Diabetes is a condition that makes it difficult for the body to regulate blood sugar (glucose) levels or to respond to insulin appropriately (insulin resistance). People with diabetes must, therefore, carefully manage their blood sugar through medication or insulin and pay close attention to the types and amounts of foods they consume.
Sometimes, a person may use their diabetes diagnosis to justify or disguise their eating disorder (or disordered eating). However, managing diabetes and eating disorders often involve similar behaviors, including closely monitoring food intake, labeling foods as "good" or "bad," and weight management.
This article will discuss the relationship between types of diabetes and eating disorders, signs of an eating disorder when you have diabetes, and treatment options.
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Diabetes and Eating Disorders: A Cause of the Other?
A systemic review suggested that eating disorders change a person's risk of developing diabetes because eating disorders can modify the amount of body fat a person has and where it is stored in the body. Since diabetes is a metabolic and endocrine disorder, fat affects how your body manages insulin.
Some research has shown that binge eating disorder and bulimia nervosa may increase the risk of developing type 2 diabetes, while anorexia nervosa does not.
Diabetes, however, does not directly cause eating disorders. Moreso, the preoccupation with eating and managing weight is shown to increase the risk of developing an eating disorder. For example, a person with type 1 diabetes may have experienced weight loss before the diagnosis, followed by weight gain when beginning treatment with insulin. This may lead to increased body dissatisfaction and preoccupation with weight loss.
It is challenging to know the exact prevalence of eating disorders among people with diabetes. Still, researchers estimate that they affect around 20% of people with diabetes (much higher than the general population). In addition, women and girls with diabetes are 2.5 times more likely to develop an eating disorder than men and boys.
Diabetes & Eating Disorders Statistics
A recent review estimates that:
- Eating disorders affect about 30% to 40% of young women with type 1 diabetes
- Binge eating disorder affects approximately 1.2% to 8% of people with type 2 diabetes
- Night eating syndrome may affect up to 20% of people with type 2 diabetes
- Bulimia is the most common eating disorder among those with type 1 diabetes
- Binge eating disorder is the most common eating disorder among those with type 2 diabetes
- As many as one-third of women with type 1 diabetes report insulin restriction, with higher levels among those between the ages of 15 and 30
What Is Diabulimia?
Diabulimia is not a clinical diagnosis but a term used by the media to describe a condition where a person with type 1 diabetes uses insulin restriction to control their weight. By restricting, skipping, or stopping insulin, high glucose levels stay in the blood. This prevents the absorption of glucose and calories and can lead to dehydration, loss of lean body tissue, and in extreme cases, life-threatening diabetic ketoacidosis (DKA) (a condition where the liver breaks down fat at a dangerously fast rate).
In a small trial intervention, acceptance and commitment therapy (ACT) resulted in participants with type 1 diabetes and an eating disorder improving their eating issues and decreasing distress around diabetes management. They also found that participants could better manage difficult thoughts and feelings to make better decisions around eating and managing their diabetes.
Recognizing Signs of an Eating Disorder
Signs will vary depending on what eating disorder a person has but may include:
- Expressing one's concern and desire to change their weight, body shape, or size (may also have body dysmorphia)
- Constantly dieting or planning their diet
- Eating very low-calorie meals
- Talking excessively about healthy food or "clean eating"
- Exercising excessively or becoming anxious or upset if they cannot stick to their exercise regimen
- A need to control food or becoming upset or distressed in social situations where they cannot control the food, such as when dinner plans change or a restaurant isn't offering what they planned to order
- Using the bathroom frequently and right after meals
- Eating secretly or feeling guilty or ashamed of their eating
- Changes in mood and energy level, including increased irritability, anxiety, or depression
- Increased digestive problems
Clinical symptoms that a person with diabetes may also be struggling with an eating disorder include:
This list is not exhaustive and should not be used to diagnose an eating disorder.
Questions From Your Healthcare Provider
Screening questions that healthcare providers may use to identify a potential eating disorder for people with diabetes include:
- Do you feel like your eating is out of control?
- Do you take less insulin than you need because of concerns about your eating or weight?
- Do you feel overwhelmed by the demands of living with diabetes?
- Do you feel that you are often failing with your diabetes regimen?
Treatment
Treatment for diabetes and eating disorders includes a full-team approach, including but not limited to:
- Mental healthcare provider
- Eating disorder specialist
- Endocrinologist
- Nurse educator
- Registered dietitian nutritionist
- Support groups such as Diabetes Sisters
In extreme cases, hospitalization may be necessary.
Ways to Improve Body Image
Research has shown that body image dissatisfaction is common among individuals with diabetes, especially for women, girls, and adolescents. Additionally, body image issues may be associated with a higher risk of disordered eating behaviors.
Strategies that may help improve body image include:
- Appreciating all your body can do for you, such as walking, holding, or hugging loved ones, breathing, and laughing
- Countering negative thoughts about your body with positive attributes you like about yourself.
- Surrounding yourself with positive people
- Limiting media and social media consumption
- Finding ways to move your body that make you feel good rather than exercising as punishment for eating or as a means to change your body
- Wearing clothes that fit and make you feel confident
- Finding weight-neutral healthcare providers and seeking additional professional support, such as a body image therapist
Summary
While eating disorders and diabetes aren't the direct cause of one another, research suggests there is a relationship between the two. Managing diabetes and eating disorders both involve closely monitoring food intake, so it is not uncommon for people with diabetes to develop disordered eating behaviors or eating disorders.
Signs of a person with diabetes and an eating disorder may present as extreme concerns or dissatisfaction about their body or weight, very low-calorie meals, or constant dieting. Clinical appearance of an eating disorder in a person with diabetes may include extreme fluctuations of daily blood glucose, unexplained dramatic change in A1C levels, or sudden weight loss.
Improving body image may help a person manage diabetes and disordered eating. However, a holistic team is the best approach, including an endocrinologist, registered dietitian, nutritionist, eating disorder specialist, and nurse.
A Word From Verywell
While research suggests that eating disorders and diabetes may be related, it's important to know that having an eating disorder does not mean you will develop diabetes and vice versa. It's important to seek help if you feel you may be developing disordered eating habits due to your diabetes. Speak with a trusted friend, family member, or healthcare provider who can provide care, support, and resources to help.
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