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Episode 003 - The Muted Conversation We're Bringing to Light.. Diabulimia & It's Impact.

Episode 003 - The Muted Conversation We're Bringing to Light.. Diabulimia & It's Impact.

October 18, 2021

This episode comes with a trigger warning, but it's an important conversation for us to have. When I was first diagnosed with type one, I was lucky enough to be 19 when I already had a pre-established relationship with food (not to say that diabetes didn't distort that relationship). Unfortunately, that's not always the case. Diabulimia is a very real and dangerous eating disorder that is not fully recognized or discussed by our endocrinologists. 

Inside this episode, we're talking with guest Natalie Swanson about her experience with diabulimia, the impact it's had on her life and how to get support if you relate to the signs. 

Here’s what’s inside today’s episode:

  1. What is diabulimia and why it's not talked about enough.

  2. The implications of chronic restrictive diets, weight loss and avoiding insulin doses. 

  3. Our personal stories with disordered eating after a type one diabetes diagnosis.

  4. How to recognize the signs in yourself or a loved one.

  5. How exercise can sneak it's way into diet culture.

  6. How to tackle food guilt and how we approach food with diabetes.

Thank you to Skin Grip for sponsoring this episode! Check out my absolute favorite patches and save 10% at check out by using the code "LISSIE"!

 

Hit the play button and let's get started!

 

 

Resources inside the episode: 

  1. Check out Skin Grip at skingrip.com and use the code “LISSIE” at check out! 

  2. Learn more about Keeping it 100 HERE

  3. Find Natalie HERE

Show Notes: 

  1. ⏰ (0:00): Intro 

  2. ⏰ (0:28): Brought to you by Skin Grip

  3. ⏰ (1:08): About our guest, Natalie

  4. ⏰ (1:59): Do you mind sharing a bit about yourself and just introducing yourself?

  5. ⏰ (1:09): Why isn’t diabulimia talked about?

  6. ⏰ (6:36): How did you recognize that there was this disordered relationship around around food?

  7. ⏰ (10:23): Type 1 vs Type 2 stigma

  8. ⏰ (15:07): There's this idea of going around the diabetes community that once you start insulin, or if you take a certain amount of insulin, you gain weight. I’d love to hear your insight on that.

  9. ⏰ (20:44): Do you mind sharing some like signs or thought processes or behaviors that may help us to recognize if we might fall into that category? Or if our loved ones may be falling into that category?

  10. ⏰ (24:35): So let's just say we're a type three. So we're somebody who is a loved one of a diabetic or you know, friend, family member partner, whatever it is, how can we differentiate the difference between preference and disordered eating? Like, where is the line? How can people understand? What are the appropriate questions to ask?

  11. ⏰ (27:59): If somebody recognizes that their patient or their loved one is having these emotions around food or are approaching food in this way, or they’re noticing the signs in their management - how can they support their loved one or their patient? Like what are some things that they can do to help them recover?

  12. ⏰ (32:01): At what point did you realize that you needed support? Like who did you turn to? What did you do to kind of start that process? 

  13. ⏰ (38:36): Is there a time where fitness and exercise is damaging? Or is that always healthy?

  14. ⏰ (41:41): Do you have any tips that you can share for tackling food guilt, especially with type one diabetes, where we do have to look at food a different way, and there's blood sugars involved? And what can you share if anybody needs some, some tips?

  15. ⏰ (46:31): What do you do to provide support?

  16. ⏰ (48:35): Do you have a website? What is your Instagram? Where can people find you?

  17. ⏰ (49:42): Wrap-up

Transcription:

 

Elisabeth Poyner  

Welcome to Keeping It 100 Radio. I'm your host, Lissie Poyner. Type one diabetic certified health coach, personal trainer and founder of Needles and Spoons Health and Wellness. Inside this podcast you'll find the real and raw conversations around diabetes management, including lessons we don't learn in our endo's office, my best tips and trainings and conversations from experts I trust inside the community so you can create more predictability in your diabetes management and feel empowered while doing so. Let's dive in.  Keeping It 100 Radio is brought to you in collaboration with Skin Grip, the only patch company that I trust with my diabetes devices. I started using Skin Grip about two years ago and before I found them my Dexcom with last maybe four or five days before falling off, making it really hard to lift weights, hike with my dogs or just wanting to do the everyday things that I love. But now I can confidently travel, work out and navigate life with diabetes without having to worry about dealing with insurance more than I have to, begging for replacements and resorting to fingerpricks. Plus, I'm in love with their mission to help us live fearlessly with diabetes. You can check out Skin Grip at SkinGrip.com and save 10% on your order by using the code LISSIE. L-I-S-S-I-E at checkout.  Hello, welcome back to Keeping It 100 radio. I'm so excited to have Natalie Swanson on today's episode. Natalie is a type one diabetic and recovered diabulimic. She now works as an ED recovery mentor and helps diabetics in freeing themselves from fear, guilt and shame. Welcome, Natalie. I'm so excited to have you!

 

Natalie Swanson

Hi, thank you so much for having me! I'm so excited to be here!

 

Elisabeth Poyner  

I've been looking forward to this episode for literally since I reached out to you like a month ago. 

