Eating Disorders and Diabetes

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Diet, exercise, medications, reduce complications. Those are the main things that come to mind when considering diabetes. Eating disorders may not be on your healthcare provider’s radar. However, the coexistence of eating disorders and diabetes happens.

Eating disorders are on the rise. Interestingly, as we learn more about nutrition and increase our public health efforts at fighting against the “obesity crisis”, we’re struggling with more disordered eating behaviors.

Blanket statements are commonly given to people with diabetes. Things like, “Just stop eating carbs”, or “You need to lose X pounds”, with very little guidance beyond that.

Add in the weight bias that so many feel when they are seeking medical care, and it’s easy for eating disorder diagnoses to go untreated.

If you’re new here, welcome! I’m Erin, a registered dietitian and diabetes care and education specialist. I’ve blended my years of experience with diabetes and intuitive eating to provide a non-diet approach for those who have diabetes and other chronic conditions.

I’m very passionate about helping those with disordered eating and diabetes. I want you to know that you are not alone if you struggle with disordered eating while managing a metabolic disorder.

Individuals with diabetes face unique challenges. In some cases, there is a need for meticulous attention to food intake.

Unfortunately, that attentiveness to food often collides with the psychological aspects of an eating disorder.

As a result, the intersection of eating disorders and diabetes is complex. Extreme care needs to be taken when balancing both physical and mental health.

Today’s post is about eating disorders and diabetes. I hope to shed light on the challenges, risk factors, and potential complications. I’ll also provide strategies for support.

Understanding eating disorders and diabetes

From the beginning of your diabetes journey, you are told to monitor numbers. Check your blood sugars, count your carbs, dose your insulin, lose some weight, etc.

While some people with diabetes can manage those numbers without any impact on mental health, I want you to know that it is normal to have a strained relationship with all aspects of those metrics.

For instance, you may have anxiety leading up to a follow-up appointment because you know your A1c will be high. Or you feel like a failure because you’ve not lost the weight your physician recommended you drop.

Has your meter grown dusty because you’ve stopped checking? You know it’ll just be high.

Managing a chronic disease isn’t easy, and can take its toll on your mental health. We know that people with diabetes are more likely to have depression.

All of these pressures can make you dissatisfied with your body, or obsessed with food. Research shows that diabetes may put a person at risk for developing an eating disorder.

Sometimes a good-natured recommendation to restrict your diet to control your diabetes actually screws up your relationship with food.

Types of Eating Disorders

Eating disorders are serious conditions classified as mental health disorders distinguished by rigid and severe eating habits.

Unfortunately, eating disorders can have very serious consequences. With a preoccupation with food and body, an eating disorder can consume a person’s mind and change their personality.

Some of the common eating disorders include:

Anorexia Nervosa

Anorexia is characterized by extreme calorie restriction, intense fear of gaining weight, and distorted body image.

People with anorexia severely restrict food, often meticulously controlling the type and amount of food they eat. There may be rituals assigned to eating, such as breaking a cracker into 10 pieces and eating one piece every hour.

While folks with anorexia may have a skeletal appearance, they believe they are overweight. Their perception of themselves is distorted.

This does not mean that someone who is overweight cannot be diagnosed with anorexia. This is considered atypical anorexia.

There may also be compulsive exercise with a focus on calorie burn. Along with those behaviors, there is an obsession with thinness.

It’s not uncommon for people with anorexia to fixate on food and “thinspo”(images and videos of others likely suffering from anorexia).

There is also a mood component to anorexia. Often those dealing with the condition can be withdrawn, irritable, anxious, and depressed.

Bulimia Nervosa

Bulimia typically involves cycles of binge eating followed by purging behaviors such as vomiting, laxatives, diuretics, enemas, excessive exercise, or fasting.

This isn’t an occasional case of overeating and eating a bit less the next day. Bulimia is characterized by repeated episodes of overeating, often with a loss of control. Essentially, you feel like you can’t stop eating, even though you’re full.

The hallmark of bulimia is that you compensate for the overeating by purging. Purging is mostly done in hiding, as there are feelings of shame and guilt.

One of the more common methods of purging is self-induced vomiting. For example, a person may make themselves vomit after a meal.

Other forms of purging include medications and over-the-counter laxatives, diuretics, and enemas. There may also be extreme exercise routines in place to “undo” the calorie intake.

Binge Eating Disorder

Like bulimia, binge eating includes episodes of consuming large amounts of food, often without control. However, it is without purging behaviors.

