Eating Disorders and Diabetes Back
Teens and young women with type 1 diabetes are more than twice as likely to develop an eating disorder as those without diabetes. Unlike their peers, type 1 diabetics have a powerful and convenient weight loss tool in the palm of their hands. To drop pounds quickly, thousands of young women are skipping or short-changing their insulin. Dubbed "diabulimia," the practice is growing and can have deadly consequences.
"It's really a double-whammy of a disorder," says Ovidio Bermudez, MD, medical director of child and adolescent services at the Eating Recovery Center in Denver and former chairman of the board of the National Eating Disorders Association. Insulin restriction causes high blood glucose (sugar) levels which can cause immediate problems such as diabetic ketoacidosis (DKA),a condition were acids build in the blood and can cause coma or death.
Insulin restriction puts longer term complications like neuropathy (nerve damage) and eye, heart, and kidney problems on "warp speed," says Dr. Bermudez. Mix that with malnutrition and you have a lethal weapon on your hands.
"Diabulimia" is not an official diagnosis and is a controversial label among medical experts. Bermudez and other experts refer to people with eating disorders and type 1 diabetes as having a dual diagnosis: eating disorder and type 1 diabetes (ED-DMT1). Eating disorders include binge eating, bulimia (binging and purging), and anorexia nervosa (self-starvation). Bermudez says insulin restriction is the number-one way people with type 1 diabetes shed calories because it works so well.
Skipping Insulin: Playing With Fire
People with type-1 diabetes need daily insulin doses to live because the pancreas doesn't produce the hormone. The body uses insulin to absorb glucose (sugar) and use it as energy or store it as fat. Without insulin, the glucose builds up in the blood and is excreted in the urine. The body quickly breaks down muscle and fat for fuel, resulting in dramatic weight loss.
Maryjeanne Hunt, a Massachusetts wellness counselor, financial advisor, and author of the upcoming book, Eating to Lose, knows the seductive power of skipping insulin to lose weight. The 50-year-old mother of two battled the eating disorder for 22 years.
Diagnosed with type 1 diabetes at age 10, Hunt started skipping insulin at 13 when she began developing unwanted curves. She was thrilled to discover she could lose five pounds in a one night by skipping insulin.
For the next two decades, Hunt put her body through nothing short of torture. "I would eat next to nothing for a few days and reward myself with something decadent when I couldn't stand the starvation anymore. That enjoyment of decadence was short-lived because I knew I was also setting the stage for another binge-a-thon which inevitably led to skipping insulin and feeling horrible." Hunt notes that she also became a very skilled liar to doctors and her parents. She denied skipping insulin and "played dumb."
Hunt says after a few close calls and years of emergency room visits, she says she "got good" at planning her insulin-omission purges. "I definitely learned how close I could get to that gray space between feeling horribly ill and full-blown Diabetic Ketoacidosis (DKA) without requiring medical intervention."
What's Behind Eating Disorders in Type 1 Diabetics?
What Hunt did not know when she was 10 is that just being diagnosed with diabetes put her in danger of developing an eating disorder. "Having type 1 diabetes is in and of itself a risk factor for eating disorders," Dr. Bermudez says. He adds that it's believed there are several reasons for this:
Weight Loss: Weight loss is one of the first indicators of type 1 diabetes. When diabetes gets under control with insulin, the weight rapidly returns. Girls and women with type 1 diabetes whose condition is well controlled are generally plumper than those without diabetes, possibly contributing to body image problems.
Eating Schedules: Instead of eating in response to hunger, people with diabetes are taught to follow a tight eating plan, including counting carbohydrates and balancing food with insulin and exercise. This may contribute to disordered eating patterns.
Depression: People with type 1 diabetes are also at higher risk of depression which is another risk factor for eating disorders.
All those factors came together in Hunt. She also believes teenage self-doubt, perfectionism and later depression were part of it. "Another is the media messages that bombard us everyday – overtly and subliminally – telling us we're not good enough as we are."
Treating Eating Disorders and Type 1 Diabetes
Treatment is complex because it's a medical condition and a psychiatric disorder in one. Dr. Bermudez says some patients may need to be treated in a psychiatric and/or medical hospital to be stabilized. Standard therapy for outpatient treatment involves a multi-disciplinary team that works together. The team needs to include experts in diabetes, eating disorders, and possibly other mental health professionals.
Dr. Bermudez says successful treatment hinges upon whether the person is really ready for treatment. Hunt agrees saying, "choosing to heal has to come first." She adds that she was under the care of a therapist with expertise in both diabetes and eating disorders for two years. "That helped, but I'm not sure it would have if I wasn't ready."
After abandoning insulin restriction as a weight-loss tool, she began to exercise to control her weight and blood sugar. She believes that's what saved her from diabetes complications.
Hunt credits motherhood as the impetus that helped her heal for good. She adds, "there were many sources of nourishment along the journey that helped – therapy, fitness, writing, motherhood, relationships, books … and also tapping into something inside me that was already good enough and always had been."
©2012 Sanare, LLC
