Diabetes and Eating Disorders
The relationship between diabetes and eating disorders is complex. Both conditions share similar characteristics including attention to body issues, weight management, and control of food. Some may use their diabetes diagnosis to justify or disguise eating disorder behaviors. In individuals who are predisposed to developing an eating disorder, the constant emphasis on “eating well” may cause them to develop an eating disorder.
By: Valisha Barclay
What is Diabetes?
Diabetes is a disease that affects how the body converts food into energy. When we eat, our body breaks down the food into various molecules including glucose. These glucose molecules circulate through our body to be used as energy in all of the body's numerous processes and systems. In order for our cells to use these glucose molecules, we need insulin. Insulin is the key that opens the cells up so that glucose can enter and provide fuel. In diabetes, this insulin regulation is disrupted.
In type 1 diabetes, the body does not produce an adequate amount of insulin. Medication is helpful in this case. In type 2 diabetes, there is insulin resistance, where the cells don’t use insulin properly. It can be managed with certain medications and the implementation of healthy behaviors. Finally, there is gestational diabetes that can develop with pregnancy. Symptoms of diabetes include polyuria (excessive urination), polydipsia (excessive thirst), and polyphagia (excessive hunger).
In individuals with diabetes and eating disorders, essential metabolic processes and normal eating behaviors are dangerously affected and can result in serious health consequences.
Diabetes as a risk factor for Eating Disorders
Good v. Bad Foods
Because certain foods raise blood glucose levels more than others, those who are not properly educated on diabetes management may end up excluding certain food groups from their diet that are perceived as “bad” in an attempt to keep their blood sugar low. This harmful perception of “good” and “bad” foods can actually worsen diabetic symptoms and perpetuate eating disorder behaviors. Food has no moral value and adhering to a hierarchy of foods can lead to severe malnutrition. It is important to work with a dietitian that specializes in both eating disorders and diabetes to answer any questions and help create an appropriate meal plan that addresses both conditions.
Diabulimia
Studies have shown that women with type 1 diabetes are 2.4 times more likely to develop an eating disorder when compared to their counterparts without type 1 diabetes. Bulimia Nervosa is the most common eating disorder in those with type 1 diabetes. Those with type 1 diabetes and eating disorders are more likely to restrict their insulin regimen in an effort to decrease the amount of glucose that their body uses. Eating disorder behavior in Bulimia Nervosa includes some form of compensatory behaviors such as self-induced vomiting, laxative abuse, diuretics, enemas, diet pills abuse, and excessive exercising. With diabetes, these individuals have an additional behavior that they can abuse — insulin control. In diabulimia, the reduced insulin dose means glucose is left in the blood and eventually makes its way out of the body in the form of urine. This often results in malnourishment as the calories consumed are not adequately utilized for energy in the body. There are many serious health consequences that can result from diabulimia.[1,2]
In addition to this, those with type 1 diabetes are usually diagnosed earlier in life when parental guidance is a part of normal care. As individuals become older and parents become less involved in care, they are able to control their own insulin regimen and therefore have more freedom to manipulate doses.
Binge Eating and Type 2 Diabetes
In type 2 diabetes, binge eating disorder is common. Possible explanations are the limited consumption of carbohydrates and obsessive weight concerns. In addition, having low blood sugar, or hypoglycemia, can lead to binge-eating behaviors due to feelings of hunger and dissatisfaction after meals.[2]
Let’s discuss some complications that can happen.
The unstable blood glucose levels can lead to diabetic ketoacidosis in primarily type 1 diabetics, but type 2 diabetics can be affected as well. If insulin levels are too low, the body will start to break down fat and even muscle tissue for energy. This process releases ketones in the body. These ketones can reach dangerous levels and cause excessive thirst, nausea and vomiting, difficulty breathing, a fruity odor on the breath, and issues with focusing. They can even cause a diabetic coma. It is recommended to go straight to the emergency room if diabetic ketoacidosis (DKA) is suspected.
Fluctuating glucose levels can also lead to hyperosmolar hyperglycemic nonketotic syndrome (HHNS) in type 2 diabetics. This can also happen with type 1 diabetics, though rare. Symptoms include altered consciousness, extreme dehydration, and hyperglycemia or high blood sugar.[3] In individuals with type 2 diabetes where there is an increased incidence of binge eating, studies have shown an elevated risk of developing cardiovascular disease, hyperlipidemia, hypertension, and sleep apnea.[4]
Long term chronic complications
Uncontrolled glucose levels can lead to long-term damage to the eyes, kidneys, and heart. Nerve damage can also occur with repeated high levels of glucose in the blood. It is extremely important for individuals with diabetes to be screened for eating disorders and to keep up with their appointments for foot care, eye care, and regular checkups. The risk of long term complications also carries an increased mortality rate for those with eating disorders and diabetes.[5]
Early recognition and treatment intervention is paramount for avoiding the dangerous health complications associated with diabetes and eating disorders. At BALANCE eating disorder treatment center, our compassionate, highly skilled team of clinicians is trained in diagnosing and treating the spectrum of eating disorders, including anorexia, bulimia, binge eating disorder, compulsive overeating, and other disordered eating behaviors and body image issues.
Our admissions team would be happy to answer any questions you may have about our programs and services. Book a free consultation call with our admissions team below or read more about our philosophy here.
This post was written by BALANCE Dietetic Intern, Valisha Barclay.
Valisha is a dietetic intern at NYU who is currently working on her Masters in Clinical Nutrition. She completed her undergrad at Hunter College and works as a Care Coordinator at Memorial Sloan Kettering Cancer Center with patients undergoing bone marrow transplants. She has also worked with patients with gynecological cancers including ovarian, uterine and cervical cancers for three years. She has a passion for learning and providing support and care. She also has a passion for food, nutritionally and culturally. Outside of school and work, she enjoys cooking with her toddler and hopes to travel and explore the world through food.
Resources
1. Goebel-Fabbri AE. Diabetes and eating disorders. J Diabetes Sci Technol. 2008;2(3):530-532. doi:10.1177/193229680800200326
2. Colton P, Rodin G, Bergenstal R, Parkin C. Eating Disorders and Diabetes: Introduction and Overview. Diabetes Spectrum. https://spectrum.diabetesjournals.org/content/22/3/138. Published June 20, 2009. Accessed November 16, 2020.
3. Brutsaert EF. Hyperosmolar Hyperglycemic State (HHS) - Endocrine and Metabolic Disorders. Merckmanuals.com. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/hyperosmolar-hyperglycemic-state-hhs. Accessed November 16, 2020.
4. Today's Dietitian. Diabetes and Eating Disorders - Together They're Linked With a Double Dose of Health Consequences. Today's Dietitian. https://www.todaysdietitian.com/newarchives/121112p40.shtml. Accessed November 16, 2020.
5. Eating Recovery Center. Diabulimia Health Risks. Eating Recovery Center. https://www.eatingrecoverycenter.com/conditions/diabulimia/health-risks. Accessed November 16, 2020.