Islets of Hope disorders associated with diabetes
Article by Lahle Wolfe
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IOH Mini Quiz
What is the most common eating disorder seen in women with diabetes?
Bulimia (the binge and purge disorder) is the most common eating disorder in women with type 1 diabetes.
For women with type 2 diabetes, binge eating is more common.
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Islet of Information
According to Michele D. Levine, MS, and Marsha D. Marcus, PhD (Women, Diabetes, and Disordered Eating) ...”The prevalence of eating disorders among insulin dependent diabetics is estimated to be two to six times higher than in the general population. Up to 25% of females with insulin dependent diabetes may have a diagnosable eating disorder. Although having diabetes has not been shown to cause eating disorders, the condition may increase the risk of developing them.”
National Eating Disorders Association
..."Women with subclinical eating disorders, who did not have weight loss or diagnosable eating pathology but did have abnormal eating attitudes, had a highly significant incidence of menstrual abnormalities (93.4% vs. 11.7% control group)." 1989 Psychosom Med 51;1:81-6, Kreipe, R. E., Strauss, J., Hodgman, C. H., and Ryan, R. M.
Eating Disorders - Section 1 print this article
Mini Site Index Famous People with Eating Disorders
Diabetics with an eating disorder are 3 times more likely to have diabetic retinopathy.
An Overview of Eating Disorders
Why should you know about eating disorders? If you, your child, or loved one has one of the many metabolic disorders that carry a medical demand of closely monitoring eating habits, there is a significant increase in the risk of developing an eating disorder. Eating disorders (EDs) are not just a problem for young girls; an all too common belief. EDs can develop at any age and also affect boys and men. In Australian type 1 diabetic children as young as 11 years old purposely under bolus insulin with meals in order to lose weight.
In the United States studies suggest up to 25% of all females with diabetes – a prevalence of 2-6 times higher in women with diabetes than in the general population – have an eating disorder. The findings from a study by Flinders Medical Centre in Adelaide, also showed children in Australia with diabetes were markedly affected by disordered eating behavior:
While diabetes does not actually cause an eating disorder, having to pay close attention to weight management and food choices places an unnatural and unhealthy focus on eating and leads to distortion of self and body image. Once a person has ED issues, it is often easy for them to hide their problem under the guise of “it is part of my diabetes care plan.”
Restricting, the elimination of certain foods or entire food groups, is a common factor in ED behavior, as is developing “safe” and “unsafe” food lists. A person may become overly concerned or anxious when offered something from their “restricted or unsafe list.” The initial limitation and focus of a food may stem from legitimate management issues (eating high glycemic index carbohydrates causes a rapid rise in blood sugars, fat prolongs highs) that develop into compulsive avoidance. Fear may also stem from weight gain which can happen with all forms of diabetes, and for diabetics, the body conscious, ultra-thin-is-desirable- culture we live in, is made even worse because diabetics are weighed at every visit and constantly reminded from a health standpoint about excess body weight and diabetes. And those with metabolic challenges, especially type 2 and pre-diabetes, hear the “thin message” from culture, health professionals, parents, and even their own still voice from within. In fact, many believe that diabetics are to blame for their onset and readily point the finger at a lifestyle out of control.
Bulimia: The Feelings Disorder
Bulimia is often referred to as a “feelings” or “emotional” disorder. That is, emotions may be deferred or dulled by overeating (bingeing), and “coped” with by subsequent purging. A sense of emotional and stress relief may be associated with the act of purging and a false sense of control is restored. However, the temporary release is just that, and feelings of negativity and loss of control return and the cycle continues.
Bingeing - During a binge, one of the common factors is that people feel out of control, as if compelled or driven to eat. The person often feels intense anxiety and out of control prior to, and during the binge session.
Binges usually consist of high carbohydrate or fatty foods, most typically sweets. Binges can occur over hours, but with bulimia "stuffing" is generally condensed into rapid, frantic eating over a short period of time almost always in secret. A sense of panic may set in, as well as guilt, during and after eating so the bulimic subsequently purges.
Serious Complications Are Associated with Eating Disorders
Eating disorders are serious business – even for the nondiabetic. More than 20% of all those with an ED will die from complications attributed to their unhealthy eating habits. This is not just true for anorexia nervosa (self-starvation) but for those with bulimia and binge eating disorders. All persons with EDs are prone to serious immediate and long-term health issues and even death.
Blindness, kidney damage, neuropathy, impaired circulation are all concerns with any type of diabetes and these risks are extremely elevated in those with an ED. Even without adding diabetes into the mix, persons with EDs are also at risk for heart failure, rupture of the esophagus from forced vomiting which leads to almost certain death. Additionally, damage to the esophagus from repeated vomiting can cause serious injury, scarring, and even lead to esophageal cancer, an almost fatal condition. Ruptures can also occur in the stomach and intestinal tract from overeating and vomiting. Vomiting and misuse of laxatives can lead to life-threatening electrolyte imbalances than can cause heart failure. Binge eaters who do not purge are often obese and morbid obesity carries its own serious health risks.
