Going inpatient is a scary event; it is the unknown and a huge leap to take. However, nine times out of ten it is the right leap to take. Going inpatient puts you at a much, much higher advantage and gives you a much higher chance of successfully recovering. Sadly, it is estimated that only 1 in 10 of eating disorder sufferers go into inpatient treatment for their problem and I expect that in diabulimics it is even less. Going inpatient can potentially save your eyesight, kidneys, limbs and most important of all, your life, so read this Q&A carefully and carefully consider going inpatient, please. If you are going inpatient you may find it useful to print this off so that you have something to refer to whilst inpatient should you not want to ask anybody.

Q: How long will my weight take to stabilise?
A: It took my weight about 8-10 weeks to get back down to my ‘normal’ weight i.e. the weight I was admitted to the hospital as. It can take anything between 6 weeks and three months to return to your pre-admission weight as this is how long excess fluid takes to redistribute itself. Please note, when I give this time period I am referring to a healthy, average weight person with a BMI of between 18.5-25.

Q: Will I be forced to gain weight?
A: Only if you are underweight to begin with i.e. with a BMI of below 18.5. To check your BMI, please go here. If you are of a normal weight you will most likely be encouraged to maintain your weight once you have been in for a few weeks and your weight begins to show signs of stabilising i.e. you sit at a particular weight for a few weeks consecutively. If you are overweight to begin with you will most likely be encouraged to maintain your weight whilst your eating disorder is managed, as weight loss will most likely exacerbate the illness further.

Q: Will they give me a weight requirement?
A: Yes, eventually. In most eating disorder units, you will discuss a ‘weight band.‘ A weight band is a weight range given to you (often with a range of about 2kg) that you must aim to stay between to ensure you are healthy and keep things consistent. Your weight band will probably be set when you have stayed at a particular weight for a few weeks consecutively as this is most likely your ‘natural’ weight, but most eating disorder professionals will be happy to listen to you and your desires surrounding the weight you would like to be and are happiest at and will reach a healthy compromise.

Q: When I take insulin I always get insulin oedema (fluid retention.) Will they help me with this?
A: This is completely normal. The reason for this is that when a person with diabulimia is in DKA they are severely dehydrated and so when you begin to take insulin again (thus unlocking the cells) the cells hold on to as much fluid again just in case you decide to withhold the insulin at any given moment. Think of it as a trust issue; the longer that you give your body the insulin it needs consistently, the sooner the cells will learn to trust you again and will let go of the fluid. Water tablets (diuretics) have been found to help slightly however these can be extremely dangerous as they lower your potassium levels so I would not advice going near them as they can become addictive and do not help in the long term. If you can just get through the discomfort of holding on to some extra fluid for a matter of weeks it is best as this DOES and will shift. Stay away from salt as salt encourages fluid retention and ironically drinking as much water as you are allowed to drink will encourage fluid to redistribute.

Q: Will I be force fed?
A: No. Generally eating disorder units do not 'force feed' however the worst case situation if you consistently refuse to eat is that you may be tube fed.

Q: What happens if I refuse to eat?
A: If you refuse to eat one meal you will most likely be asked to have a supplement drink. If you refuse supplement drinks consistently, after time it will be likely that you will be tube fed as it is very dangerous especially if you are injecting insulin but not eating as this obviously will give you hypos. If you refuse to inject insulin AND refuse to eat you will most likely be tube fed and given insulin by a drip.

Q: Will I be allowed to eat any 'treats' whilst in inpatient?
A: Most likely, but it is probable that you will need to ask for this. I deeply encourage you to do so and ask to perhaps once a week have a dessert or something sweet, if you like sweet things. This will teach you how to manage the feelings of guilt associated with eating sugar as a diabetic and that you CAN enjoy sweet things as a diabetic and how to inject sufficient insulin to cover it. The first and second time I was inpatient I refused to eat anything 'outside' my meal plan and stuck to a very rigid diet but this set me up for failure as I felt deprived and restricted. The best thing to do is tackle 'treats' whilst you are in the safety of inpatient and when you leave inpatient continue to permit yourself perhaps 1-2 times a week to inject insulin to cover and enjoy a dessert or a bar of chocolate. This will most likely get you used to the idea of normal eating and you will not feel deprived and will also reduce your chances of binging/eating more than you should due to the feeling of feeling left out etc.

