How would you approach the conversation if you suspected insulin omission for weight control?

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Accepted Answer

I would approach the conversation in a private, calm setting and adopt a non-judgemental tone. Rather than directly accusing, I would explore her experience of living with diabetes using open questions such as: 'Many people find managing insulin and weight challenging — how have you been finding things recently?' If there were indicators of insulin omission, I would sensitively explain the medical risks of recurrent DKA while acknowledging the emotional and psychological pressures that can accompany body image concerns. It is important to normalise the difficulty without normalising the behaviour. I would avoid confrontation and focus on support — involving the DSN and considering referral to a diabetes psychologist or eating disorder service. The aim is to build trust, not assign blame, and create a safe pathway for longer-term support.

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