Are There Connections Between Eating Disorders and Diabetes?

The relationship between diabetes and eating disorders isn’t one of occasional coincidence. Girls and women with diabetes are more than twice as likely to develop an eating disorder than are their agemates without diabetes. (Joslin Diabetes Center, n.d.). Because people with diabetes must take great care with what they eat in order to keep blood sugar levels within a healthy range, it might seem surprising at first that eating disorders and diabetes are such a problem. However, it may be because of that strict attention to diet that eating disorders develop in both type 1 and type 2 diabetes.

How Weight Control in Diabetes Can Lead to an Eating Disorder

People with diabetes do indeed have to closely monitor what they eat and how much they eat, taking great care with calories and carbohydrates. Further, throughout their day they must monitor their blood sugar and adjust what they eat and when they eat it. They must constantly watch their weight, too, as overweight and obesity worsen diabetes. This hyperfocus on food and weight can lead to an eating disorder.

Another issue that can contribute to the development of an eating disorder with diabetes is the need for some semblance of control. Diabetes management is intense, and food consumption is greatly restricted; therefore, people with diabetes often feel that they have little freedom and control in their lives. Eating disorders can develop out of a basic need for taking back some control over what for others is a basic, automatic, easy process.  

Diabetes and eating disorders are dangerous together. Let’s look at what this combination is like and what it can do.

Common Eating Disorders in Diabetes

Typically, eating disorders in diabetes involve binge eating. While anorexia nervosa, a disorder in which someone starves themselves to lose weight, isn’t unheard of in diabetes, it’s less common than binge eating behaviors.

The most common eating disorder in diabetes type 1 is bulimia. It involves consuming large quantities of food in one sitting, a behavior known as bingeing. This is coupled with behaviors to purge the body of such large amounts of food, such as vomiting, use of laxatives or diuretics, fasting after the period of binge eating, and over-exercising. In diabetes, another way of purging the system is through insulin restriction, where diabetes itself is used as a weight loss tool.

Insulin restriction is extremely unsafe. The practice of insulin restriction to purge calories and control weight has been nicknamed “diabulimia.” People living with type 1 diabetes need insulin to survive because their bodies don’t make it on their own. It’s needed to help glucose (sugar) enter the body’s cells to be used as energy. Without insulin, glucose can’t enter the cells and so the body starts to burn fat for energy. The byproduct of this process is the production of ketones, which leads to a potentially fatal condition known as diabetic ketoacidosis (DKA).

Diabulimia affects many. Alarmingly, ten to 20 percent of girls in their mid-teens practice insulin restriction and 30 to 40 percent of young women in their late teens engage in this dangerous behavior.

Like type 1 diabetes, eating disorders in diabetes type 2 primarily involve compulsive eating. The difference, though, is that while type 1 eating disorders involve purging or insulin restriction, type 2 involves binge eating alone. Binge eating disorder and diabetes greatly disrupt blood glucose levels, making glucose control nearly impossible.

Both bulimia and binge eating are dangerous to anyone’s health. When someone has diabetes, the consequences are even more dire.

Consequences of Diabetes and Eating Disorders

People with diabetes can suffer multiple effects from binge eating and diabulimia:

• Uncontrolled blood sugar
• High A1C levels (blood indicators of the average blood glucose level over the past several months)
• Recurring episodes of diabetic ketoacidosis
• Infections
• Early development of diabetes complications (nerve damage, eye damage, kidney disease, heart disease)
• Repeated hospitalizations

These consequences can also serve as warning signs. In addition to the above, other signs include anxiety or obsessions about weight and body image and excessive exercising.

Because eating disorders impact diabetes control and are so damaging, it’s important to seek treatment for yourself or a loved one.

Treating Eating Disorders and Diabetes

Treatment of eating disorders in diabetes is difficult, but it is indeed possible. Whether it’s you or a loved one who is struggling with an eating disorder, doctors and mental health professionals recommend such approaches as:

• Talking openly
• Listening closely without judgment
• Avoiding confrontation or the “tough love” approach
• Staying away from scare tactics to convince someone to get help
• Getting professional assistance to overcome the eating disorder
• Working closely with your diabetic care team
• Develop an eating plan that allows for flexibility and choices

Eating disorders, in general, are harmful to mental and physical health. When diabetes is in the picture, the consequences are even riskier. Seeking help for eating disorders and diabetes can be lifesaving.

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