According to diagnostic criteria (DSM-5), binge eating episodes are associated with at least 3 of the following:

1. Eating faster than normal
2. Eating past comfortable fullness
3. Eating large amounts of food when not hungry
4. Eating alone because of shame and embarrassment
5. Feeling disgusted, guilty, and/or depressed

As for how often binge eating occurs, diagnostic criteria state at least 1 day a week for 3 months.

Binge eating disorder, or BED, is the most common eating disorder in people with type 2 diabetes. As you can imagine, binge eating would make it difficult to manage blood sugar.

Additionally, many folks go undiagnosed. Whether it’s fear of judgment, lack of assessment of eating behaviors, or both, many suffer alone.

Diabulimia

A disorder affecting almost 9% of people with type 1 diabetes, diabulimia is characterized by inadequate dosing of insulin with the objective of controlling body weight.

In type 1 diabetes, exogenous insulin (injection or pump) is needed to live. Purposely underdosing or skipping insulin can be very dangerous.

Instead of glucose going into the cells, where it’s needed for energy and primary functions, it is stuck in the blood.

This creates starved cells and a risk for ketoacidosis when the body relies on fat for fuel.

Besides elevated blood sugar, those with diabulima are at risk for fast-tracking short-term and long-term complications associated with diabetes.

Orthorexia

Orthorexia is an obsession with health-related aspects of food. Food choices aren’t necessarily driven by impact on body shape, but rather overall health.

While orthorexia is not considered an official eating disorder diagnosis, it can be debilitating and isolating.

Whether or not orthorexia should be classified as an eating disorder is a debated issue. What matters to me is that it’s a real thing and people with diabetes are at risk.

For example, you stop eating grains, meat, or sugar. You almost fear them because you’ve deemed them unhealthy.

People with orthorexia often will avoid eating out and may talk a lot about food.

How eating disorders complicate diabetes management

Because eating and blood sugar are impossible to separate, it’s obvious that eating disorders will impact your blood sugar in some way.

For individuals with diabetes, maintaining consistent blood sugar levels is crucial. Disordered eating patterns can disrupt this balance, leading to hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar).

Likewise, irregular eating habits, purging behaviors, or extreme dieting can undermine diabetes self-care, potentially leading to long-term complications.

Risk factors for developing eating disorders

There are multiple reasons people develop eating disorders. However, there are some risk factors that make it more likely to occur:

1. Genetics
2. Gut bacteria/microbiome
3. Exposure to disordered eating in youth
4. Personality traits (perfectionism, anxiousness)
5. Mental health conditions
6. Gender
7. Socioeconomic status
8. Ethnic minority
9. Body image issues
10. Social influence
11. Athlete
12. Abuse and trauma

Strategies for support

If you have any disordered eating behaviors, I urge you not to go it alone. You can have freedom from disordered eating.

Here are some ways that you can get help for an eating disorder:

1. Integrated Care:
   • It takes a village! Eating disorders are complicated and nuanced and will require multiple disciplines for true healing.
   • Talk with your primary care provider or endocrinologist about your eating concerns.
   • Seek collaborative care involving endocrinologists, dietitians, mental health professionals, and diabetes educators is essential.
   • Finding treatment for both diabetes and the eating disorder is crucial for holistic recovery.
2. Counseling and Therapy:
   • Cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT) have shown efficacy in treating both eating disorders and diabetes-related distress.
   • Individual and group therapy can provide a supportive environment for addressing psychological and emotional challenges.
3. Nutritional Guidance:
   • Collaborating with a registered dietitian specializing in both diabetes and eating disorders can help individuals develop a balanced and sustainable approach to food.

Conclusion

Eating disorders and diabetes require a comprehensive and compassionate approach. You should feel understood and heard.

If you’re constantly being pressured by your healthcare team to lose weight or cut carbs, find new providers.

Find yourself a team that will help you work on the physical and mental aspects of these conditions simultaneously.

You can work towards a healthier relationship with food, improved diabetes management, and overall well-being.

It will be a journey, but early intervention, support from healthcare professionals, and a strong support system will help you successfully navigate an eating disorder with diabetes.

If you need help, please reach out. I want you to feel at peace with food and your body. I’m here to listen!

Disclaimer: This information is intended as a self-help tool for your own use, at your own risk. My opinions do not reflect the values, thoughts, or opinions of the Academy of Nutrition and Dietetics or other professional health organizations.

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