 

Natalie Swanson

Oh my gosh, you're so kind. I've been I've been looking forward to talking with you too. It's so nice to kind of finally like talk face to face. And I know we've been you know, chatting via Instagram and other social media platforms, but it's like nice to actually talk to you.

 

Elisabeth Poyner  

I know, I know, face to face like, I wish it was in person but we'll get there one day. Do you mind sharing a bit about yourself and just introducing yourself?

 

Natalie Swanson

Absolutely. So as Lissie said my name is Natalie. I am an eating disorder recovery coach and mentor who specializes in the eating disorder diabulimia after my own struggle with diabulimia. I am a diabetic, type one diabetic and have been for 26 years coming up in this October. I had a pretty normal childhood when it comes to diabetes management. I I'm 29 now, so I've had diabetes for most of my life. And I had great supportive parents, I had an excellent team and just happened to be when I was 12, 13 ish. with, you know, a little bit of teenage angst. Some, you know, diet culture influence and some unforeseen circumstances. I ended up developing the eating disorder diabulimia and for those who don't know what diabulimia is, diabulimia is an eating disorder within type one diabetics when they omit or reduce the amount of insulin in order to lose weight. And this can be very dangerous because this can set off episodes of DKA, can lead to complications, and really be life threatening, and is actually one of the most dangerous eating disorders there is.

 

Elisabeth Poyner  

Thank you so much for first of all, sharing your journey and, you know, introducing us to what this is. And like I was, I think we have pretty different journeys in the sense of like, I was 19 I was diagnosed with diabetes. So in one, you know, on one end, that's kind of a good thing, in that I had already kind of developed my relationship with food at that point, it still did distort it a bit. But you know, have you grew up with diabetes, you had it from that, you know, teenage years. So it can, you know, make its impact on our relationship with food and just how we view food in importance to our body. But so with that being said, this was something that I didn't hear about until a few years into my diagnosis. And you know, at that point, we have Google, we have social media. So why isn't this talked about? Like why is this something that's kind of I feel like it's pretty muted. There's not enough conversations about it, which is why I wanted to bring this conversation to this podcast. But yeah, why like why isn't it talked about? 

 

Natalie Swanson

Absolutely. So unfortunately, when it comes to diabulimia, diabulimia is not recognized within the DSM. The DSM is a diagnosis code that can be used for insurance purposes. Just a diagnosis in general. And so a lot of the medical community does not know about diabulimia which is so heartbreaking because so many people with diabetes suffer with this. Also too, a lot of times the early symptoms of diabulimia is burnout. And just like mismanagement, that can be seen as laziness, and so doctors assume that, okay, like, you're not taking yourself because you know, you don't care enough, you, you know, don't want to. And that's not the case at all. There's a lot of things that go on mentally behind taking your insulin carb counting that it's sometimes it's just like hard to voice and explain. And that's kind of what what we're going to be talking about today to make it easier to, you know, talk to medical professionals about what you're going through. But yeah, unfortunately, I had to teach many of my own doctors what diabulimia is, and that's where the major issue comes to play.

 

Elisabeth Poyner  

Yeah, I just it's not, it's not organized. I remember. So I went on a pump after only six months of being diagnosed, because I hated injecting so much that I would avoid eating. And I'm lucky enough in the sense that like, I recognized that that wasn't healthy. And I recognized that, like, that's not sustainable. But I can only imagine that there's a lot of people who might kind of take that as an indicator of Oh, this is what my life looks like now. And this is what it means to have a healthy management, quote, unquote, healthy management for diabetes because at that point, my A1c came down my endo was like, congratulating me for bringing my A1C down. But it's really it wasn't the healthy healthy route. How did you? How did you recognize that there was this like, disordered relationship around around food or mentality?

 

Natalie Swanson

Yeah, so for myself, I, I knew something was going on when I could not like no matter what I tried, I could not get my diabetes together, I say, quote, unquote, diabetes together. I used to, you know, see other like, I've tried, like, doing volunteer missions to maybe like, inspire myself, or, you know, I talked to other diabetics. I used to like joke that, like, there are diabetics that walk in the light, and they just have it all figured out, and I can't, and I'm just never going to be that girl, I'm never gonna have my diabetes, in check. And really, there was a lot of other things going on. You know, I, unfortunately, with myself, and with a lot of people with diabulimia it's not so much about losing weight. It's more about having control. Diabetes, in general, it's just, it's so unpredictable that like, you do want some sense of control. So what can we control in this? You can control the amount of insulin, you can take control the carbs you're eating, how much you exercise. And so I wanted to be able to control something, and also outside of diabetes, unfortunately, during that time, my father passed away, and my mother was dealing with a brain tumor. So what else could I control during that time? I could control what I could eat, and I could control how much insulin I took. And that's when I noticed something else was like, clearly going on. And it was more about the food. And it is more about more than just the food for a lot of us. And on top of all that, like bring in like the diet culture and the diabetes diet culture, too, like we are told so many rules, that we feel so restricted and so limited, that it's also kind of like a sense of wanting to be quote unquote, normal when it comes to like, different spectrums of eating disorders. So it is known that 40% of women with Type One Diabetes will have some sort of disordered eating. It doesn't necessarily have to be diabulimia. But a lot of times, you know, people will, you know, restrict, and so they don't have to take as much as, they may not be omitting insulin, and still taking the correct dose, but they'll not eat carbs, or we see a lot of times orthorexia within type one diabetics, eating healthy in the sake of, you know, taking management of their diabetes. And so, there, there really is a wide spectrum when it comes to eating disorders within type one diabetics, and I think that again, the rules set in place and what we've been taught for so long, oh you can't eat more than 15 grams of carb for a snack. Oh, you have to stay in a certain limit for your lunch, dinner. Whatever, hit a certain number of carbs during the day. Oh, you're not allowed to eat pizza. Oh, you can't have cake. And then on top of that, like the joke people make too, like, oh, like, I, you're going to be a diabetic if you eat too much sugar. Like, it's also a cumulative that I have to commend the people who don't have eating disorders with Type One Diabetes, because it's just, it's literally coming at you at all angles, all the time.

