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November 27, 2018

The Intersection of Eating Disorders and Diabetes

The Intersection of Eating Disorders and Diabetes

What Are Eating Disorders?

Eating disorders are prevalent and often severe mental health illnesses that are categorized by a disturbance in eating behaviors and related changes in thoughts and emotions. There are many types of eating disorders and treatment is available. While serious, eating disorders do not have to be a lifelong illness. Individuals can experience recovery and continue on to live healthy, happy lives.

What Is Diabetes?

Type 1 diabetes

Diabetes is a disease that affects how an individual’s body is able to use glucose (blood sugar). Type 1 diabetes means that a person’s body is unable to make insulin, which is a hormone produced by the pancreas that regulates the amount of sugar in the blood. Type 1 diabetes is not curable, but it can be managed with proper diet, exercise, and medications or insulin therapy (Mayo Clinic).

A concerning behavior among some individuals with type 1 diabetes is the misuse of insulin, often referred to in the media as ‘diabulimia’. This type of insulin mismanagement, where insulin doses are manipulated to influence body weight, can lead to serious conditions like ketoacidosis. Additionally, known as type 1 diabetes with disordered eating (T1DE), individuals may engage in harmful behaviors including excessive exercise, food restriction, and an obsessive focus on body weight and shape.

Type 2 diabetes

Type 2 diabetes is an illness where a person’s body doesn’t produce enough insulin or is resistant to it. It is unknown exactly why this happens, but genetics and environmental factors “seem to be contributing factors” (Mayo Clinic). Type 2 diabetes can be managed through lifestyle changes, medications, and/or insulin therapy.

The Intersection of Eating Disorders and Diabetes

Both eating disorders and diabetes are serious illnesses. We know that eating disorder incidence rates for the general population are 6–8% in females and 3–4% in males. We also know that incidence rates for those with diabetes are 2–4 times higher than that rate. But the question is: Why?

Those just diagnosed with diabetes experience a new and strict emphasis placed on food types and amounts. This strong focus placed on food choices, even though it is put in place in order to manage the diabetes, is one risk factor for developing an eating disorder. With these new food rules, those suffering from diabetes may begin to see foods as “good” or “bad” (labels based on blood glucose management), which is a similar belief found in many individuals with eating disorders. In addition to new food rules, individuals often begin to pay closer attention to their food intake, activity levels, and weight. This hyper-focus on food, eating, and weight is often a contributing factor in the development of an eating disorder.

Diabetes is also often a notable life event and stressor in an individual’s life, which may be another risk factor for developing an eating disorder. The stress, food rules, and constant need to pay attention to eating well and “do it right” may lead individuals to develop an eating disorder, especially those who tend towards perfectionism.

In addition to these risk factors, those using insulin may develop something called diabulimia, a life-threatening practice where an individual reduces or omits insulin doses to lose weight. It is important to note that this behavior is not a risk factor, but instead a severe form of an eating disorder that requires prompt and specialized treatment.

Girls and women with diabetes are over twice as likely to develop an eating disorder than those without diabetes. Some experts attribute this to the perfectionist tendency of managing diabetes and how it focuses on “food and numbers, [which] may lead girls and women to judge being good or bad based on eating patterns and blood glucose level” (Neithercott, 2013).

Studies have shown that adolescents with type 1 diabetes are significantly more likely to experience disordered eating behaviors compared to their peers without diabetes (Jones et al., 2000; Young et al., 2013). Additionally, it is estimated that between 12% to 40% of people with type 2 diabetes have an eating disorder (García-Mayor & García-Soidán, 2017).

The coexistence of diabetes and eating disorders can lead to devastating health consequences. Individuals with type 1 diabetes and an eating disorder face serious risks like prolonged high blood sugar, neuropathy, and even life-threatening conditions such as stroke, heart disease, and coma. For those with type 2 diabetes, complications can include kidney damage, blindness, and severe diabetic coma.

Specific dietary recommendations for managing type 2 diabetes, such as consuming high-fiber foods and reducing refined grains and sweets, can inadvertently heighten anxiety around food choices, potentially triggering eating disorder behaviors. This mismanagement can lead to serious complications including neuropathy, gastroparesis, and increased cardiovascular risks.

Early Detection Is Crucial

For those suffering from diabetes and an eating disorder, early detection and intervention are crucial to lasting health and recovery. Recognizing an eating disorder in patients with diabetes may be tough, however, because the symptoms can be similar to those of poor diabetes management. Look for the following symptoms and bring up concerns with patients immediately:

  • Weight loss (occasionally even when there is a decrease in calorie consumption)
  • High A1C
  • Multiple hospital visits for poor blood sugar control
  • Glucose fluctuations wide in range for no apparent reason
  • “Forgetting” treatment (log-keeping, using insulin, etc.)
  • Excessive exercise
  • Menstruation irregularities
  • Hair loss and dry skin
  • Distorted thinking around food, weight, and appearance

Recovery Is Possible

Recovering from distorted thinking and disordered eating is possible. For those with diabetes, the road to recovery may have additional hurdles, but many individuals with diabetes find success in overcoming their eating disorders. We always recommend individuals suffering from eating disorders seek help from eating disorder treatment centers that specialize in eating disorders, like The Emily Program.

While in treatment, a client’s team (often a dietitian, therapist, and doctor) will help them learn to cope with the stress of diabetes management and teach them healthy ways to keep their diabetes under control. Staff will work with the client to decipher their true food preferences, hunger cues, and emotions surrounding food. Staff will also assist individuals in bringing structure to their routine, allowing them to manage their diabetes and to lessen eating disorder urges and feelings. With a treatment team, hard work, and determination, recovery is possible.



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