Q: How do I deal with the guilt of eating?
A: I found that, when I went inpatient and I was forced to eat, I was able to leave some of the guilt at the door because I had no choice in the matter. I had to finish everything on my plate and stick to my meal plan. It was almost as if someone had given me permission to eat - somebody is basically telling you that you need this food to live, you deserve this food to live and you deserve to enjoy this food as it is a basic human instinct to enjoy and crave food. If you still feel guilty after eating, find somebody to talk to straight after the meal. Where I was inpatient we had a session after every meal called 'supervision' - a chance to talk about the meal and our feelings surrounding it followed by 45 minutes of relaxing, reading or watching television. This helped tremendously as I could vent my frustrations and be upset if I needed to be in a supportive and encouraging environment.

Q: Will I be allowed to choose my own meals/food?
A: Most likely, yes. You will most likely be given 2-3 choices to choose between everyday.

Q: How do I make good food choices whilst in hospital i.e. when picking from a menu?
A: It can be very difficult making good decisions when you are diabulimic regarding the menus/food options. You may be tempted to go for the choice you think contains the less amount of calories/carbohydrate or equally you may be tempted (as a bulimic) to go for the choice that seems more food, as a basic instinct and feature of bulimia. Do not fall prey to either of these options as neither will benefit you in the long term. When choosing between meals I advise you go for the option that will a) best benefit your diabetes management and b) the thing you will most enjoy in a healthy, rational manner. I.e. if you have an option between sausages and mash or a fresh salad with fish and new potatoes and you enjoy eating healthier, the likely hood is the second option will best benefit your diabetes management. It is most likely that the staff at the EDU will tell you to 'choose what you enjoy best' however as diabetics we need to take our health in to serious consideration so be mindful that you need to pay attention to both your health AND the enjoyment of your food. Both are equally important in regards to recovery.

Q: What sort of food is served?
A: As much as I hate to admit it, in an eating disorder unit most of the food is not geared towards diabetic preferences. Many of the options will be geared towards weight gain i.e. high in calories but it's VITAL that you work with the dietician to come up with an alternative meal plan to fit in with your diabetes. I.e. when I was inpatient I communicated that it was not realistic for either my weight or my diabetes management that I have two main meals a day with desserts  and so the dietician came up with an alternative plan of a sandwich, soup or salad every day followed by fruit and a main meal followed by a low sugar/low fat yoghurt for dinner. This fitted in beautifuly with both my diabetes/weight management. Beware, you may feel some envy from the other girls as you will get to eat healthier food than they but bear in mind you have a chronic illness that you did not ask for. You will learn in time to shrug their envy off and ignore it.

Q: Why am I being admitted to a general hospital first?
A: If you find yourself being admitted to a general hospital before your eating disorder unit admission, try and go with it. It is very likely that they suspect you will not be in good medical condition on arrival to the unit and most units are unable to cater for this if you are in a particular bad way. Your medical state will need to be a stable condition before your admission and so you may need to stay in hospital for a day or two, perhaps a week, to re-stabilise blood sugars and insulin first and get out of DKA. If you are in good medical condition and have been managing insulin at home and do not feel you are in DKA, still go with it and go to hospital. You can prove there with blood tests that you are not in DKA and can go straight to the eating disorder unit.

Q: Will they watch me take my insulin and test my blood sugars?
A: I highly recommend that they do. It is fairly certain that you will not recover unless they do as if they don't it will be extremely tempting to omit insulin for weight loss; that is why you are there in the first place! It is also useful to have someone watch you inject as you can talk it through with the person supervising if you are particularly struggling.