The physical implications of should be taken seriously, but so also should the emotional and psychological damage living with an ED brings. Social isolation is often self-imposed, and in some cases the ability to function in previously enjoyed activities becomes impossible.
Most persons with EDs believe that they are the exception and will not suffer serious health consequences but this is not the case. All persons with EDs suffer both physically as well as psychological and emotionally. Many also fail to believe that they have a problem, or, that they are in control of their disordered eating. The fact is, the behaviors take over and control thought processes, which become all-consuming, and activities and social encounters will even begin to be structured around abnormal eating behaviors.
Warning! Some persons with an ED will use syrup of epicac to induce vomiting. This is extremely dangerous and can lead to cardiac arrest. If you find hidden bottles of this over the counter medication get help for your child immediately.
Insulin: Misuse Can Be Addictive
Those using insulin therapies may refuse to bolus with food, or deliberately under bolus. High blood sugars are dangerous and have serious, even life-threatening consequences, but also result in weight loss – an obsession with almost all suffers of EDs. But the weight loss is due to body tissues, not just fat, being dissolved and excreted in urine.
Sometimes, there is a temporary improvement in blood sugars when persons with diabetes fast. Prior to insulin therapy, fasting was actually one way patients were told to deal with their disease. When food, particularly carbohydrates are not eaten, less insulin is required. A person may think that they are actually “curing” or helping their diabetes because they require less insulin. The truth is not that they are getting better are requiring less insulin, but they are starving their bodies of both food and insulin.
Of particular concern are persons with type 1 diabetes who have an absolute insulin deficit. Fasting is not beneficial to diabetics because it may lead to a reduction in levels of circulating insulin. The body needs circulating (basal, or background) insulin on a consistent, continual, daily basis. If a persons with type 1 stops taking insulin or reduces the amount needed, diabetic ketoacidosis (DKA) will quickly set in. Not only will DKA develop over a shorter period of time, but at lower glucose levels than if the person had been regularly taking insulin. (This is why pump users should never turn off their pumps at night. If sugars are low pumpers should increase their snack intake at bedtime rather than turn off their basals for the night – something I learned the hard way!)
Diabetes Management vs. Eating Disorders: Much in Common
Eating disorders and diabetes have some common characteristics so it is important to understand the dynamics of ED behavior. Both diabetes management and EDs go hand-in-hand with weight management, focusing on types and quantities of food ingested, and revolve around numbers and constant vigilance. Both diabetes and EDs have “good” and “bad” foods that a person will try to avoid, even fear. And just as persons with EDs become consumed with the numbers on the scale, diabetics must be highly focused on the scale and by the numbers on their glucose monitors.
With both diabetes and EDs control is a constant issue and food a constant thought process to be planned and calculated and perhaps even to be executed rather than enjoyed. A person with diabetes must constantly attempt to control their disease so that it does not control them. A person with an ED believes they are in control of the habits, but eventually EDs control the person who will usually deny this, going so far as to even state it is their active choice to pursue unhealthy, disordered eating habits.
How do you know if a person is simply exercising rigid control in their diabetes management or has an eating disorder?
The connection between diabetes and the risk of EDs may be a result of both disorders sharing much in common. For example, diabetes and eating disorders both involve the idea of “forbidden” or “restricted” foods, and keen attention to diet. Both diabetics and those with EDs may become overly concerned or fixated on how food impacts their bodies. Diabetics may misuse insulin to control weight – a dangerous behavior that can lead to all the serious complications normally of concern with diabetes. Misuse of insulin can cause elevated blood glucose levels, affecting a persons A1c, as well as putting them at risk for diabetic ketoacidosis (DKA), and long term health problems including kidney failure, heart disease, blood circulation difficulties, neuropathy, damage to the eyes, blindness, and even death.
Having diabetes often feels like the disease is controlling the person. Persons with EDs seek to regain control through modification of their weight or eating habits. However, the truth is that the ED soon takes over and the person is compelled, rather than choosing, to maintain unhealthy ED practices; something the person will deny deny deny, believing and stating that they can stop anytime they wish to.
Since it can be difficult to detect an eating disorder (many with EDs go to great lengths to hide their problem), look for some of the following warning signs, especially in adolescents who may be in charge of their own care:
Additionally, many persons with EDs will binge and purge in secrecy and come up with excuses to fast when other people are around. They push their food around on their plate, may seem anxious, cut food into smaller and smaller pieces, or only eat one pea at a time. They may become highly defensive when confronted with weight or eating habit concerns. Bulimics tend to be at, or near-normal weight, anorexics are underweight, and binge eaters tend to be overweight. Both anorexics and bulimics can go through periods of fasting and bingeing, which is almost always followed by some form of purging.
If you suspect someone you know may have an eating disorder you can also expect them to probably deny it.
Page Updated 03/30/2006