biblical narratives, using a visual language that would resonate with them and locate them mentally.

In the creative process, the artist looks at a subject from a personal point of engagement with it, combined with established ways of seeing.  Animation lends itself to translating inner thought and inner states, in a creative process based on lateral approaches to thinking and the use of associative emotions and imagination. Hamias and I have been thinking about how parallels might be drawn between modern visual language and medieval visuals. Might traditional techniques be applied to modern narratives, in a creative anachronism?

Formally, medieval manuscripts have much in common with modern animation: both condense time and space, through discontinuous visual and verbal narrative; both can rapidly illustrate change over a long period and produce memorable narrative through a ‘familiar’ iconography and media in service of popularly-held or generally-endorsed views; both can reveal metamorphosis and sudden change, sudden effects which are accepted by audiences because of their familiarity with the world created by the medium.

The emphasis of the residency is on Hamias’ artistic and creative freedom to respond to medieval sources in his own distinctive way. Hamias and I have met at least weekly during the residency, sometimes in libraries and archives with medieval manuscripts in front of us. The first animation project we have produced focusses on pilgrimage and visual movement. We have taken the idea of ‘visual storytelling’ and given it a contemporary take. We feel that our methodology remains ‘medieval’: our project is constructed entirely from things we have read in medieval texts or found in medieval visual culture. Moreover, Hamias put himself in a similar position to the medieval artist, who was imagining things based largely on received stories and depictions. Our first short animated film is called ‘The Matter of Jerusalem’, after William Wey’s 1460s manuscript book which describes the journey from Venice to Jerusalem.

We now have plans to develop this film and to collaborate on an exhibition about Birkbeck’s own medieval books in summer 2018.

You can follow Anthony and Shay’s project on their Instagram page @animatedpage

 

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