 

Elisabeth Poyner  

Right. I remember when I was first diagnosed, like that was very conflicting for me of being like, wait, like, there are two types of diabetes. But I don't really understand the difference. I'm being told by society that there's kind of this, like, perception that you give yourself diabetes, right. I'm sure we've all heard that stigma at one point or another, which I hate that stigma. Because whether you're type one or type two, who asked for diabetes??? Like

 

Natalie Swanson

No one!

 

Elisabeth Poyner  

Like, so here, I am thinking, Oh, I can't eat bread, I have to limit my carbs. I have to eat salads every day for the rest of my life. Which, salads are great. They're, they taste good sometimes. Do I want to eat a salad every day for the rest of my life? Absolutely not. So like between that and then you know, again, looking at numbers for everything. Okay, now we have to count carbs. Now we have to calculate our food, we have to calculate our insulin doses, we have to like measure our blood sugars. Everything's [speaking at the same time] number. Yeah, add that on top of like, if you are somebody who watches or you know, measures your weight, or, like, there's so many different numbers involved now and that even be like, that can lead us into burnout. I remember I had a, a client and you know, for privacy purposes not gonna mention too much specifics, but she was misdiagnosed with Type Two. And when she had that diagnosis of type two, she, you know, started exercising every single day, because she was told Oh, you have to lose weight. This is how you reverse it. She was told, you know, just eat healthy all the time. Or, you know, go on a diet, limit your carbs, all those things. So even that, like stigma of type two diabetes, you do this to yourself. I feel like it's really damaging to not only to the type two community but the type one too, because then we have this kind of like, I know, this is a little bit off topic, but I feel like it just goes on to say like, it's really, really damaging how the media portrays and stigmatizes diabetes in general that it's healthy for any diabetic, unhealthy for any diabetic.

 

Natalie Swanson

Absolutely. And definitely like type two diabetes like it is managed a little bit differently. I know they don't have as much control, because they don't take insulin. Or some of them don't take insulin. And so yeah, diet is the best way to, quote unquote, manage their blood sugars. But the the, just like you said, No one wants this disease. No one's asking for this, this is a phrase too that I absolutely hate that people bring up all the time, and that I've been told so many times, it literally hurts my heart, is people say, Well, at least it's not cancer, right?

 

Elisabeth Poyner  

Ugh that's the worst!!!

 

Natalie Swanson

And I actually, you know, I have, one of my closest friends was just diagnosed with thyroid cancer, and she's going through so much, but she actually said something that was very meaningful to me, is because she had thyroid cancer, she did have to, like, watch some of like her eating. And she was like, Oh, my gosh, Natalie, like, I have a whole new respect for what you diabetics like have to do because I didn't necessarily have to do exactly what you do. But I had to monitor like, what I was eating, and then I was all kind of thrown into all this medication. And diabetes is really, really hard, like really hard. And we, a lot of us put on a brave face. And we try to do everything, as you know, as, again, quote unquote, normal as possible. But just some of these comments that people make, at least it's not cancer, oh, you know, don't eat that, because you're going to give it to yourself. Like, it's just, it's, it breaks my heart because there's a stigma that doesn't need to be there. And so it all leads, again, back to disordered eating. Because we even if we're like diagnosed later in life, like we have this idea in our mind, like, Oh my gosh, I, if I eat the certain foods, I'm going to be a diabetic. And if I eat  certain foods, I won't be able to control my diabetes. So you start building this up and you create these ideas in your mind that these foods are good, these foods are bad. I have to eat a certain amount of carbs every day. And you get this idea of like having to be perfect. So of course we're going to develop disordered eating, of course, we're going to have the stigma around this stuff, because society has brought this upon us.

 

Elisabeth Poyner  

Right? It's almost installed in our brains. So here, here's another question for you and I didn't put this in our notes. So I'm actually [...] your response. But there is this kind of, I don't know if it's a myth or what to call it. But there's this idea of going around the diabetes community that once you start insulin, or if you take the, if you take a certain amount of insulin, you gain weight. And I feel like that 

 

Natalie Swanson

I love this topic, 

 

Elisabeth Poyner  

Let's, let's dive in, I want to hear your your insight to it.

