Type 1 Diabetes and Eating Disorders
Since being diagnosed with type 1 diabetes (T1D), the way that you think about mealtimes and your relationship with food may have changed. It may be hard to remember a time before you had to consider everything that passed your lips, count every carb, study your plate when the food arrives at a restaurant, and listen to endless, unwanted advice from well-intentioned people about what they think you should or should not be eating.
The subject of eating disorders is popular these days as the prevalence of it is increasing and it is being diagnosed at younger ages. There is excessive pressure in our society to look thin, no matter the cost, which can lead to a negative body image and unhealthy behaviors around food. Mental health issues, family circumstances, and environmental factors can all play a role in developing disordered eating habits.
Experiencing disordered eating tends to be more common if you have type 1 diabetes but the rates vary from study to study. Both females and males struggle with eating disorders though we don’t yet have good data on the prevalence of it in men with type 1 diabetes. After T1D is diagnosed and insulin therapy has started, people experience weight gain, restoring the weight they lost before diagnosis, which may or may not contribute to worries about weight gain and body image.
People with diabetes who have eating disorders also have high rates of fear of hypoglycemia as well as diabetes distress. They also have high rates of other psychological diagnosis such as depression. So, getting treatment for eating disorders is important for long-term health and well-being.
Insulin Omission to Lose Weight
People with diabetes and eating disorders—men and women alike—often face the same feelings about weight and body image as people without diabetes. But there is an additional way that people with type 1 diabetes lose weight – if they restrict or omit their insulin. For people with type 1 diabetes, insulin omission in order to lose weight is the most commonly reported disordered eating behavior (this was referred to previously as “diabulimia”).
When people try to lose weight by manipulating their insulin, they purposefully take less insulin than is required to induce hyperglycemia or diabetic ketoacidosis (DKA). This condition develops when your body doesn’t have enough insulin to help the sugar (glucose) from the food you eat enter your cells. Without enough insulin, your body begins to break down your body fat as energy (which causing the weight loss).
Symptoms include:
- Thirst
- Frequent urination
- Ketones, when you check them by using a urine stick or fingerstick
- Nausea and vomiting
- Shortness of breath
- Fruity-scented breath
- Feeling tired or fatigue
DKA can be very dangerous and can lead to coma or death. If you are experiencing these symptoms it is important to call your health care provider and/or go to your local emergency room.
The short-term benefits of weight loss are motivating to people, despite the longer-term risks of keeping blood sugars high which can lead to serious complications. Other signs of insulin omission can include:
- High A1Cs (typically over 9.0%)
- Episodes of diabetic ketoacidosis (DKA)
- Concerns about weight and body shape regardless of current body size
- Exercising a lot
- Changes in eating patterns (often restricting food and then binge eating)
- Skipping monthly menstrual periods (amenorrhea)
Not all disordered eating has to do with restricting or omitting insulin. People with type 1 diabetes experience other eating disorders just like the people without diabetes.
Other Eating Disorders
Anorexia Nervosa
There are both emotional and behavioral aspects to anorexia. A person with anorexia has an unrealistic perception of their body and/or a strong fear of being fat. To lose weight they restrict their food intake and/or binge eat and then make themselves vomit or take laxatives. People also tend to exercise excessively.
Bulimia Nervosa
There are also both emotional and behavioral aspects of bulimia. A person’s self-worth is based on their weight and shape. They have reoccurring episodes of binge eating and a lack of control over what and how much they eat during the episode. After binging a person makes themselves vomit or takes laxatives to compensate for what they ate to prevent weight gain.
Binge Eating Disorder
People who have binge eating disorder have reoccurring episodes of binge eating and a lack of control over what and how much they eat during the episode. They feel embarrassed by how much they are eating and feel disgusted or very guilty afterwards, but they do not make themselves vomit or take laxatives to compensate for what they ate.
Treatment
The American Diabetes Association (ADA) recommends that all people with type 1 diabetes should be screened by their healthcare providers for disordered or disrupted eating if there are unexplained high blood sugars or weight loss, so treatment or a referral to a mental health provider can be made early. If your healthcare provider doesn’t ask about how you about your feelings regarding your weight and eating, it is important that you speak up and tell them! Getting treatment early is key for any disordered eating is important and can help to improve your long term medical and psychological outcomes.
Treatment for disordered eating is a multidisciplinary approach and includes endocrinologists, nurse educators, dieticians, and mental health providers. In both children and adults this can include cognitive-behavioral therapy, family therapy or other evidenced based therapy, as well as diabetes education, and nutritional counseling. Finding a mental health provider that is knowledgeable about diabetes can help. The ADA has an online directory of mental health providers by state that have training and experience in diabetes: https://professional.diabetes.org/mhp_listing.
If you are struggling with disordered eating or restricting insulin to manage your weight, talk to your diabetes care team. Getting treatment early is important for both your short- and long-term health and well-being.