What are the issues?
Diabetes doesn’t cause eating disorders but some elements of diabetes management can contribute to what’s known as ‘disordered eating’. Managing diabetes involves focusing on the control of food and eating. It encourages people to pay close attention to their weight and to the types and amounts of foods they eat, as well as the timing of meals. It can also lead people to viewing some foods as either ‘good’ or ‘bad’. Having diabetes can make it more difficult to eat ‘normally’ because food is often eaten in response to blood glucose levels rather than hunger. Needing to eat when you’re not hungry, and then having to restrict your food intake at other times, can certainly take away some of the pleasure we usually associate with eating. For some, the hunger and weakness associated with hypoglycaemia (low blood glucose levels) can encourage binge eating. In addition to the usual methods of weight loss (eating less or exercising more), people who take insulin to control their diabetes can erroneously use it to lose weight. By reducing their insulin dose, blood glucose levels rise and the excess glucose spills over into the urine. This does lead to weight loss but can be dangerous, increasing the risk of developing complications.
What are the risks?
People with type 1 who suffer from an eating disorder have poorer blood glucose control, a higher risk of having diabetes complications and are at greater risk of death. Hospitalisation for severely low or high BGLs is more common in those with diabetes and an eating disorder, plus there is a higher incidence and earlier onset of diabetes-related problems such as eye, kidney and nerve damage. Those with type 2 who have disordered eating are more likely to be overweight, have poorer BGL control and a higher risk of cardiovascular complications.
How can I tell if I have an eating disorder?
● You have an unhealthy preoccupation with food and weight, beyond what is needed for managing your diabetes.
● You feel anxious about being weighed.
● You restrict your food intake and/or exercise excessively to control your weight.
● You feel out of control with your eating and/or often eat large quantities of food to the point of feeling uncomfortable.
● You feel guilty, embarrassed, disgusted or depressed about eating.
● You miss insulin doses to lose weight.
● You experience frequent hypoglycaemia (low blood glucose levels) due to restricting food intake.
● You experience frequent hyperglycaemia (high blood glucose levels) and possibly hospitalisation for DKA (diabetic ketoacidosis) due to omitting or restricting insulin.
● If you’re a teenage girl and your periods never started, are irregular, or stopped.
Where can I go for help?
If you have diabetes and suffer from an eating disorder, you need to seek treatment as soon as possible. People do recover from eating disorders and the sooner you start treatment the shorter the recovery period will be and the lower the chance you have of developing complications. Speak to your GP or healthcare team who can advise you on where to go for help. This may include a psychologist to help you deal with underlying emotional issues and a dietitian to provide nutrition advice as well as guide you back to eating a varied and well-balanced diet.
EATING DISORDERS EXPLAINED
Anorexia Nervosa: A persistent restriction of energy (kilojoule) intake, intense fear of gaining weight and disturbance in self-perceived weight or shape.
Binge Eating Disorder: Regular episodes of binge eating without compensatory exercise (or those behaviours associated with Bulimia Nervosa). Many people with Binge Eating Disorder eat when they’re not hungry and are overweight or obese.
Bulimia Nervosa: Repeated episodes of binge eating followed by compensatory behaviours such as self-induced vomiting or over-exercising after binge eating. People with bulimia also place an excessive emphasis on body shape or weight in their self-evaluation.
Other Specified Feeding or Eating Disorder: This diagnosis is given to someone who presents with many of the symptoms of other eating disorders but doesn’t meet the full criteria for diagnosis of any single disorder. It is the most common form of disordered eating.
By Dr Kate Marsh, Diabetic Living Diabetes Educator and Dietitian