 

Natalie Swanson

Yes. So especially when it comes to when, if you are just diagnosed with diabetes, and you gain weight, one, it's because your body needed to. When we are in ketoacidosis, or have higher blood sugars, we do lose weight, because it's the deterioration of our muscles, it's the deterioration of even our organs, because of like the high blood sugar and insulin allows it allows the absorption of the nutrients into the body. So you're just eating food, and not absorbing any of it because you don't have the insulin So you're actually malnourished, most likely when you were first diagnosed. So gaining weight, because you take insulin is because you're getting nourishment again. Okay? So I think that is something that's very important to understand. Also, when it comes to eating disorder recovery, when you enter recovery, there's something called insulin edema. Okay, so this actually can also happen when you first start insulin therapy, you begin to swell, and you can see weight gain overnight. And that is just again, because you are having the absorption of nutrients. And a lot of times, that's sodium, my friends, you are holding water weight. And so it's very deterrent. Also, if you're entering eating disorder recovery, that you start taking your insulin, and oh, my gosh, the next morning, your pants don't fit, your face to the moon, you have moon face. And you're like, why did I decide to recover? Like look at I'm gaining weight already. And it's, and it's nothing, it's not real weight, it's all water weight. And so I think people need to understand that insulin, what insulin does is it only allows the nutrients to be absorbed into the body, it's not going to cause any fat or weight gain. It's just if you are gaining weight from influence, it's because you're most likely malnourished. So I think that's very important to understand.

 

Elisabeth Poyner  

Yeah, I remember after like a few months of my diagnosis, I had done a Facebook post and I put like two pictures side-to-side. One picture of like right before I was diagnosed when I was like skin and bones, you know, like 95 pounds, like nothing to me. And then I put a picture of like, six months later, when I had more, you know, just more of my normal body back, my normal weight. And I put an eye like had mentioned Oh, like, the stigma around diabetes, like this is kind of what happens, you lose weight, your body isn't getting what it needs. And then now that I'm on insulin, and I have been diagnosed, you know, I'm healthy. And I tried to phrase it in that way. And one of my old family friends commented on that picture. And he's like, Wow, I didn't know that diabetes gave you abs. And like in reference to the first picture. And I'm like, again, I'm very happy that like, I didn't take that to heart. I didn't, you know, judge my current body for it. But there are people who may take that in a different light and say, Oh, I looked better before my body was getting what it needs. And it's just whether that whatever the intentions are, I don't think that person had bad intentions, but it's damaging, it's damaging and it you know, it if that those words fall in the, you know, the fall into the wrong person it can be it can change everything about how they go about their management. So, yeah, I'm really glad that we touched on that topic.

 

Natalie Swanson

Yeah, absolutely. And I think another important thing too, when someone like comments, like they made a comment on your posts, again this has to go with the, with the IDs, society has always praising us for being smaller, always praising us for shrinking ourselves. Because we've been subscribed to this way of thinking that it's like the smaller we are, the less carbs we eat, the less, the less we are then we're more worthy of love, more worthy of being congratulated, more worthy of being noticed and that's not true at all. And again, like I just needed to make that point because it's we just need to stop this commenting on bodies in general because to be small isn't isn't anything to be praised about and to be large isn't it anything to be praised. It's it's all body neutral, neutral over here, so.

 

Elisabeth Poyner  

Right, exactly. Like comment on people's personalities and like how like you look happy, like you look like I don't know, I love when people use the words like happy or like, like powerful or like, you know more of those words than things that I want to be not about my body and yeah.

 

Natalie Swanson

I love your energy. That's my favorite. 

 

Elisabeth Poyner  

And it Yes, 

 

Natalie Swanson

I love your energy. Yeah, give me that! 

 

Elisabeth Poyner  

Yes. I love it. Okay, so obviously, you had talked about kind of the spectrum of eating disorders, especially within the type one community. So we we know that these, like eating disorders aren't black and white, they're not something that just fall into one specific category. And like you mentioned, some people might not even know that they're falling into that spectrum, or they might not even really acknowledge or be aware of these thoughts that are happening. So do you mind sharing some like signs or thought processes or behaviors that may help us to recognize if we might fall into that category? Or if our loved ones may be falling into that category?

 

