Back in 2007 I contributed to a People Magazine article on diabulimia, which was then starting to attract mainstream attention. The subject of the article was a 26-year-old medical technician living in Yakima, Washington named Kelie Gardner. She had been diagnosed with Type 1 diabetes when she was 14; at 18 she began lowering her insulin doses in order to lose weight. Without enough insulin to process glucose in her body, sugars passed through her system unabsorbed, resulting in weight loss. Four years later she added bingeing and purging to her self-destructive arsenal of weight-manipulation techniques.

Ironically it was through a book her mother read to her about teenagers with diabetes that Kelie learned she could do this. “There was a girl getting ready for prom. She skipped her insulin shot so she could fit into her prom dress,” Kelie recalled recently after we had reconnected through email and phone calls.

It started simply, but eleven years of diabulimia and seven years of bingeing and purging have had a devastating effect on Kelie’s body. An early symptom was diabetic neuropathy caused by chronic low insulin levels, which caused a burning sensation that made her feel like her whole body was on fire. Then she was hospitalized for diabetic ketoacidosis, a life-threatening situation that results when the body begins to break down fat for energy.

In 2008 Gardner moved from her home in Yakima to Pullman, Washington, where she met a mechanical engineer named Andy Bryson. The two wed in 2009, and three months later Kelie became pregnant.

She was by then making progress in overcoming her eating disorder but was still not entirely free of it. Instead of bingeing and purging four to five times a day as she had done at her sickest, those episodes were occurring three to four times a week, though she was still shorting her insulin intake. One change that helped her get better was starting to use a continuous glucose monitor, Kelie recalls. The constant monitoring made her feel that keeping a normal blood sugar level was not such an impossible goal after all.

“When I found out I was pregnant it was like, ‘I can’t throw up anymore,’” recalls Kelie, who by then went by the last name Bryson. Six weeks into the pregnancy she became extremely ill, suffering from dangerously high blood pressure and hyperemesis gravidarum, or extreme nausea and (involuntary) vomiting. She was admitted to the hospital for the remainder of her pregnancy. “There were points where I didn’t know if I was going to live or if Levi (her son) was going to live,” she recalls. Although it was never clear to doctors why, she became severely anemic, receiving about a dozen transfusions before Levi was born.

Levi arrived 10 weeks early and weighed two pounds two ounces. Although steroid injections helped mature his lungs enough to function despite the premature delivery, Kelie says that even now, when Levi, age 4, gets sick, “it goes right to his lungs and we have to give him nebulizer treatments.”

Things got worse for Kelie after Levi’s birth. For a year after, she suffered from extreme high blood pressure and constant nausea and vomiting. She was eventually diagnosed with cyclic vomiting syndrome: whenever her body experienced any kind of stress she began throwing up. Kelie is convinced that years of purging put her gag reflex on a hair trigger; vomiting became an indicator of what was happening in her life. Eventually the long-term effects of her chronic eating disorder plus high blood pressure caused her kidneys to fail. In 2011, with her 56-year-old father as her donor, Kelie underwent a kidney transplant.

I learned all of this when Kelie contacted me recently to tell me that she wanted to talk about her and Andy’s adoption of a newborn baby girl in 2013. After it became clear that Kelie’s body would not sustain another pregnancy, the couple began exploring open adoption, in which they and their child would maintain a relationship with the child’s birth mother. While the story of their adoption is dramatic and moving story, I’ll leave that for another time and place.

Kelie has been completely free of eating-disordered thoughts and behaviors since becoming pregnant, she says, though her disorder has left her with permanent gastrointestinal issues. She has also not yet been able to stop taking the anti-seizure medication that keeps her nausea and vomiting at bay, even though she has tried many times. Kelie notes too that the task of working through the “the emotional components that drive our eating-disordered behaviors” in the first place—in her case anxiety and relationship issues—is an ongoing “work in progress.”

Asked what advice she would give to people struggling to free themselves from diabulimia, Kelie says, “The importance of reaching out and asking for help. This is a huge secret that people carry around,” she explains, often occurring with other eating-disordered behaviors. “When you are able to feel safe and tell someone your secret, the process of recovery can begin,” she adds. “Don’t let feelings of shame or guilt keep you from moving forward. Ask for help, find tools. Walk toward your recovery and away from harmful behaviors.”