Talking about food, weight, and diabetes is a complicated and difficult topic. Type 1 diabetes and Type 2 diabetes have distinctive patterns of diagnosis, management, and stigma associated to each, but they share a commonality; in that women who have either type of diabetes are at an increased risk for eating disorders1 and both have pieces of management where hyper focus on food, calories, and carbohydrates are critical. Add on top of that the relationship between insulin and weight, and it is a very dangerous recipe for negative health outcomes.
In an effort to bring awareness to this painful and challenging combination, this month we are focusing on the relationship between diabetes and eating disorders. Women with diabetes that also struggle with eating disorders often experience a host of painful emotions, including: depression, anxiety, shame, and chronic perseveration about body shape, image, or weight. The Joslin Diabetes Center2 explains that warning signs for diabetes and eating disorders include:
- unexplained elevations in A1C values
- repeated problems with diabetic ketoacidosis (DKA), which can be fatal
- extreme concerns about weight and body shape
- change in eating patterns
- unusual patterns of intense exercise (sometimes associated with frequent hypoglycemia)
- amenorrhea (skipping monthly menstrual periods)
Often, these symptoms show up in conjunction with skipping or missing insulin or oral diabetes medications in efforts to purge the body of food or excess weight. It is thought of in similar terms as bulimia, with the insulin omission equating the purging behavior that follows either binging or distressed eating habits. It is unclear what “causes” eating disorders, but does seem to be linked to increased focus on caloric intake, carbohydrate counting, and intensive tracking of food. That is exactly the “prescription” women with diabetes are asked to do for “good management”.
These unhealthy patterns are extremely risky and can result in severe medical outcomes such as higher A1C levels, developing infections, episodes of DKA, and higher rates of diabetes complications.
Bear in mind, that many people struggle with a few elements of these behaviors and others may exhibit all of them, but in all cases this is a crucial thing to seek support around. It is important to find a mental health professional versed in both diabetes and eating disorders, and begin to open up to your health care team about these difficult patterns. With support and new strategies to manage the anxiety around weight gain or concern about body shape, many clients establish a new and healthier relationship to food, their bodies, diabetes, and their health.
1Herpertz et al. (1998) Comorbidity of diabetes and eating disorders: Does diabetes control reflect disturbed eating behavior? Diabetes Care, v21, n7.
Dr. Diana Naranjo is a Clinical Psychologist who works at Stanford University/Stanford Children’s Health in the Pediatric Diabetes Clinic in Palo Alto, California.