Natalie Swanson

Yeah. I think, you know, first and foremost, like, if you're listening to this right now, and you think, I'm not sick enough to get help, or I don't think I'm there yet, you are. Because if you're even thinking that, at all, you definitely need help. And it's nothing to be ashamed about. It doesn't need to be like, You're way deep in it. You know, even if you're struggling a little bit like it's okay to ask for help. And you don't even need to have a full blown eating disorder, like a lot of people just have like, unhealthy relationship with food. And it's okay to get help. Another thing too, that very, like I said, common earlier, is burnout. If you're struggling with, you know, taking your insulin, if you're struggling with wearing your your devices, or measuring your blood sugar, that can be a very, like, common sign. And, you know, it's something that's very much looked, um whats the word I'm? Not looked, looked at, looked upon? Swept under the rug. Any type of like, you know, disordered eating is very, like common as well. So if people are saying, Oh, I'm not going to eat the pizza because of diabetes, and they, especially I remember for myself, I loved using that as an excuse. Oh, I'm not eating right now because my blood sugar is high. Oh, I'm not in like, I would use those excuses. So often, just so people wouldn't, they wouldn't question me about it. Because Oh, Natalie knows what she's doing. She's had diabetes for forever. So if she says she's not gonna to eat, she's not gonna eat. Like pay attention to those little things like, Oh, no, I'm not going to eat. I'm going to have, you know, the lettuce wraps instead of the sandwich. Like those little things like of course, like, but people do genuinely enjoy that. But if it's like a constant thing, definitely keep an eye out for that. Also missing social gatherings. You know, isolation, very, very common too because, you know, why? Why would you want to put yourself into a situation where people are looking at you or watching what you're doing, like, of course, you're going to be withdrawn. So those are some important signs as well as like high A1C, you know, the common high blood sugar, like first diagnosis, symptoms, like constant urination, constant thirst, like, oh, my goodness, okay, I remember I used to carry a jug of water with me, everywhere. And it I people have like their support water bottles, or whatnot that they call it and I had like, my Yes, but mine was because my blood sugar was so high that I had to be constantly drinking something all the time. And that's so exhausting. So just like, kind of watch out for those common high symptoms that, you know, were diag, that you would like, see if you're first diagnosed. But, yeah, those are just some like common things to look out for. And also to like, if you're worried about someone, ask. Sometimes we just need someone to ask us because we're so nervous and afraid to ask for help and you know, just be like, hey, how's everything going? What's what's going on? Are you struggling? That's actually so important.

 

Elisabeth Poyner  

Yeah, sometimes we just need that entryway like just to know that somebody somebody cares. So just to pick your brain about a little bit. So let's just say we're a type three. So we're somebody who is a loved one of a diabetic or you know, friend, family member partner, whatever it is, how can we differentiate the difference between preference of like some people do prefer a low carb, they prefer kind of the healthier alternate alternative, so let's just use the lettuce wrap example How can we tell the difference between preference and disordered eating? Like, where is the line? How can people understand? Or like, what are the appropriate questions to ask? Yeah.

Natalie Swanson

Yeah, I think what what's important is understanding the all or nothing mindset that a lot of us live in. So, if your loved one does prefer, you know, have living that low carb lifestyle, and they have to stick to that, like, if they feel anxious, if you notice that, like, if, you know, there's a change of plans, like say, you're out at a restaurant, and they're out of the lettuce wrap entree, and so they have to order something else, and they completely freak out, they don't even order something. Like, that's something to be like, oh, red flag, or, you know, they can't enjoy little little, like special moments like birthday cake, or, you know, there, there has to be some gray area like living just low carb, like, even if you are low carb, like, there is definitely ways to make that sustainable, where you're not just always eating that way. And I think noticing those, those times where people are anxious, or kind of have like, complete, like fear is very important. Also, like just asking them about it. It's so important to, you know, be curious, and I should get that tattooed across my forehead is be curious. Because, you know, I think that's important with diabetes management, in recovery, or healing your relationship. Also, as you know, a partner. I think, you know, even like my husband, sometimes he is so, so, so supportive and he'll he'll kinda ask me like why, why are you choosing to eat that today? Or, you know, and I have an answer for it. Oh, you know, my blood sugar is actually higher today. And I don't feel like I got to, you know, bring it down or listen to the answer. Like, I think we're all very intelligent, like you can notice when like something is out of fear or anxiety. So be curious, act.

 

Elisabeth Poyner  

Yeah, I think that matters. Like, I, I'm somebody who, I don't care what diet you're on, you can do low carb, you can do whole food, plant based, you can do like standard American diet, whatever it is, it should be an empowered one. And if there's any room for like, fear, or you're right, like anxiety or overwhelm around food, that's something telling you that something might be off with how you're approaching food. So yeah, I love that answer. If it's coming from the wrong place, it's not necessarily about what you're eating or what you're not eating. It's where, where it's stemming from. So 

 

Natalie Swanson

Absolutely, 

 

Elisabeth Poyner  

Yeah. So okay, so we kind of talked about how this is something that's not really noticed or brought to the attention of physicians, loved ones aren't necessarily warned about it, or like, taught about it. So if somebody recognizes that their patient or their loved one is under, you know, having kind of these emotions around food or approach approaching food in this way, or they're noticing the signs in their management, how can they support their loved one or their patient? Like, what are some things that they can do to help them, help them recover?

 