Q: Will I be pinned down to be given insulin if I refuse it?
A: I must mention, before you refuse insulin, breathe in and out slowly and think it through. What you are about to do will have huge repercussions on your recovery and your treatment as it puts you in a very dangerous position. If you are struggling, discuss it first with a member of staff. If you feel insulin refusal coming on before a meal, find someone and explain rather than wait and kick off. If you do refuse it you will not be 'pinned down' however you will most likely be sectioned (see 'freedom' below), taken to a general hospital and be forced to have an insulin drip in your arm which, coming from experience, is not a nice event to have to go through.

Q: Will I be allowed to exercise?
A: I highly recommend you push for exercise to be part of your treatment programme. You will have a consultant responsible for your care - make sure you get your diabetes care team to communicate with them how important exercise is for diabetes management. It doesn't have to be a gym workout every day of the week - even 30 minutes of walking broken up a day will suffice. I particularly struggled with having my exercise limited and eventually I insisted on having walks incorporated in to my day and was given 3 10-minute walks everyday which did wonders for my blood sugars and weight maintenance. It also helps with the fluid retention that you may suffer with on first giving insulin.

Q: Will I get my own room?
A: It varies from place to place. Having your own room is a luxury and in many private hospitals (particularly those in the USA) you may find you have your own room however in many (UK) NHS hospitals you will probably be expected to share due to financial reasons.

Q: Will they check my bags and take anything off me?
A: Yes, as this is part of your safety and protection. They will most likely take things like razors and sharps off you, but you will be able to ask for these to use when you need them.

Q: What will I NOT be allowed to take in with me?
A: Food, drink, drugs, alcohol, un-prescribed medication i.e. diuretics, laxatives, diet pills.  

Q: Will I get any privacy?
A: Within reason. At first you may need to be watched when you go the toilet, especially if you have a problem with purging. The technique that most eating disorder units use is that they take all the control off you and then gradually allow it back in time. This sounds scary but it often helps with the recovery process as you learn to feel and behave normally again.

Q: Will I be allowed to leave the unit i.e. to go shopping, on trips with friends etc?
A: Eventually, yes. As mentioned before many things that you are used to in daily life will be stopped at first and then, as time goes on and you begin to show signs of getting better you will be given these back in a gradual manner. However I must mention that if you are under a section it makes doing these sort of normal things very difficult as you must have someone with you all the time by law.

Q: What does a 'section' mean?
A: A section has two categories. It means that under the mental health act a patient is forced to receive mental health treatment as they are classed as no longer being able to decide for themselves. There are two types of mental health acts; section three and section. Section three is for and section is for. It is hard to say whether having diabetes and an eating disorder puts you at higher risk of being sectioned however it is very likely that, due to high blood sugars you can become uncooperative and even aggressive so it may mean you need to be sectioned in order to treat you. Also, if you regularly refuse insulin whilst in hospital it may be that they section you in order to give you insulin against your own will and potentially keep you alive. This sounds very scary but any decent doctor will only section you if it is the last resort and is absolute paramount to keeping you alive and well.

Q: Will I be sectioned?
A: Not automatically. The best way to avoid a section is to try and work with the unit as best as possible. This means taking insulin, testing your blood sugar levels when asked, eating all meals and generally trying to stay calm and in control i.e. not getting angry or aggressive. Of course feel free to cry and shout if you are feeling frustrated, sad or angry - that is why you are there in the first place and that is what the professionals are there for.

Q: How long will I be made to stay - how long do I need to stay?
A: This totally relies on your personal circumstances. It could be anything between 2 weeks and a year. If you are particularly unwell with your diabetes, expect to stay longer than 2 weeks whilst they re-stabilise your blood sugars. Blood sugars often take 2 weeks and up to get back to normal and weight can often take anything between 8 weeks and 3 months to also re-stabilise. It is not a wise choice to go home when you are not uncomfortable with your weight; this puts you at greater risks of relapsing and going back to manipulating your insulin. Also, if you have a set amount of weight to gain, this will also impact how long you will need to stay.

Q: Can I continue with my studies whilst an inpatient?
A: You can, but I wouldn't recommend it. Recovering is a full time occupation. I myself took a year out to recover and it was the best thing I ever did because as soon as I left college I felt a huge feeling of relief and began to work much better at recovery without the pressure of going back above my head. It will be a difficult decision choosing between leaving education and not leaving education but bear in mind that education is something you go back to at any point whereas if you don't recover you can never get your eyesight back, or even your life.

