Diabetes and Eating Disorders

Dr Alpesh Jain, Consultant Diabetologist, Masina Hospital gives detailed inputs in the management of eating disorders due to diabetes with the help of family, friends and certain precautions

In recent years, cases of diabetes are seen in an increasing number of children and young teens. However, research suggests that women, especially young teenagers, with diabetes have a higher tendency of developing eating disorders than women who do not have diabetes. Those with type 1 are twice as likely to suffer from disordered eating patterns.

Because both diabetes and eating disorders involve attention to body states, weight management and control of food, some people develop a pattern in which they use the disease to justify or camouflage the disorder. Because the complications of diabetes and eating disorders can be serious or even fatal, responsible, healthy behaviour is essential.

A close relationship often exists between the physical and mental health of individuals with diabetes. This is due to the complex and constant requirements of diabetes management and because of the influence of living with a chronic medical condition on psychosocial functioning.

There are pervasive influences for women in many cultures to strive for unrealistic body weight and shape goals through dieting, while they are simultaneously exposed to large quantities of high-calorie, palatable foods that promote overeating and weight gain.

Usually, eating disorders are caused due to an underlying paranoia of the patient’s body image. These individuals often have high levels of concern about their body weight and shape. They are constantly paranoid. They might believe they are overweight even if they are not or constantly fear gaining weight or becoming fat, leading to disturbed attitudes towards food, calories and eating.

Types of eating disorders

The different types of eating disorders are:

Diabulimia: “Diabulimia” is an eating disorder characterised by intentionally withholding insulin to result in weight loss.

The insulin restriction results in high levels of glucose in the blood that spill over into the urine, leading to the excretion of calories from glucose. The repercussions can be severe, including dehydration, loss of lean body tissue, and in extreme cases, diabetic ketoacidosis.

Diabulimia is shockingly common; as many as a third of women with type 1 diabetes report insulin restriction, with higher levels among those between the ages of 15 and 30.

Researchers estimate that 10–20 per cent of girls in their mid-teen years and 30–40 per cent of late teen aged girls and young adult women with diabetes skip or alter insulin doses to control their weight.

Anorexia (or anorexia nervosa) is an eating disorder centered on an obsessive fear of weight gain. Anorexia involves self-starvation and excessive measures for weight loss.

Bulimia (or bulimia nervosa) is characterised by recurrent binge eating (the rapid controlled consumption of large amounts of food). Purging may occur with self-induced vomiting, laxatives, diuretics, insulin omission or reduction, fasting, severe diets or vigorous exercise.

Binge eating disorder (also known as compulsive overeating) is characterised primarily by periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full. While there is no purging, there may be sporadic fasts or repetitive diets and often feelings of shame or self-hatred after a binge.

Eating disorders not otherwise specified (EDNOS) is a range of other disordered eating patterns that doesn’t fit the other specific types.

Bulimia is the most common eating disorder in women with type 1 diabetes, whereas, among women with type 2 diabetes, binge eating is more common. It is important to look out for the warning signs to ensure these women the help they need from an early stage. Some of the warning signs to look out for might include:

• Unexplained increase in A1C levels
• Repeated episodes of diabetic ketoacidosis
• Extreme concerns of body size/shape
• Very low-calorie meals
• Exercise more than is necessary to stay fit
• Severe stress
• Avoiding diabetes related appointments
• Extreme increase or decrease in diet
• Extreme anxiety about body image
• Restricting certain food or food groups to lower insulin dosages
• Avoids eating with family or in public
• Discomfort testing/injecting in front of others
• Increase in sleep pattern
• Withdrawal from friends and/or family activities
• Depression and/or anxiety
• Infrequently filled prescriptions

Consequences of eating disorders

Short-term effects

Eating too much will make your blood sugar levels go too high. This is known as hyperglycaemia which can make you feel really tired and cause headaches.

Restricting insulin will also make your blood sugar levels go too high. And this can quickly lead to a serious and life-threating complication called diabetes ketoacidosis, or DKA for short. You need emergency treatment for DKA.

Restricting insulin not only affects your blood sugars, it can also make you lose weight. But losing too much weight can make your bones and muscles weaker, which will affect how well you can get around. If you continuously make yourself sick to try and avoid putting on weight, you’re affecting your oral health too. There’s a lot of acid in vomit and this can damage your teeth and gums.

Long-term effects

If you have high blood sugar levels over a long period of time, it can seriously damage your blood vessels. Which can lead to further complications in other body parts like your feet, eyes, kidneys and heart.

Alternative solutions health experts can give to patients

Talking to family or friends

Patients will be most comfortable with friends and family, it will be easiest for them to talk to someone they can trust. This could be a friend, a parent or sibling, a flat mate, or a colleague. Healthcare providers can encourage their patients or their family members to constantly check on how they are doing. Speaking to their friends or family and getting their support can help reduce one’s anxiety or stress about their condition.

Reaching out to their diabetes healthcare team

Whether one has been diagnosed with an eating disorder or not, seeking professional help is the fastest road to recovery. Hence the healthcare provider can constantly check up on their patients to see how they are doing. With no judgement, they will be able to help the patient by making a plan to manage their disordered eating.

If necessary, the patient can even be referred to a psychologist who will give them specialist advice and support, and talk them through different treatment options like talking therapies or medication.

Write a food and feeling diary

Keeping a food and feelings diary can be helpful for understanding some eating patterns and emotions linked with food and patients can be recommended to maintain the diary regularly.

This is a great way to track what food has been eaten and the effect it could have on mood and diabetes.

The diary can be taken in for the next consultation (for instance, with a psychologist). This will better help understand the patient and provide them with the proper medication or help they need.

Eating disorders are more common in individuals with type 1 diabetes than in the general population.

These conditions significantly affect the physical and emotional health of individuals with diabetes and are associated with impaired metabolic control and a high risk of medical complications, including higher mortality rates.

Clinicians should maintain a high index of suspicion for eating disorders, particularly when there is unexplained poor metabolic control. Attention to eating problems may be life-saving in a condition such as diabetes, in which outcomes are so dependent on behavioural adherence.