Natalie Swanson

Yeah, and I know we like kind of just touched on this, but even if it's just being a listening ear, if you can't physically do anything, like it's so important to be able to come from a place of non-judgment, if you have a loved one who, let's say, for example, literally, it causes them to have a mental breakdown to take their insulin, okay? I, I would want someone who would just be there to listen to them, hear what they're saying, because these thoughts that we have, are irrational, I'm not going to lie. And I say this, from a place of love. The eating disorder mind is absolutely crazy. We will make things up, we will believe in things that are not true at all, literally from a it's just, it can be the craziest stuff ever, but we just need you to listen and to understand why we are feeling this way. And to be encouraging. I think one thing that we I know, as a mother, like if, if I think of my son dealing with us, I would be like, Okay, well, I'm going to get I'm just going to give him insulin or I'm going to you know, make sure that he's measured his blood sugar and he's doing this and that and you can't push us. We have to kind of, in a weird way come to terms ourself. And so again, just by listening to us, be encouraging, be there when we decide, hey, I want to take my insulin. Great. Be there next to me, support me, give me, tell me positive things and say I'mdoing a good job. If I'm not eating a sandwich for the first time in years because bread gives me the heebie jeebies, eat a sandwich with me, like, have, you know, just be there to be a support. That's so, so important and like for the medical community, again, listen, and just understand where I'm coming from. Don't tell me that I, you know, am not dealing with what I'm dealing with. Unfortunately, I had an endocrinologist who did that. And I probably put off getting help for a good two years because my endocrinologist just believed that I, you know, was an angsty teenager, and I told them I was struggling. And just, again, just listen, it's so important. Again, and again. Listen, listen, listen, let let's be that safe person, be that person that's not coming from judgment, be that safe person that's not going to guilt, shame, overly push you just be there. Yeah,

 

Elisabeth Poyner  

Yeah. Forcing that like, you know, that mentality of, Okay, well, you're diabetic, you have to take your insulin or like this is going to lead to complications down the road, or pushing those kind of agendas, which yes, the intention might be there to support your health, but it's not like. I hate the just do it mentality of like, just take your insulin, just eat the food, just, you know, just do it. 

 

Natalie Swanson

Yeah. 

 

Elisabeth Poyner  

Because that's not like, we humans don't operate in that way. On some some subconscious level, there's something blocking us. And if we can't get to the root of that, or get the support that we need to facilitate that transition, it's not going to be sustainable. And we're just in the act out of resentment, like a physician telling us to just take your insulin and get our acts together. You're right, like, just like you said, it costs you to not get help her recover for another two years. And, you know, it's just a process to kind of fight back rather than get the help that maybe we need if it's coming from an understanding place and supportive place.

 

Natalie Swanson

Absolutely.

 

Elisabeth Poyner  

So going back to your own journey, you know, you had talked about kind of like what you recognized in your own behaviors, your own thought patterns. Where did that like at what point did you realize that you needed support? Like who did you turn to? What what did you do like to kind of start that process? 

 

Natalie Swanson

Yeah, so I, what happened to me was, I was struggling the worst when I was in college, it was, I was by myself, there was no one watching me. I was I just graduated from Michigan State and I was getting read, I graduated with a degree in dietetics. So to be like a new, registered dietitian, and I was sitting in the living room after graduation and looking at applying for different internships for my my RD. And I was thinking to myself, like, I don't think I can do this. And I was at that point, probably every month at least going to the hospital for a week for DKA. I started seeing signs of neuropathy, and gastroparesis. And I literally just, I pulled up an article, I was looking into somethings myself, and I pulled up an article on my goodness, about diabulimia. And I read that and I was I just started crying because I was like, This is what I'm going through. And I remember I knocked on my mom's bedroom door, and I was like, Mom, I need to talk to you. I was like, I can't apply for any internships because I really think I'm, I'm sick. And she's like, Oh, are you like, what's going on? Like, do we need to go to the hospital? I was like, no, no, no, like, please read this. I didn't have words to tell her what I was struggling with. So I was like, read this article, please, this is what I'm going through. And luckily for me, I had such a supportive mom, she was so awesome. And she was like, Okay, I'm calling, I'm calling my therapist tomorrow, we're gonna get you, you know, get you seeing someone and let's call your diabetes team. And at that time, I had an amazing diabetes team. And so they really rallied around me and I was in like, quasi-recovery and what quasi-recovery is it's like, you're definitely like, towards the right steps, but still, like leaning into old behaviors because they're comfortable. Unfortunately, with myself, I started seeing more and more complications. And the gastroparesis really picked up and I started having vision problems, and I actually ended up losing the vision in my right eye due to retinopathy. And when I lost the vision in my right eye, I said, Oh, no, no, no, no, we're not doing any of this anymore. This, I am sure people who are blind can live a very full and beautiful life. But that is not for me. And so I weirdly was kind of forced into recovery. And I found a way of eating with, but like, I fell in love with the gym, and If It Fits Your Macros, and I found some sort of freedom with that, and I was able to, you know, take my insulin and, you know, be able to, like get my diabetes on track, but I didn't necessarily completely heal my relationship with food because I had a whole nother issue with it, if a If It Fits Your Macros, where I was obsessing over that. And it wasn't until I actually hired a coach of my own. And that's why I love coaches, I think they're so important. Who necessarily wasn't necessarily a diabetes coach, or, you know, an eating disorder coach, but she was a fitness coach who focused primarily on mindset, and was healing their relationship with food. And that's where I fell in love with the journey and fell in love with mindset, train, training, and really, you know, changing your perspective when it comes to food. And so, you know, that's kind of where my journey led me and now, I have gotten into contact with the organization, We Are Diabetes, and we primarily focus with, you know, peer mentorship, and I have my own recovery, coaching as we can get into that later. But yeah, I think again, all in all, it's just finding the right support and finding, you know, people who will listen, and it's just, you know, if you don't get the response you need the first time, you keep on talking, and you keep on being your own advocate, and you keep on, you keep on sharing your story until you get heard, until you get the help you need.

