Diabetes and Eating Disorders -- What's the Connection?

It is no secret that with diabetes comes various nutritional and lifestyle restrictions. People with diabetes, both type one and type two, are advised to make changes to their diet, restrict their carbohydrate intake, and aim to lose weight in order to live a healthier life. While this is true for improving physical health, we want to delve into the impacts on one’s mental health.

People with diabetes, specifically females with type 1 diabetes mellitus (T1DM), are twice as likely to develop an eating disorder as those without T1DM. Some eating disorders you may have heard of include anorexia, bulimia, and binge-eating. Today we are going to discuss an eating disorder you may have heard referred to as ‘Diabulimia’ or Eating Disorder Diabetes Mellitus Type 1 (ED-DMT1).

ED-DMT1 is classified as an omission or underdosing of insulin to promote weight loss (Koman, 2014). A study by Goebel-Fabbri (2008) found that 30% of women and girls with T1DM skip or reduce insulin doses to lose weight. The omission of insulin promotes weight loss in two ways: Insulin causes weight gain as a side effect of the medication, so underdosing or omission limits the effect of weight gain. Secondly, insulin allows blood glucose to get into the cells via GLUT4 insulin-sensitive transporters, with glucose as the cell’s primary source of energy. However, with the lack of insulin, the body has to rely on other sources of energy including fat and protein stores, resulting in weight loss (Koman, 2014).

Though to some, this might seem like the perfect method of weight loss, it comes with serious and fatal consequences. The process of using fat stores as a source of energy results in the production of ketones. High levels of ketones can lead to diabetic ketoacidosis (DKA), a fatal condition that can cause multiple organ failure and death. Additionally, high blood glucose levels over time leads to macro- and microvascular complications including kidney damage, cardiovascular conditions and nerve damage. A study by Geobel-Fabbri (2008) found that females who used insulin omission to prevent weight gain had an average age of death at 45 years old, significantly lower life expectancy than diabetics who administered normal insulin doses.

So you’re probably thinking, how do we move forward from here? While Anorexia and Bulimia are DSM-5 recognised diagnoses, Diabulimia is considered under the category of Eating Disorder Not Otherwise Specified (EDNOS), meaning that it is an eating disorder that fails to meet the criteria for a DSM-5 diagnosis (Koman, 2014). This lack of recognition makes it hard for diabetes educators and psychologists to collaborate to identify and address this condition. However, it is important to note that the DSM-5 only recognised eating disorders as a psychological condition in 2013, and it is expected that ED-DMT1 to be recognised within the upcoming years.

Written by: Alegria Benzaquen

References:

Goebel-Fabbri A. E. (2008). Diabetes and eating disorders. Journal of diabetes science and technology, 2(3), 530–532. https://doi.org/10.1177/193229680800200326

Koman, S. (2014). Studies Show Patients with Type 1 Diabetes Are More Than Twice as Likely to Have This Dual Diagnosis. Walden Eating Disorders. https://www.waldeneatingdisorders.com/blog/studies-show-patients-with-type-1-diabetes-are-more-than-twice-as-likely-to-have-this-dual-diagnosis/#:~:text=Studies%20show%20that%20a%20person

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