Does anorexia cause diabetes?

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This is a question that many people with anorexia nervosa (AN) ask. There is no direct relationship between anorexia and diabetes. Anorexia isn’t known to cause diabetes. 

Diabetes is a metabolic and endocrine disorder that results in an inability to properly digest sugar. Anorexia nervosa is an eating disorder where not enough food is coming into the body, which results in many different metabolic disturbances. (1) Over time it is possible that some of the metabolic disturbances can lead to blood sugar imbalances, usually low blood sugar (hypoglycemia) as opposed to high blood sugar (hyperglycemia) typical in diabetes.

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Insulin sensitivity in diabetes 

“Insulin sensitivity” is the ability of the tissues to allow insulin into the cells. After eating a meal, blood sugar levels naturally rise from sugars in foods. This sends a message to the pancreas to make more insulin and send it into the blood. The insulin allows blood sugar to enter into the cells where they can use the sugar for energy to function and grow. T

When someone has type II Diabetes (the most common adult form of diabetes), their bodies are constantly exposed to so much sugar that their cells become “insensitive” to insulin and do not absorb that sugar into the cells. This causes two problems: First, the cells are deprived of the sugar they need, and are essentially starving. Second, all the sugar stays in the body’s vasculature, building up and causing a number of complications including nerve damage, obstructed blood flow to the kidneys and heart, and difficulty fighting off infections.

Insulin sensitivity in anorexia

Unlike Diabetes where the body is constantly being exposed to too much sugar, anorexic patients are usually taking in too little sugar and calories in general. What happens to insulin levels in anorexic patients?Do they have insulin sensitivity or resistance?

This has been studied for a long time. Belgium doctors in 1988, almost 3 decades ago, looked at anorexic patients and insulin levels and actually found that low levels of sugar in anorexic patients corresponded to lower insulin levels released from the pancreas and higher insulin sensitivity. (3) 

In contrast, some studies show that when someone with anorexia takes an oral glucose tolerance test, glucose tolerance is impaired even though the insulin levels rise (4)

So the answer is, we don’t really know how calorie deprivation and decreased sugar availability in the diet affects insulin sensitivity in both the short and long term. However, we do know that anorexic patients do NOT seem to be at increased risk of developing diabetes.

Does having anorexia predispose someone to developing diabetes? 

The bottom line answer here is no, anorexia does not predispose someone to developing diabetes. It is very rare for someone with anorexia nervosa to develop diabetes as a result of their restrictive eating. There is no thought in the medical community at this time that anorexia predisposes an individual to developing diabetes. However, if they have a family history of diabetes or other risk factors for developing diabetes, they of course may develop diabetes regardless of their eating disorder. However, the anorexia itself is not thought to be a cause or risk factor for developing diabetes.

What is “diabulimia”?

If someone has Type 1 diabetes and an eating disorder (bulimia), this is sometimes called diabulimia. This is not an established medical diagnosis, but is more of a colloquial term. It’s where someone reduces or stops taking their insulin because they want to lose weight.

When a patient has diabetes and insulin cannot help sugar to enter the cells, the cells of the body eventually starve, and have to use their own fat and protein stores to feed themselves. Counterintuitively, this actually leads to weight loss over time. While this may be the desired effect, it is actually a very dangerous form of weight loss, a result of the cells of your body starving to the point where the body is extremely malnourished. 

Diabulimia is dangerous because not taking insulin when you are supposed to can cause death, particularly in type I diabetics. If you or someone you know has type I diabetes and is not taking their insulin - either intentionally to lose weight, or unintentionally - they need medical assistance, and you should reach out for help. 

If you or a loved one have symptoms of “diabulimia”, or are intentionally skipping insulin injections in order to prevent weight gain, please contact your healthcare team or reach out to our clinical care team at Within Health today. Support and more information is available.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Liyanarachchi K, Ross R, Debono M. Human studies on hypothalamic-pituitary-adrenal (HPA) axis. Best Pract Res Clin Endocrinol Metab. 2017 Oct; 31(5):459-473. https://pubmed.ncbi.nlm.nih.gov/29223281/ 
  2. Winston AP. Eating disorders and diabetes. Curr Diab Rep. 2020 Jun 15; 20 (8):32. https://pubmed.ncbi.nlm.nih.gov/32537669/ 
  3. Scheen AJ, Castillo M, Lefebvre PJ. Insulin sensitivity in anorexia nervosa: a mirror image of obesity? Diabetes Metab Rev. 1988 Nov; 4 (7):681-90. https://pubmed.ncbi.nlm.nih.gov/3069398/ 
  4. Dostalova I, Smitka K, Papzova H, Kvasnickova H, Nedvidkova J. Increased insulin sensitivity in patients with anorexia nervosa: the role of adipocytokines. Physiol Res. 2007;56(5):587-594. https://pubmed.ncbi.nlm.nih.gov/17184143/
  5. Insulin and weight gain: Keep the pounds off. Mayo Clinic. Accessed Feb. 21, 2022. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/insulin-and-weight-gain/art-20047836
  6. Hodish I. Insulin therapy, weight gain and prognosis. Diabetes Obes Metab. 2018 Sep; 20(9):2085-2092. https://pubmed.ncbi.nlm.nih.gov/29785843/
  7. Cichosz SL, Lundby-Christensen L, Johansen MD, Tarrow L, Almdal TP, Hejlesen OK, The CIMT Trial Group. Prediction of excessive weight gain in insulin treated patients with type 2 diabetes. J Diabetes. 2017 Apr; 9(4):325-331. https://pubmed.ncbi.nlm.nih.gov/27130075/
  8. McFarlane S. Insulin therapy and type 2 diabetes: management of weight gain. J Clin Hypertens (Greenwich). 2009 Oct; 11 (10): 601-7. https://pubmed.ncbi.nlm.nih.gov/19817944/

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