Type 1 Diabetes with Disordered Eating (T1DE)

What we do

The Type 1 Diabetes with Disordered Eating service (T1DE) is a pilot clinical service that brings together diabetes and mental health care under one team. The service helps patients with type 1 diabetes who have severe fears of weight gain on insulin (sometimes referred to as ‘diabulimia’). It aims to improve their confidence and ability to manage their diabetes and mental health.

This is the first integrated service of its kind in the UK. We have received funding from NHS England (London division) for a limited period to offer this pilot service.

This service is for adults with type 1 diabetes who have severe disordered eating and related insulin omission leading to significant difficulties in managing their diabetes effectively.

Please contact the consultant diabetologist in advance on kch-tr.t1de@nhs.net if the patient has advanced diabetes complications to discuss whether T1DE is the most appropriate service.

Useful resources
Visit the Diabetes UK website for more information on diabulimia. King’s College Hospital was also involved in the production of a BBC 3 documentary 'Diabulimia: The World's Most Dangerous Eating Disorder', which sheds light on this condition.

Preparing for your appointment

Please bring your glucose meter, insulin pens, insulin pump, sensor and any other diabetes-related equipment. It would also be helpful if you could bring copies of recent clinical letters, such as:

  • eye screening report
  • diabetes clinic letter
  • psychology or psychiatry letter (if applicable)
  • blood results

Expect to spend at least four hours at the hospital. You can bring someone with you for support. Please also bring some food and drink.

You will meet several members of our multi-disciplinary team (MDT). We are diabetologists, liaison psychiatrists, diabetes nurse specialists and psychotherapists.

We will need to check that are you clinically safe to have an assessment on the day. This will involve taking some blood, checking your ketones, and an ECG (tracing of the heart) if necessary. We will ask you some questions about your physical and mental health to get a complete picture of your situation. If you would like us to, we will talk to your relatives or friends either separately or with you.

You will also complete some questionnaires about your mood, anxiety, eating patterns and quality of life. These will help us monitor your progress with you. We will then bring together all the assessments and meet with you to share our findings. We will discuss the treatment options with you. Your own ideas about what might help you will be very important.

Location

Ground Floor, Venetian Building, Caldecot Road, SE5 9RS

Contact Details

Patient Information Leaflets

Conditions we treat

This service is for people who meet the criteria for severe disordered eating and related insulin omission. These criteria are:

  1. diagnosis of type 1 diabetes
  2. fear that insulin causes weight gain
  3. deliberate omission of insulin
  4. serious effects on diabetes self-care, including at least one of the following:

  • recurrent diabetic ketoacidosis (more than one admission in the past two years)
  • HbA1c 10% or greater in the past 12 months
  • recurrent severe hypoglycaemia
  • low body weight (body mass index 15 kg/m2 or less) or significant weight loss

For referrers: please note that this service is for patients who are registered with a London-based GP surgery or specialist diabetes team. If you have any queries regarding eligibility please email us directly on kch-tr.t1de@nhs.net.

There are several treatment options, tailored to patients' individual needs. These take into account what is available, realistic and what patients want help with. These include:

  • diabetes cognitive behaviour therapy
  • psychodynamic psychotherapy
  • carer support
  • optimising diabetes care
  • medications review for a patients' diabetes and mental health
  • inpatient admission

Patients are only admitted to an eating disorders unit if their condition puts them at high risk of developing dangerous complications or of death.

The frequency and location of consultations, and which health professionals the patient will see, will depend on the patients' needs, wishes and where they live. We expect that a patients' treatment will last for about 6 to 12 months, but it could be longer.

What is required before referring a patient

  • Make sure the patient is informed about this referral.
  • Complete the diabetes psychiatry and psychology service referral form (which includes the T1DE service).
  • Attach the most recent diabetes clinic letter.
  • Maintain local diabetes services. T1DE is a step-in step-out service and it is expected that the local diabetes team will remain in place.
  • Set up local emergency support if appropriate. We do not provide emergency diabetes or psychiatric care. For patient safety, please advise your patient and their carers about this. If you think a patient may need emergency support please refer them to their local community mental health team (CMHT) and ensure that local emergency diabetes and mental health services pathways are in place.

Booking a patient at King's

Routine Referrals

Complete the generic Diabetes Psychiatry and Psychology Service referral form (which includes referrals to T1DE) and return to kch-tr.DiabetesPsychiatryPsychology@nhs.net.

Referral Forms

Please complete the relevant form and note any pre-consultation investigations required:

Key Clinical Staff

Name Job Title
Dr David Hopkins Diabetes Consultant
Dr Miranda Rosenthal Diabetes Consultant