October is National Diabetes Month and according to the American Diabetes Association, girls and young women with Type 1 diabetes have about twice the risk of developing an eating disorder as their peers without diabetes. This may be because of the weight changes that can occur with insulin therapy and good metabolic control or the extra attention individuals with diabetes must pay to what they are eating.
Type I Diabetes
Individuals with Type I diabetes do not produce insulin. The body breaks down the carbohydrates you eat into blood sugar, or glucose, that it uses for energy. Insulin is a hormone that the body needs to get glucose from the bloodstream into the cells of the body. Without insulin, glucose isn’t able to enter the cells, and sugar builds up in the bloodstream, causing bodily complications.
Eating Disorders and Diabetes
Two well-known eating disorders are anorexia nervosa and bulimia nervosa. People with anorexia restrict their food intake to stay thin. Their perceptions of their body are often distorted. People with bulimia repeatedly eat excessive amounts of food and then induce vomiting or take laxatives to purge the food from their bodies.
The most common features of eating disorders in girls and young women with type 1 diabetes are:
- Dissatisfaction with their body weight and shape and desire to be thinner
- Dieting or manipulation of insulin doses to control weight
- Binge eating
In people with diabetes, eating disorders can lead to poor metabolic control and repeated hospitalizations for dangerously high or low blood sugar. Chronic poor blood sugar control leads to long-term complications, such as eye, kidney, and nerve damage. Early warning signs of an eating disorder amongst women with diabetes include:
- Extremely high A1C test results; a simple blood test that measures blood sugar levels over 3 months
- Frequent bouts of and hospitalizations for poor blood sugar control
- Anxiety about or avoidance of being weighed
- Delay in puberty or sexual maturation
- Binging with food or alcohol
Diabulimia is a media-coined term that refers to an eating disorder in a person with diabetes, typically type I diabetes, wherein the person purposefully restricts insulin to lose weight. Sometimes it begins with body image issues or a desire to lose weight, and sometimes it begins as diabetes burnout. Regardless of how it begins, treatment can be challenging as individuals with type 1 diabetes tend to show higher dropout rates and poorer treatment outcomes than other patients. Treatment regimens must address both diabetes and eating disorder aspects of the disorder.
Diabulimia does not have a separate diagnostic code so a person’s specific diagnosis will depend on their eating disorder behaviors. Insulin omission is considered a purging behavior, therefore it may be coded as bulimia nervosa if the person is binging then restricting insulin. It may be diagnosed as purging disorder if the person is eating normally and restricting insulin, or anorexia nervosa if the person is severely restricting both food and insulin.
No matter where someone is at in their eating disorder or recovery, a multidisciplinary team is necessary to address the many entangled issues present with eating disorders and diabetes. Our team of talented dieticians, therapists, chefs, medical professionals, clinicians, and educators work together to provide the best possible care. To learn more about how Avalon Hills can help you, visit our website or give us a call at 866-733-8132.