In today’s society—where we are bombarded with images and messages about how to eat, take care of ourselves and look— it is not uncommon for people to feel dissatisfied with their body shape, size, or features. However, there is a point at which this ‘normative discontent’ can grow into unhealthy relationships with food, body image, and/or body weight.
There is a handful of research around diabetes and eating disorders. What we know from that data is that women with Type 1 diabetes are more than twice as likely to develop an eating disorder than women who do not have diabetes. Although the research to date focuses on women’s experiences of eating disorders and diabetes, it is important to know that men with diabetes can and do experience eating disorders as well.
People with diabetes may be affect by any variety of eating disorders, however most studies to date have focused on what has become known as “diabulimia”—where insulin is intentionally manipulated for the purpose of losing weight. The term diabulimia began to be more widely known in 2007, when several news, magazines, and health journals began running stories about the condition. Clinicians, however, will often refer to diabulimia as ED-DMT1; though sometimes it is also categorized as Other Specified Feeding and Eating Disorders (OSFED).
Some warning signs that a person is dealing with ED-DMT1 (diabulimia) include:
- Consistently high hemoglobin A1C results.
- An A1C that is inconsistent with blood glucose logbook readings.
- Body image concerns.
- Unexplained weight loss.
- Overly strict food rules.
- Avoiding eating around family, friends, or others.
- Exercising compulsively.
- Irregular or non-existent menstrual cycles.
- Repeated episodes of diabetes ketoacidosis (DKA).
- Not following through on appointments.
Keep in mind that some of these warning signs could be related to other issues as well. For example, high A1Cs or missing appointments could mean a lot of things—stress, life transition, anxiety, and/or depression could also affect diabetes management and appointment follow-up.
Eating disorders often start as a way of coping with other difficult issues in your life. It can be hard to think about your eating disorder as a foe when it has helped you through your most difficult times. Know that there might be times when it pulls you back from asking for help or from your recovery. Recognize that it will likely be scary to open up to others and ask for help or decide to move towards recovery. Try to be patient with yourself as you begin this process
The earlier you are able to find some supports to help you address difficult relationships with food, body image, weight, and diabetes management the easier it will be to work through them. If you are comfortable with talking to your endocrinologist, diabetes nurse educator, or dietitian, this can be a good place to start. Your team might also suggest you connect with a mental health professional who specializes in eating disorders; sometimes they might even have someone connected to the clinic who you can see.
It can be difficult to find organizational supports for dealing with diabetes and an eating disorder, especially in Canada, but there are a few organizations in the United States and the United Kingdom that focus specifically on ED-DMT1:
Diabulimia Helpline (US)
We Are Diabetes (US)
If you don’t feel comfortable reaching out to people quite yet, but would like to start thinking or working toward recovery, We are Diabetes has a great Recovery Toolkit that you can access for free through their website. The document is full of helpful information around some common concerns when going through recovery and what to expect as you work through an eating disorder with diabetes.
Finally, you can also contact the National Eating Disorders Information Centre in Canada for more information and resources related to eating disorders in general. They also have a toll free helpline (1-866-633-4220), a directory on their website to find mental health clinicians who specialize in eating disorders and some information for family and friends about how best to offer support to someone dealing with an eating disorder.
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Looking for more information? Here are some suggested readings to get you started:
Overcoming Binge Eating: The proven program to learn why you binge and how you can stop by Dr. Christopher G. Fairburn
Diabulimia: Towards understanding, recognition, and healing by Aarti Sharma
“Diabulimia: What is it and how to treat it” (article) by Grace Huifeng Shih, RD, MS