Diabetes and eating disorders

What is an eating disorder?

An eating disorder is a serious mental health condition characterized by a significant disturbance in eating, as well as related emotions and thought patterns. Common eating disorders include: (1)

• Anorexia nervosa (AN): A common eating disorder that involves severe food restriction, a compulsive pursuit of weight loss, distorted body image, and self-esteem that’s dependent upon body shape and weight.
• Bulimia nervosa (BN): Involves binging episodes characterized by eating a significant amount of food and a loss of control, followed by compensatory behaviors, such as laxative use, fasting, forced vomiting, or excessive exercise.
• Binge eating disorder (BED): Involves binging episodes without engaging in purging behaviors afterward, feeling out of control during a binge and unable to stop eating, and experiencing feelings of guilt and shame afterward

Eating disorders can affect people of all sizes, weights, genders, races, ages, and sexualities. They are caused by a complex interplay between biological, sociological, and psychological risk factors. One of those risk factors may include diabetes.

What is diabetes?

Diabetes, which occurs when your blood sugar is too high, is a medical condition that impacts your body’s ability to metabolize food and turn it into energy. Typically, food is broken down into glucose, or sugar, which is then released into your bloodstream. When your glucose levels are high, your pancreas releases insulin, signaling to your body’s cells to use glucose as energy. (2)

When someone has diabetes, their body either can’t effectively use the insulin or their body doesn’t make a sufficient amount of insulin. When this happens, too much glucose remains in their bloodstream, which can lead to many health complications, such as kidney disease, vision loss, and heart disease. (2)

Type 1 vs. type 2 diabetes

When someone has type 1 diabetes, their body stops producing insulin. It typically occurs in children, adolescents, and young adults. People with type 1 diabetes must take insulin every day to compensate for the body’s inability to make it. (2)

Conversely, when a person has type 2 diabetes, their body isn’t able to use insulin effectively. It’s typically diagnosed in adults and develops over the course of several years, though more young people are being diagnosed as of late. (2)

What is the prevalence of co-occurring diabetes and eating disorders?

Eating disorders are common in people with diabetes, although the exact prevalence is unknown. Many studies only focus on young women who have type 1 diabetes, and they have estimated that between 30% and 40% of this population have an eating disorder. Accounting for other genders and ages, approximately 20% of people with type 1 diabetes are affected by an eating disorder. (3)

One literature review found that binge eating disorder is found in about 1.2% to 8% of individuals with type 2 diabetes, though some other studies estimate that 20% of people with type 2 diabetes have this condition. (3)

Type 1 diabetes and eating disorders

The connection between eating disorders and diabetes depends on the type of diabetes. 

Having a diagnosis of type 1 diabetes may predispose someone to develop an eating disorder, especially anorexia or bulimia. This is because a diagnosis of type 1 diabetes causes a person to monitor their eating, weight, and food intake in a way that they previously were not. (3)

What starts as a healthy form of attention and monitoring could progress to preoccupation with thoughts of food and weight gain or obsessive behaviors related to eating. This may be of particular risk to someone with high perfectionism, as they may pressure themself to manage their diabetes flawlessly. (3)

Blood sugar levels

Additionally, people with type 1 diabetes may begin to view food as “good” or “bad” due to how these foods affect their blood sugar levels. Similarly, people with eating disorders typically tend to place food in these categories, often related to how they affect weight, appearance, or body shape. This overlap could cause someone with type 1 diabetes to develop disordered eating behaviors. (3)

Control is also an overlapping feature between type 1 diabetes and eating disorders, such as anorexia. Someone with diabetes may expect they can always control their glucose levels despite the fact that blood sugar is affected by several factors, including stress. When this person’s blood sugar is too high, they may view it as a failure on their part to effectively control their condition. This false belief about failure could cause them to attempt to gain control in unhealthy ways, such as by restricting food altogether. (3)

Lastly, individuals with type 1 diabetes may not trust their hunger or satiety cues because of experiences in which they’ve listened to their body’s cues and experienced hyperglycemia or hypoglycemia. This distrust of their body’s signals could be a risk factor for disordered eating behaviors. (3)

Diabulimia: A dangerous consequence of type 1 diabetes and eating disorders

Diabulimia is the term used to describe the behaviors of a person with type 1 diabetes and an eating disorder in which they purposely take an insufficient amount of insulin in order to lose weight—also known as insulin restriction. This isn’t a risk factor for eating disorder development. Rather, it is a potentially life-threatening consequence of having both an eating disorder and type 1 diabetes, and it requires immediate medical attention. (4)

Treatment for diabetes and eating disorders

Treatment for diabetes and an eating disorder aims to develop a multi-modal treatment plan that works to address underlying factors and establish a better relationship with food and eating that encourages intuitive eating to effectively manage the person’s diabetes and ultimately eliminate eating disorder behaviors. (4)

Another goal of treatment is to rectify the judgmental language related to categorizing food as “good” or “bad”—for both diabetes management and eating patterns. Patients learn to view food through a descriptive lens, understanding how various foods affect their health, energy, and functioning, as opposed to assigning moral value to food. The treatment team may teach patients to view their blood sugar levels as data instead of a failure on their part. Viewing it this way can allow them to be compassionate with themselves. (3)

Inpatient treatment for eating disorders and diabetes

Patients with an eating disorder and diabetes should seek out specialized care from treatment providers who have in-depth experience treating both conditions. The most intensive form of care involves an inpatient program, which involves living at the treatment facility throughout the duration of the program. But understandably, not everyone can commit to an inpatient treatment program. 

Remote eating disorder treatment

A virtual treatment program or a partial hospitalization program that allows you to continue living at home while receiving the care you need is another option if inpatient is not viable. Receiving a comprehensive assessment from an eating disorder professional will help to determine what level of treatment is appropriate for your situation. They will evaluate your physical and mental health, as well as biological, environmental, and social factors that may be contributing to your condition, and provide treatment recommendations.