Eating Disorders and Type 1 Diabetes

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Eating disorders are a significant health problem for many people with Type 1 diabetes, especially among adolescents. In Type 1 diabetes, the pancreas cannot produce insulin because the cells that manufacture insulin have been destroyed by the body’s own immune system. This insulin must be replaced in order for the body to absorb glucose from food, therefore people with Type 1 diabetes need to administer insulin daily. Managing Type 1 diabetes is a complex balancing act between different pharmacological insulin regimes and support from a diabetes health care team.

A healthy eating plan is a central part of managing Type 1 diabetes, alongside insulin injections or a pump, and a program of physical activity. This means that a person with diabetes will have to focus on their food intake over a long period of time, which can sometimes lead to a problematic relationship with food and eating.

Who is at risk?

Anyone living with diabetes can be at risk of developing an eating disorder, however research suggests that adolescent and young adult women are most at risk. This may be due to the particular challenges that come with this period in their lives.

For example, during adolescence, factors such as school, peer pressure and body image concerns can lead to significant stress. In addition, developmental and hormonal changes can have an impact on blood sugar control, leading to difficulties in diabetes management.

Young adulthood is a similarly challenging time. Schedules often become busier, there are increasing work pressures, new friendships and serious relationships are formed. This is also a time that people begin to create their own identity.

Factors that may increase the risk of developing an eating disorder

As well as individual, family and social stresses that can contribute to eating disorders there are additional risk factors for people with diabetes. Some parts of the management and living with Type 1 diabetes that may increase the risk of developing an eating disorder are:

• As part of diabetes management a person will have to focus on their food intake over a long period of time which can sometimes lead to a problematic relationship with food and eating.
• Individuals also often experience acute weight gain with the initiation of treatment or improvement in blood glucose control, which can be very distressing.
• Frequent hypoglycaemia (low blood glucose levels) needs to be treated by eating extra sugar and carbohydrates. This extra food can sometimes cause weight gain or trigger bulimic behaviours.
• ‘Insulin-purging’: Restriction or omission of insulin to induce weight-loss by ‘purging’ wanted calories.
• Feelings of depression, guilt and/or anxiety can be increased by some aspects of diabetes, such as the constant monitoring of blood glucose levels and worrying about the long-term complications of diabetes.
• Adherence to routine meals, snacks and ongoing diabetes management can be disruptive and place limitations on an individual’s life which can cause frustration.

Are eating disorders worse for a person with diabetes?

Eating disorders can create extra risks for a person with diabetes:

• They are particularly concerning in combination with Type 1 diabetes as they lead to poor glucose control, and increased risk of secondary diabetes complications such as diabetic eye, nerve and kidney damage.
• Persistent high blood glucose levels can lead to weight loss, with increased risk of long-term complications of diabetes.
• Diabetic ketoacidosis (DKA), a potentially life-threatening condition, can potentially be precipitated by the high blood glucose levels caused by missing or decreasing insulin doses so that glucose and calories are lost through the urine.
• Episodes of severe low blood sugar (hypos) can occur if food is restricted or purged (vomited), which makes it difficult for the appropriate insulin dose to be taken. Specific warning signs of an eating disorder in a person who has diabetes
• Extreme fluctuations in blood glucose levels.
• Frequent high or low blood glucose levels and/or diabetic ketoacidosis (DKA), possibly resulting in hospital admission.
• Consistent extremely high HbA1c (a blood test which measures the overall blood glucose levels over the last two to three months).
• Missing insulin doses, or changing doses significantly or frequently.
• Extreme fluctuations in weight.
• Fear of hypoglycaemia.
• Fear or distress at injecting, or insistence at injecting in private.
• Frequent requests to change meal plans.
• Non-diabetic eating disorder symptoms.

A number of other symptoms can occur and not all of these need to be present for someone to need help.

What can I do to help my child, partner or friend who has Type 1 diabetes?

If you think someone you know is at risk of an eating disorder, refer to EDV’s ‘ What should I say?’ fact sheet which has some useful tips on how to appropriately share your concerns with someone you care about.

Please contact the EDV Helpline on 1300 550 236 for more advice or information or download our Eating Disorders and Diabetes Fact Sheet.