Eating disorders and diabetes type 1 and 2
Diabetes is a chronic illness that impacts how someone’s body breaks down glucose (carbohydrates). The traditional treatment for diabetes is centered in diet culture and fat phobia, traditionally requesting that folks with this diagnosis lose weight, restrict carbs, and keep their lab values at a perfect level. Due to the hyperfocus on food, food groups, and body size, it makes sense that the rate of eating disorders in this population is higher (10% in adolescent females with diabetes compared to 3.8% in their counterparts) (1).
The term “diabulimia” is used to describe someone with an eating disorder who takes insulin (typically type 1 diabetes, ED-DMT1, but can be someone who has insulin-dependent type 2 diabetes, ED-DMT2). Neither diabulimia nor ED-DM are diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The DSM does consider insulin omission a form of purging. When the body doesn’t have enough insulin, a person experiences starvation regardless of their intake. The body’s cells cannot use ingested carbs from food, instead breaking down fat for energy. This leads to weight loss from both fat breakdown and insufficient stores of glucose in the body (2).
The word “diabulimia” comes from the earliest presentations of ED-DM, in which folks were experiencing bulimia nervosa, utilizing insulin manipulation or omission as a form of compensation for binge eating. Dia- coming from diabetes, bulimia coming from bulimia nervosa. That said, “diabulimia” can also reference the overlap of any eating disorder in folks with diabetes, including individuals with anorexia or other specified feeding and eating disorder (OSFED).
The treatment of ED-DM requires a full interdisciplinary team – endocrinologist, medical doctor, certified diabetes care and education specialist (CDCES), dietitian (like me!) and psycho-therapist. As clients work towards stabilizing their blood sugars, we also provide education around carb counting, portion sizes, insulin dosing, and how each individual’s body responds to different types of carbs.
We do not believe in restriction of carbs or weight loss as a solid nutrition philosophy in the treatment of diabetes. Rather, we look at balance and variety of food to work on slowing the absorption of blood glucose. This may mean pairing carb-rich foods with fiber, protein, or fat. It may mean taking a mindful walk before or after a meal. It may mean reconsidering when carbs are ingested throughout the day. All of this requires listening to your body and being intentional about menu planning.
When people hear that treatment of diabetes doesn’t include restriction of carbs, they tend to get confused. It’s important to look at all factors, outside of food, that could be playing a role in blood sugar management (3).
- Dehydration
- Meal timing
- Medication dose/timing
- Exercise, level of fitness, time of day
- Not enough sleep
- Stress and illness
- Allergies
- Menstruation
- Puberty
- Celiac disease
- Smoking
- Temperature
- Altitude
- Sunburn
Our goal is to treat the whole person, which includes taking a self-care assessment and determining how your food choices, in addition to lifestyle choices above, are impacting your blood sugar.
Knowing that diabetes is a chronic illness, there is no “cure”. That said, it’s always possible to heal your relationship with food and your body, to allow peace while treating your diabetes. When we think about being recovered from an eating disorder or disordered eating in this population, we think about consistently taking appropriate amounts of insulin, not engaging in rigid dieting or over-exercise behaviors, not intentionally having high blood glucose levels, flexible eating more often than not, and not acting on eating disorder thoughts or feelings.
If you think you may be struggling with disordered eating or an eating disorder, reach out! It’s never too early to get help in making peace with food.
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References
- Hanlan ME, Griffith J, Patel N, Jaser SS. Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options. Curr Diab Rep. 2013 Sep 12:10.1007/s11892-013-0418-4. doi: 10.1007/s11892-013-0418-4. Epub ahead of print. PMID: 24022608; PMCID: PMC4002640.
- Gaudiani, Jennifer. Sick Enough: A guide to the medical complications of eating disorders
- https://diatribe.org/42-factors-affect-blood-glucose-surprising-update
