According to the American Diabetes Association, women who have type 1 diabetes are 200% more likely to display disordered eating patterns. The ADA says that bulimia is the most common eating disorder among women with type 1 diabetes. Often, people who have both an eating disorder and a chronic illness use their health symptoms to hide or explain away disordered eating behaviors. Left untreated, this dual diagnosis can result in serious and even fatal health complications.

Understanding Bulimia and Type 1 Diabetes

People who have this eating disorder quickly consume excessive amounts of food in controlled binge eating sessions. After each binge, they engage in calorie purging through punishing exercise, restrictive diets, use of diuretics or laxatives, or self-induced vomiting. Bulimia affects about 2% of women and a much lower percentage of men.

According to the Juvenile Diabetes Research Foundation, girls and young women who have type 1 diabetes may be negatively impacted by the new emphasis on food after diagnosis. They may feel pressure to eat the perfect diet to avoid the health consequences of the disease. Some teens in this situation become preoccupied with counting carbs and calories as they also experience the body image issues that affect many girls in the adolescent years and beyond. 

Some people who have type 1 diabetes even restrict their insulin dosages as a means of weight management after a food binge. The ADA refers to this type of behavior as “diabulimia,” but the clinical term is eating disorders in diabetes mellitus type 1 (ED-DMT1).

The Impact of ED-DMI1

The practice of omitting or decreasing insulin causes excessive blood glucose to enter the urine. The person excretes these glucose calories, resulting in rapid weight loss. According to the ADA, up to 33% of women who have type 1 diabetes engage in insulin restriction; diabulimia occurs more commonly among teens and young women ages 15 to 30. 

Left untreated, insulin restriction can cause muscle wasting, dehydration, and eventually, diabetic ketoacidosis. With this complication, your body cannot effectively use glucose for energy because of a lack of insulin. At first, bulimia causes weight loss to occur as the body breaks down fat. Over time, DKA causes excessive urination, constant thirst, fruity-scented breath, the presence of ketones in the urine, fatigue, vomiting, nausea, and difficulty breathing. Left untreated, this condition can cause coma or even be fatal. 

Symptoms of Disordered Eating With Type 1 Diabetes

When diabetes occurs along with bulimia or another eating disorder, the person may display these warning signs:

    • Strictly limited calorie intake
    • Extreme exercise routines
    • Irregular or interrupted menstruation
    • Preoccupation with body image or body shape
    • Hypoglycemia
    • Recurrent diabetic ketoacidosis
    • Increased A1C levels without explanation

It’s also important to be aware of the general signs of eating disorders, which often include:

    • The desire to eat only in private
    • Irregular or sporadic meals
    • Discomfort, shame, guilt, embarrassment, or stress about eating
    • Use of the bathroom immediately after a meal

Complications of Disordered Eating With Type 1 Diabetes

Diabetes eating disorders also amplify the other health risks associated with the disease, such as kidney disease and nerve damage. According to a report on Today’s Dietitian, people who have diabetes and eating disorders at a young age develop chronic conditions associated with type 1 diabetes decades earlier than expected. The publication cites a study that appeared in the journal Diabetes Care in which researchers followed 234 female type 1 diabetes patients for 11 years. Those in the study who engaged in insulin restriction had a 300% higher risk of diabetes-related mortality as well as higher rates of nerve damage and foot problems that impact mobility and quality of life. 

Other Types of Eating Disorders

Bulimia is not the only eating disorder that affects individuals who have type 1 diabetes mellitus. Some other common diagnoses include:

    • Anorexia, characterized by restricted food intake because of an overwhelming fear of weight gain. People who have anorexia nervosa can experience serious physical side effects. The National Eating Disorders Association reports that about 1% of women in the United States suffer from anorexia; men represent less than 10% of people with this condition.
    • Binge eating disorder, which includes compulsive sessions of uncontrolled eating well past feeling full. Unlike with bulimia, individuals who have binge eating disorder do not engage in a calorie purge, although they may have periods in which they diet or fast after a binge. The ADA reports that binge eating is more common among individuals who have type 2 diabetes. This condition affects an estimated 3.5% of women and 2.5% of men.
    • Eating disorder not otherwise specified, which refers to disordered eating behaviors that do not meet the criteria for another illness (but still need serious medical attention). Examples include chewing but not swallowing food, occasionally binging and purging, and intermittently restricting food intake to control body size and weight. 

Prevalence and Risk Factors

Another Diabetes Care study, this one published in 2015, followed 126 girls ages 9 to 13 for 14 years. After the study period, the now-adult women had an average age of 23.7 years–and almost 60% reported some degree of disordered eating. The study participants commonly said they engaged in restrictive dieting and insulin omission to prevent weight gain. Although all the females in the study received ongoing care management for type 1 diabetes, the rates of disordered eating increased over the study period. 

In addition to the presence of type 1 diabetes, risk factors for eating disorders include:

    • Having a parent or sibling who has an eating disorder
    • Having a personal or family history of depression, anxiety, or another mental health disorder
    • Displaying perfectionism, especially very high expectations of oneself
    • Having an unrealistic or negative body image
    • Being exposed to societal messages about the importance of remaining slim and losing weight
    • Experiencing bullying in one’s peer group
    • Being in one’s teens or twenties
    • Experiencing stressful life transitions
    • Participating in extracurricular activities that prohibit weight gain

Just as type 1 diabetes increases the risk for developing an eating disorder, a history of dieting, restricting food or having an eating disorder can also increase the likelihood of developing type 1 diabetes. 

See also: Is COVID-19 Something that Causes Diabetes?

Treatment of Eating Disorders With Diabetes Type 1

Many women avoid seeking treatment for bulimia and other forms of disordered eating because they develop feelings of guilt and shame associated with these habits. The ADA recommends an approach that integrates the diabetes care team with mental health providers and other healthcare providers, including a nutritionist, nurse educator and endocrinologist. Many eating disorders require ongoing therapy and the most severe cases require hospitalization until the person becomes stable.

Concurrently managing diabetes and eating disorders must include careful attention to blood glucose levels. Families impacted by these health conditions can connect with MedEnvios Healthcare for convenient access to home delivery of continuous glucose monitoring equipment and other diabetes supplies.

Click here to see which blood sugar monitoring device to use with diabetes disorders.

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