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Molly is a 22 y.o. female performing arts students at CSUCI with an emphasis in theater. At 16 y.o., she was diagnosed with type 1 DM. Her pharmacological regimen consist 2 different types of insulin, which include glargine (long acting, basal) and humalog (rapid acting, meal coverage). Molly is an aspiring actress and struggles with her body image. She noticed weight gain ver since she started taking insulin. She discovered that by skipping her insulin she is able to “lose weight” and is able to maintain her image of an “industry standard body.” Molly’s  roommate found her in a decompensated state in their dorm and called 911.

Upon field assessment, Molly was confused and diaphoretic. She was oriented X2 (person, place). Pupils were equal, round, reactive to light, and accommodated. She was tachycardic and had +1 peripheral pulses. Molly had Kussmaul respirations with a RR of 34 b/min with an abdominal pain level of 7/10. Her blood sugar was 850 mg/dL. Field Vitals: BP: 90/52, HR: 110, RR: 34, O2: 92% RA, 99.9. An #18 guage needle on her left AC, 1 L fluid bolus started, and NC at 2L/min was placed.

Questions

1. What are your primary concerns with Molly’s?
2. Why do you expect type I diabetic mellitus patients such as Molly engage in behaviors consistent with diabulimia?
3. As the case manager, what resources would you recommend prior to discharge?