Living with diabetes means that you need to strictly monitor your food intake, regularly assess your blood glucose levels, and use precise portions to avoid unnecessary spikes or dips in your blood sugar. Those with type 1 diabetes begin management regimens from an early age, thus increasing risk for diabetes distress or frustration over time. However, one factor that’s been previously overlooked is the relationship between diabetes and food that develops in adolescents during a period of time where body image is scrutinized. To help bring awareness to this relationship, we’ll discuss more information on eating disorders and type 1 diabetes.
The Relationship Between Eating Disorders and Type 1 Diabetes
As mentioned, people living with diabetes are required to put in a certain level of focus and restraint when creating meal plans, measuring out their food portions, and monitoring their overall food intake in relation to insulin. This is especially important for carbohydrates and sugars. Due to the requirement for this level of focus, it’s not uncommon for unhealthy relationships with food to develop. This is especially true in regard to adolescents and teens, but it can occur at any age.
During adolescence, body image becomes more scrutinized and your relationship with food may change, especially if you’ve been living with type 1 diabetes for years. This becomes increasingly difficult if you have friends or family members who give you constant input about what you should or should not be eating. When you have to be hyperaware of what you eat, how your body reacts to it, and what is considered “attractive” in society, it can create mental health problems that develop into eating disorders.
If an individual with type 1 diabetes develops an eating disorder, it’s commonly paired with diabetes distress and even ongoing fears of hypoglycemia, depression, anxiety, and more. To better understand signs and symptoms of eating disorders, we’ll explore some of the most common ones.
Insulin Omission for Weight Loss
Insulin restriction or omission for weight loss purposes is commonly referred to as “diabulimia.” As many people with diabetes know, taking insulin is often associated with weight gain. To avoid this, diabulimia involves skipping or administering lower doses of insulin in an effort to restrict caloric intake or purge calories already consumed.
Skipping or under-dosing your insulin levels causes blood glucose levels to rise exponentially. As blood glucose levels rise, your body attempts to excrete glucose in urine, which results in a loss of calories. This is the most commonly diagnosed type of eating disorder in individuals living with type 1 diabetes, but it’s also extremely dangerous. Improper management of diabetes leads to the increased risk of several chronic conditions, some of which are life-threatening. If you or a loved one begin to experience symptoms of diabulimia or negative thoughts associated with body image and food/insulin intake, see a professional as soon as possible. It is possible to treat eating disorders before they cause serious harm, but those affected must be willing to take the necessary steps.
Dangerous Symptoms to Look For
Since insulin is necessary for people living with diabetes to manage their blood glucose levels, skipped or reduced dosages can be extraordinarily dangerous. In many cases, those suffering from diabulimia will experience diabetic ketoacidosis (DKA) at some point. If DKA is not treated, it can result in a coma or even death. Some dangerous symptoms of DKA to look for in those suffering from diabulimia (and in anyone with diabetes) include:
- Increased thirst
- Frequent urination
- Ketones in the urine
- Nausea and vomiting
- Stomach pain
- Shortness of breath
- Fruity-scented breath
- Tiredness or fatigue
- Confusion or dizziness
Diabetic ketoacidosis should be treated as soon as possible to avoid serious, long-lasting complications and death. Seek medical care immediately, especially when these symptoms are paired with high blood sugar levels.
Other Symptoms of Insulin Omission
In addition to the dangerous, sometimes obvious signs of insulin omission, there are a few things that can occur that might be harder to notice in a loved one. Aside from increased blood glucose levels, some signs of insulin omission include:
- High A1Cs (often over 9.0%)
- Concerns about weight
- Concerns about body shape regardless of size
- Increased levels of exercise
- Changes in eating patterns
- Skipping menstrual periods
Talk to a medical professional if you or a loved one are experiencing any of the symptoms for diabulimia or if you’re struggling with your body image.
Common Eating Disorders in People with Type 1 Diabetes
While diabulimia is one of the most common eating disorders in individuals with type 1 diabetes, it’s not the only one. People with diabetes can experience any of the same eating disorders as people without diabetes. Some of them include anorexia nervosa, bulimia nervosa, and binge eating disorder.
Anorexia Nervosa
Commonly shortened to anorexia, this eating disorder is rooted around an obsessive fear of gaining weight. To avoid any weight gain, those who suffer from anorexia often undergo self-starvation. This leads to excessive weight loss that can cause psychological distress if even one or two pounds are re-gained. Anorexia is often paired with body dysmorphia, which can lead to extreme and potentially deadly weight loss. When untreated, anorexia leads to several physical complications which can cause serious, long-term damage. In severe cases, anorexia can be fatal. When combined with type 1 diabetes, these complications worsen and can create debilitating effects.
Bulimia Nervosa
Bulimia is an eating disorder that’s characterized by a cycle of binge eating and purging. Binge eating is when an individual consumes a substantial amount of food—far more than needed for satiety—in a short period of time. Purging is therefore, when an individual eliminates the food from their body, either through self-induced vomiting, the use of laxatives and diuretics, fasting, crash diets, excessive exercise, or even insulin omission/reduction. This can cause extreme spikes in blood glucose levels for those living with type 1 diabetes and exacerbate complications. If the purging method involves vomiting, bulimia can also cause substantial damage to the esophagus and sphincter.
Binge Eating Disorder
Binge eating disorder isn’t as commonly discussed, as the side effects aren’t as stereotypical as other eating disorders. Binge eating disorder is characterized by an individual who compulsively consumes large amounts of food in a short period of time. These moments are often uncontrolled, impulsive, and involve continually eating past the point of being full, thus causing extreme discomfort. Binge eating disorder differs from bulimia in that there is no purging involved, but the individual may undergo periods of shame or self-hatred that can result in restrictive or harmful diets. Binge eating disorder can disrupt your blood glucose levels and cause extremely high spikes and dips, which can be harmful if insulin administration is not adjusted.
In addition to those listed above, there are several eating disorders that may not fit specific patterns. However, any type of eating disorder—regardless of the pattern—requires intervention and treatment to avoid catastrophic results.
Treating Eating Disorders
Those with type 1 diabetes are at increased risk of complications, especially when eating disorders are left untreated. To help avoid the onset of eating disorders, screenings should be conducted from pre-adolescence into early adulthood along with healthy eating habits and body positivity. If eating disorders are diagnosed, swift treatment often leads to the best outcome.
Treatment varies based on the type of eating disorder and the individual affected. It’s often a very personal experience and requires a long-term commitment to get better. Remember, early treatment will lead to improvements in medical conditions and psychological outcomes, so don’t be afraid to speak up.
Treating eating disorders requires a multidisciplinary approach that utilizes the knowledge and experience from various professionals such as nurses, dieticians, endocrinologists, and mental health providers. This allows those affected to learn body positivity, understand their triggers, and create a solution to approach diabetes management in a healthy manner. For help, the American Diabetes Association (ADA) has an online directory of state-by-state mental health professionals with diabetes training.
Eating disorders carry a significant level of risk for individuals, regardless of if they have type 1 diabetes. Unfortunately, type 1 diabetes considerably raises these risks and can even lead to increased mortality when left untreated. If you’re struggling with your diabetes management or think that you may have an eating disorder, seek help today. There are thousands of support groups to help you process your emotions and plenty of loving family members and friends who can help you along the way. For assistance with ongoing diabetes management, Byram Healthcare has a range of glucose monitors and educational resources at your disposal.
