Type 1 Diabetes and Eating Disorders: Know The Signs

People with eating disorders, and type 1 diabetes experience symptoms similar to non-diabetic people who have eating disorders—with one a major difference.

Those with diabetes may engage in calorie purging, or eliminating calories by restricting the use of insulin. This leads to a mismanagement of their diabetes, and a greatly increased chance of medical problems such as:

• Higher A1C levels.
• Greater risk of DKA (diabetic ketoacidosis), which can be fatal.
• More likely to develop infections.
• More frequent hospital/ER visits.
• Higher rates, and earlier onset of diabetes complications such as vision problems, kidney disease, nerve damage, and even heart disease.

Despite these adverse consequences, one longterm study initiated with 11 to 23 year old females* with type 1 diabetes, revealed the likelihood of their developing an eating disorder (ED) by age 25 to be 60 percent. Further, the possibility of ED onset remained substantial into later adulthood.

The Signs

Because the risk of developing an ED with type 1 diabetes is high, those who have type 1, and the people who care about them, are encouraged to know the warning signs:

• Unexplained A1C elevations.
• Extreme concerns or preoccupation with body shape and weight.
• Recurring problems with diabetic ketoacidosis.
• Altered eating patterns.
• Amenorrhea, or skipping menstruation.
• An unusual pattern of intense exercise that may be associated with frequent episodes of hypoglycemia.

These warning signs are fueled by a self-perpetuating cycle involving negative feelings about body image, shape, and weight; depression, anxiety, and a sense of shame; elevated blood sugar levels; and compromised diabetes self-care with insulin restriction.

Starting The Conversation

This cycle is difficult to undo, and the sooner an individual seeks help, the better. However, those with EDs are often wary of treatment and need to be approached with compassion.

If you suspect your type 1 friend or family member has an ED, one useful approach is simply to share your observations, and express concern. For instance, “I notice you’re working out a couple hours each day now, you’ve started skipping breakfast, and your last couple A1C values were higher than before. I love you and am concerned for your health.”

A non-judgmental approach such as this may get a conversation started. However, a conversation is just the first step of a long journey. People with EDs rarely recover on their own, and their acceptance of professional help may take time, requiring the patience and fortitude of friends and loved ones.

Source: Joslin Center
Photo credit: Vladimir Pustovit

*Though this study involved girls and women, EDs are not a female disorder, and the incidence of EDs in young males has increased over the past couple decades.