Q: What shall I do about work whilst inpatient?
A: This one warrants a similar answer to the above question. If you have an understanding employer (assuming you have told your employer where you are going) and they often to hold your job open for you, fantastic, as you can return to work when you leave the inpatient treatment however if they threaten to end your employment I highly recommend you leave the job as they are clearly not an employer that will support you getting better. As said before, a job is replaceable, your eyesight is not.

Q: How can I trust people?
A: Trust is very difficult when you are suffering with an eating disorder, especially if you have been let down in the past or perhaps told somebody about your condition and received a bad reaction. Whilst inpatient, try and learn to trust a) your therapist (they are not allowed to share information with others unless it is potentially risking your safety) and b) the staff at the unit. Learn to build relationships; try and build a relationship with at least one member of staff that you can talk to in times of distress.

Q: I'm scared - what shall I do?
A: When we are scared, we tend to regress to childlike behaviour - we may live in fear, kick off and have a 'tantrum', cry, worry etc. The best thing you can do when scared is talk to someone about how you are feeling and it is very likely you will be comforted and feel better. Again, learn to develop a relationship with at least one member of staff that you can talk to.

Q: Will they treat my depression/underlying mental illness?
A: If you suspect that you have depression/an underlying mental illness (such as bi-polar, borderline personality disorder, OCD etc) it is VITAL that you communicate this to your consultant doctor or a member of staff as your eating disorder will be extremely difficult to treat unless you are either medicated or treated for it. I myself suffer with bi-polar and depression and it wasn't until I was medicated for them that I began to properly recover as I was too depressed to approach recovery in a positive manner.

Q: How important is honesty whilst an inpatient?
A: Honesty is vital whilst in recovery. For weeks, I was secretly getting away with pretending to inject insulin whilst being supervised and in hindsight this hindered my recovery and wasted the first few weeks of treatment as there was no way I could recover whilst I was lying to everybody. When you are lying you are only lying to yourself, and deep down you will know that what you are doing is wrong. Equally if you pretend to be better just to 'get out' of inpatient you will be doing yourself no favours as it extremely realistic you will relapse quite promptly after discharge. If you do not feel right about something or have even a little doubt about something, communicate it. Nobody can help you until you learn to be brutally honest and upfront about what you are suffering with.

Q: How can I have a relationship whilst inpatient?
A: It is hard, but it can be done. Make sure your partner knows everything there is to know about where you are going, what you will be doing and how you will be treated. Make sure to include them as much as possible as it may be likely they will feel pushed out if they are away from you for long periods at a time. It would be a good idea to include them in many ways which includes having them at the unit for dinner, accepting visits from them, taking them in to meetings with a doctor etc. If this is a person you spend a lot of your time with, the more they know about your illness and the more open and honest you can be with them about your struggles, the better. However, many people find that when suffering with an eating disorder they cannot hold down a functional relationship and this is also okay. If somebody truly loves you they will understand if you need to take some time out of the relationship to step back, breathe and think.

Q: I'm worried about losing my friends - what if my friends find out and they think i'm weird?
A: One simple answer; then they're not friends! I lost a lot of 'friends' through my struggle and in hindsight I know that they were never friends to begin with. The people that have stuck by me through thick and thin and know everything about me yet still care for me and love me are my true friends and it goes without saying that this should be the situation with everybody. You deserve to have people around you that love you for who you are, not who you feel you need to be or must be.

Q: What financial help am I eligible for whilst sick?
A: If you are in the UK then the answer is, quite a lot. This includes disability allowance (for both the diabetes and an eating disorder), income support, incapacity benefit and perhaps even more. Please refer to the directgov website for more information. As far as the USA goes, I am not sure what the situation with finance whilst sick is but many employers will pay sick pay if you go inpatient and cannot work. This is the same for the UK.