 

Elisabeth Poyner  

Yeah, this, this whole thing kind of reminds me of a, it was like an Instagram post that I saw the other day, but it was like, a picture of a speed speedometer from like a car, you know, that tells you what speed you're going. And there's one like that's like halfway, or maybe it's a gas tank, I don't even remember, but it's one like, two of them - one's halfway and it's like, one, we should take rest. And then there's another one, that's what when it's like all the way empty or all the way and it's like when we actually take rest. So I think it kind of goes for like when we should ask for help versus when we actually asked for help. Like, we don't need to get to that point, kind of like in your journey, you said like it took you really like a few years and to get to the point of being like, alright, this has the ability to impact my vision, it has the building to really impact my future. I don't want to get to that point. So then you were kind of forced to get help. But really, like, we don't have to get to that point. But if you said if we have any of those thought process of like, Oh, I don't need help yet. That's the time. So it just kind of reminded me of that.

 

Natalie Swanson

No, that's beautiful. I love that.

 

Elisabeth Poyner  

I actually had another since you had kind of brought up the fitness industry and getting into your fitness journey. Just a quick question in that, is there a time where fitness and exercise is damaging? Or is that always healthy?

 

Natalie Swanson

No, I think definitely. So when I was in quasi-recovery and found the fitness and If It Fits Your Macros, I think it was difficult because one - I was looking, it's a double edged sword. Okay, so I loved the certain physique, which was like the bodybuilder which was very popular 2015-16 everyone was doing their workouts and heavy lifting. And I loved that physique. So, what was great was, I did realize that if I wanted to look look like that, which wasn't so great, I had to one - eat and I had to two - take my insulin. So I could look like that. Now, what came into play where it wasn't so healthy was the obsession of having to never miss a workout and never miss a Monday. You know, meeting my criteria for my macros and you know, getting the idea that I have to cut or bulk and do all that stuff. And for me too, was hidden I used to wear when those polar watches which pre-Apple Watch, I'm kinda dating myself now, am I? And, you know, I had to hit a certain amount of calories. So it became an obsession, a different type of obsession. Where, yes, I was kind of healed from my eating disorder, but it was a different kind of disorder.

 

Elisabeth Poyner  

New level, new devil.

 

Natalie Swanson

Yeah, I made it to a new level where I guess it wasn't as like damaging, like to me, like physically but mentally, it still, it still was. And I think you know, as I know you help, with people Lissie is, you know, coming from a different, viewing exercise differently and viewing exercise from a place of empowerment instead of shrinking yourself, instead of, you know, wanting to lower your blood sugar or, like doing crazy things like that, like there's, you can still move your body in a healthy way that doesn't have to be, you know, so crazy.

 

Elisabeth Poyner  

Right! Yeah, I had somebody come to me too. And they're like, I feel like to even control my blood sugars I need to walk like three times a day. And I need to go squat in the bathroom after dinner at my friend's house, because I need to bring my blood sugars down. She's like, I'm exhausted, like, does everybody feel this way? And it's like, no, like you don't, that's not that like, that's where, like yes movement can be such a powerful tool, and it can help our blood sugars and it can help our, like endorphins and all these things, it can have really positive impact. But at what point? You know, there's a line with that, too. 

 

Natalie Swanson

Absolutely 

 

Elisabeth Poyner  

I'm glad that you shared that it's not always healthy, it's important to recognize like, what, yeah, that there are spectrums to that too. So if anybody's listening, and they find that that's like a tool that they feel like they have to use all the time, they're always squatting, they're always walking, they're always like trying to move their bodies just for the means of their blood sugars. Like that's not, that's not good either.

 

Natalie Swanson

That's not how we do it friends!

 

Elisabeth Poyner  

No! So, do you have any tips that you can share for tackling food guilt, especially with obviously type one diabetes, where we do have to look at food a different way, and there's blood sugars involved? And, you know, what, what can you share if anybody needs some, some tips persay? 

 

Natalie Swanson

Absolutley. So a lot of times when we have food guilt, it is because we've labeled foods, good or bad. And it's because certain foods holds a certain title, it holds, it holds, you know, judgment, or we've been taught that certain foods aren't, you know, the best for our bodies, but I want to remind everyone, that every single food, even a cupcake holds some sort of nutrient and provides something to your body. And so I encourage everyone to change the way you view food, carbs in general. And instead of focusing on, okay, this food has this amount of calories, has this amount of carbs, maybe start seeing foods like, okay, I, you know, the grilled cheese, I enjoyed a grilled cheese, because makes me feel good, it's nostalgic. It also, you know, carbs provide energy to my body, there's calcium for my bones, like, start looking at foods with how they benefit you, and from how they get you from point A to B. Stop focusing so much on you know, of course, we have to always, to a certain degree focus on how it's going to affect our blood sugar. But also too like, you know, bring in a little bit of like, why do you want to eat this? If you're craving something, eat it! Like, there's no, there's no shame in that. You know, there's definitely ways that like, you know, we can make sure that they don't have, you know, such an impact on your blood sugar. And that's what coaches like you help and other other people help with. But there's definitely like ways where you can enjoy every single food and there's nothing wrong with any food out there. Every food has a purpose for you, every food has nutrients. And just some foods have, you know, more nutrients than others. So, eat the cupcake, eat the pizza, it's still you know, giving your body what it needs.

