The pressure to be thin can feel overpowering in our society. Eating disorders are common among women and girls in the general population. Research suggests that eating disorders are probably more common among women with diabetes than among women without diabetes. However, people with type 1 diabetes are twice as likely to suffer from disordered eating patterns. However, people with type 1 diabetes are twice as likely to suffer from disordered eating patterns. However, people with type 1 diabetes are twice as likely to suffer from disordered eating patterns.

Bulimia is the most common eating disorder in women with type 1 diabetes. Among women with type 2 diabetes, binge eating is more common.

Because both diabetes and eating disorders involve paying attention to body states, weight control, and food control, some people develop a pattern in which they use the illness to justify or mask the disorder. Because the complications of diabetes and eating disorders can be serious or even deadly, responsible and healthy behavior is essential.

Eating disorders are diseases with a modified biological basis influenced by emotional and cultural factors. While eating disorders are potentially life-threatening, help is available, and recovery is possible.

Different Types

• Anorexia (or anorexia nervosa) is an eating disorder focused on an obsessive fear of weight gain. Anorexia involves self-starvation and excessive weight loss. Although anorexia is a psychological disorder, the physical consequences are severe and sometimes potentially deadly.
• Bulimia (or bulimia nervosa) is characterized by recurrent binge-eating (rapid, controlled consumption of large amounts of food). Purging can occur with self-induced vomiting, laxatives, diuretics, insulin omission or reduction, fasting, strict diets, or vigorous exercise.
• Binge Eating Disorder (also known as compulsive overeating) is primarily characterized by periods of uncontrollable, impulsive, or continuous eating beyond the point of feeling comfortably full. While there is no purging, there may be sporadic fasting or repetitive diets and often feelings of shame or self-hatred after a binge.
• Eating Disorders Not Otherwise Specified are a range of other disordered eating patterns that do not fit into the other specific types. These conditions remain serious, and intervention and care are necessary. Other types of eating disorders may include:
  • Disordered eating or disordered eating with some but not all characteristics of an eating disorder; for example, people who severely restrict food intake but do not meet the full criteria for anorexia nervosa.
  • Chewing food and spitting it out (without swallowing).
  • Bingeing and purging intermittently, such as during times of increased stress.

Warning Signs of Eating Disorders

• Unexplained increases in A1C levels (glycosylated hemoglobin).
• Repeated episodes of diabetic ketoacidosis.
• Extreme concerns about body size/shape.
• Excessive exercise and exercise-related hypoglycemia.
• Very low-calorie meals.
• Absence of menstruation.

Eating Disorders and Pregnancy

Women with eating disorders have higher rates of miscarriage than healthy, normal-weight women. Additionally, babies may be born prematurely, meaning they would not weigh as much or be as well-developed as babies born full-term.

Women with anorexia nervosa have low weight and may not gain enough weight during pregnancy. They are at risk of having a baby with abnormally low birth weight and related health problems.

Women with bulimia nervosa who continue to vomit may experience dehydration, chemical imbalances, or even heart irregularities. Pregnancy increases these health risks.

Overweight women due to binge eating have an increased risk of developing high blood pressure, gestational diabetes, and babies that are overgrown. Low birth weight babies are at risk for many medical problems, some of them potentially fatal.

Your teeth and bones could become weak and brittle because the baby’s need for calcium takes priority over yours. If you do not replenish calcium with dairy products and other sources, you may find yourself with stress fractures and broken bones in later years. Once calcium has leached from your bones, it is difficult, if not impossible, to replace it.

Diabulimia

Unexplained weight loss is a symptom of diabetes that often alerts a person that something is wrong. This, along with other symptoms like excessive thirst and frequent urination, often leads to a diagnosis of diabetes. The treatment for type 1 diabetes is insulin. ‘Diabulimia’ is an eating disorder characterized by the intentional withholding of insulin to result in weight loss.

Restricting insulin leads to blood glucose levels spilling over into the urine, leading to the excretion of glucose calories. Repercussions can be severe, including dehydration, loss of lean body tissue, and, in extreme cases, diabetic ketoacidosis.

Diabulimia is surprisingly common; up to a third of women with type 1 diabetes report insulin restriction, with higher levels among those aged 15 to 30.

How to Get Treatment

Once insulin restriction or other disordered eating behaviors are identified, a cycle of shame, guilt, and other negative feelings can make seeking help difficult, making the condition challenging to treat.

A team-based approach is the gold standard. The team should include a mental health professional along with other members of the healthcare team, such as an endocrinologist, diabetes educator, nutritionist, and others as needed. In very severe cases, hospitalization may be necessary until the person is more mentally and medically stable. Ongoing therapy at least monthly or more frequently with team members is also likely necessary.