Q: I can't afford to pay for my treatment! what help can I get with finances?
A: In both the UK and USA many private eating disorder units accept many different health insurance companies. It is definitely worth contacting your insurance company and asking them about their policy regarding your situation. With reference to the UK, if you cannot get private funding, it is worth going to your GP and explaining the situation. You will most likely be referred to an eating disorder team who will later decide whether or not you will be eligible for NHS funding should the situation become dire but, as a diabetic with a chronic health condition, it will be more than likely you WILL be eligible for NHS funding.

Q: Will I be able to see my family?
A: Most likely, yes, however some eating disorder units use limiting access to family as a motivation to get better i.e. if you are not eating your access to your family may be limited and contact or visits will be stopped until you are eating again however this will most often only be used in extreme circumstances.

Q: Will my family be affected?
A: Unfortunately the answer is yes. It is extremely hard for families not to be affected by either diabetes or eating disorders. However, bear in mind your relationship will most likely become stronger in other ways as the family is taken to the edge. For more information please refer to 'helping loved ones' in the navigation above.

Q: Will I go to groups?
A: Yes, most likely. Most eating disorder programmes incorporate groups in to the recovery process. It is often comforting hearing others struggling with similar problems as it can normalise the situation a little and stop you feeling like the odd one out.

Q: Will I get therapy? What type of therapy will I receive?
A: Yes, therapy is part of any good eating disorder programme. You may receive psychotherapy, CBT (cognitive behavioural therapy) or perhaps even both. CBT is proven to work best with bulimics and I have found from experience it works extremely well with the insulin purging routine that diabulimics take part in as often this cycle is very cognitive.

Q: Who else will be in the unit with me?
A: Many different people. Anorexics, bulimics, compulsive overeaters and those with EDNOS (eating disorder unspecified.) You may even come across men with eating disorders as this is becoming more and more common. You will find a vast age range, also.

Q: What shall I take with me clothes wise?
A: It is a good idea to take in 'sloppy' clothes at first whilst the fluid retention is at its worst i.e. pyjamas, jogging bottoms, baggy t-shirts and hoodies. However, as time goes on, make sure you begin to incorporate more everyday clothes in to your routine as otherwise you will become too used and comfortable to being in 'safe' clothes. You will most likely find that, as the fluid retention lessens and your body image improves and you veer towards recovery that you are more likely to want to dress in everyday clothes to improve your body image further. This is definitely a good sign that you are recovering.

Q: What shall I take with me?
A: Comfortable clothes, books, DVDs, a laptop if you have one, a journal to write in, a mobile phone to contact friends and family, jewellery, make up (useful to improve body image!), toiletries, dressing gown, slippers and you may want to take your own mug for your drinks, this can often help remind you of home.  

Q: If I go on holiday during my recovery will I still be able to get travel insurance?
A: First things first, do not book any holidays until you are sure that you will be well enough to go; try and leave it until you have had a couple of months of stability before you book anything. I have fallen trap to this and booked a trip when I was not well enough to go and lost the money for it. If you have been in hospital in the last few years your insurance will of course cost slightly more but it is most likely that you will still be able to get it.

Q: I'm worried about being around anorexics in the unit - won't I find how skinny they are triggering?
A: This is a difficult one as it can indeed be triggering being around anorexics in a unit but you must, must, must remember that, like you, they are there because they are SICK. They are underweight, this is a medical fact and they are there to (as well as get better) gain weight because underweight is not normal or healthy. You will most likely be around other people who are normal weights and will come to accept, eventually, that a normal weight is healthy and that they are not.

Q: Whenever I go in to hospital/see doctors I always get the same old lecture; do you know what you're doing to yourself, etc. Will I get this in an eating disorder unit?
A: Often doctors come out with this response because they are genuinely shocked at what they are hearing, but often doctors do not understand eating disorders. You may well get this in an eating disorder unit as people are often shocked by what lengths a person with diabulimia will go to but remember that the staff are trained to deal with eating disorders and will therefore understand the power that they hold over those suffering with them. If a member of staff in particular is distressing you with these unhelpful comments make sure you tell somebody as this may hinder your recovery if you are made to feel guilty for something you cannot help or control.