 

Elisabeth Poyner  

Yeah, and there's an important point to that you mentioned it's like food serves different purposes. Like food is like yes, it provides our body's fuel but it also like we center social gatherings around food. Food is the center of relationships, of traditions, of holidays, of cultures, like there are so many different purposes for foods and to put a label on those that's good or bad. Like, every year for Christmas Eve, my family gets Chinese food. And while I can say okay, nope, no Chinese food for me. My blood sugar is like it's a high fat meal. I'm going to have blood sugar spikes all night. That's a tradition that like reminds me of my grandmother and like, just like bonds us together. And that's like, that takes the cake. You know, like, I'm not going to worry about my blood sugars or how, like the actual nutritional value of that food because it serves a bigger purpose in that that time.

 

Natalie Swanson

Absolutely. Yeah, and I think to like take this with a grain of salt but you know, choose you know, times where like it is worth it. Like, there is definitely times where it's worth to like be a little, you know, more relaxed with the blood sugars and whatnot like, we're not, no one is perfect with their diabetes management, not a single one of us, we all will have blood sugars, I mean how the blood my blood sugar is high because the sky is blue, like, it's just diabetes is crazy. So there are times in our lives that it's okay if your blood sugars a little higher, because you're enjoying those moments. Like, it doesn't have to always be like, so strict. And so oh I always have to have my, my numbers in range, or I always have to have that perfect CGM line like it's going, it's going to happen, it's going to happen for us for no reason. And sometimes, if it's your birthday, go ahead. Enjoy your birthday. That's okay. That's a perfectly fine day to be a little less. Okay. Yeah, Christmas, it's a perfect time to be a little less like, you know, be smart about it, obviously.

 

Elisabeth Poyner  

Yeah, like, what is it worth having that perfect 5.5 A1C and the perfect lines, if you're not living your life and enjoying yourself?? Like that, like how we need to be full, like we need to, like feel impactful in our lives and feel like, it feel like it's fulfilling. Like, how can we do that if we're feeling so restricted? And have putting so much of our mental energy to food? 

 

Natalie Swanson

Absolutely.

 

Elisabeth Poyner  

Yeah, so final, kind of like a wrap up question, you know, where, like, what do you do to provide support? You had mentioned that you're a mentor, and you work with other? You do some peer work? Like, where do we find you? What do you do? Yeah, let's talk about that.

 

Natalie Swanson

Yep. So I have, I do have my own recovery coaching. And basically, what I do is I am another leg of support within your recovery team. Now, it's very important that we all have our endocrinologist, our dietitians, our therapists, but sometimes when it comes to, you know, our medical team, we don't have one - the accountability all the time, or, you know, being able to, you know, at three o'clock in the afternoon, be like, Oh, my gosh, I'm freaking out, like, please help me. And that's kind of where I step in, is, as someone who not only you know, under, like, I understand what you are going through and understand your fears, maybe a little differently than any of the rest of your team, because I've walked your shoes. So I help with basically being someone who gets it and help you kind of change your perspective when it comes to, you know, yourself, chronic illness, food. So you can live a balanced life, but also, you know, again, coming from a place of understanding. So I have my own recovery coaching. And I really believe that everyone should be able to get help, and doesn't matter your financial status. And I also work with We Are Diabetes, which is a free mentorship program, which has been something so beautiful, and literally, like the team I work with is just fantastic. And so there is help for everyone out there. No matter how much you're struggling or your financial situation, you can get help with your eating disorder, you can get the support you need. It doesn't have to be anything holding in your way. Just go and get help. Please, I beg of you!

 

Elisabeth Poyner  

Yes! I want people to know that there are people like you that can support them and add what you said that extra layer of support. So where, like do you have a website? What are your Instagram? Like? Where can people find you?

 

Natalie Swanson

Absolutely. So I'm primarily on Instagram at @typebalanced_. Um I do have applications for coaching, which you can find in the link in my bio, I also am cool, like the Gen Z'ers out there, and I'm on TikTok, as well, @typebalanced. And that's more like fun and bubbly. You know, like just like relatable, like post stuff, but really, I'm very receptive to DMs. And I, I really, you know, if you're struggling message me, if I can't help you, I will find someone who can help you. So please reach out to me reach out to Lissie as well, because we're all we're all just here to help. We all just want to make diabetes as easy as possible because we've we've both been through it. So we know the ups and downs. We know that it's possible to live a very healthy, balanced life with diabetes and that's what we want to help you with.

 

Elisabeth Poyner  

Yes, and if you are somebody who, like you had mentioned, don't know how to put into words about what you're going through or how you're feeling. Go to her profile. Look, watch her reels, like look at her posts and send that to your loved ones because like you had said, like there's only so much that sometimes we can understand about what we're going through, but sometimes other people put it into better words than we can. And I feel like your page does that perfectly. And yeah, you're just so like, it's beautiful what you're doing and yeah, I love it. Thank you so much for coming on and talking with us and having this open discussion and sharing your journey. You're so happy to have you.



Awe, thank you Lissie. It was so great to be here!



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