Women with type 1 diabetes (T1DM) are more than twice as likely to develop an eating disorder than those without diabetes. In order to understand why this might be, you first need to understand the complexity of T1DM and an eating disorder symptom – insulin restriction – which is unique to diabetes.

What is T1DM?

T1DM is an autoimmune disease in which the body’s immune system attacks cells in the pancreas so they no longer produce insulin. When our food is broken down into sugar – which circulates in the blood stream - insulin is the hormone that allows sugar to move into the cells to use for energy. Without insulin, blood sugar rises to an unhealthy level. The body attempts to reduce blood sugar by excreting the sugar into the urine. Calories from the sugar are lost in the urine inducing rapid weight loss. Once insulin treatment begins, blood sugar returns to a healthy range, the body rebuilds itself and regains weight.

Eating Disorders in T1DM:

We don’t know why women with T1DM have higher rates of eating disorders. Some people think it may be that after experiencing the rapid weight loss and regain, girls and women may start to believe, “Insulin made me fat.” However, the reality is that insulin allowed their bodies to heal. Another possible factor is that the people with T1DM must pay close attention to blood sugar levels, insulin, and food. Some people with diabetes are taught to avoid “bad foods” containing sugar. This can mirror the rigid food rules of most eating disorders; that sugary foods are “bad.”

Under-dosing or skipping necessary insulin doses, intentionally causes high blood sugar levels and functions like a dangerous and powerful calorie purge that can be lethal at times. However, not all girls and women with eating disorders and T1DM restrict insulin. But for those who do, insulin restriction and eating disorders are associated with higher rates of T1DM complications, such as kidney, nerve, and eye problems – at younger ages and earlier in the disease process.

How to Help a Loved One with an Eating Disorder and T1DM:

If you or your loved-one’s healthcare team suspect an eating disorder, these are some ideas to consider.

1) Most people who are struggling with insulin restriction or an eating disorder and T1DM that does not involve insulin restriction, feel quite ashamed and secretive about it.

2) Tread lightly and be careful not to use “fear tactics” about developing medical complications. Express your concerns and worries in a non-judgmental way.

3) Use open-ended questions to try to help get a straight-forward conversation going about how you might be able to help and whether or not they feel ready to try treatment.

4) Treatment works best with a team that includes a diabetes physician, a nurse educator, a dietician (preferably who knows both T1DM and eating disorders but at the very least T1DM), and a mental health professional who either knows T1DM and eating disorders or at least is an eating disorder specialist. Finding mental health professional with the diabetes expertise is unlikely, so having an eating disorder specialty may be more important.

5) The treatment team must be willing to communicate regularly so all team members are educated about T1DM and eating disorders as well as the particular treatment goals being targeted.

The Good News:

While eating disorders and T1DM are complex and difficult to treat, people can and do get better. How the recovery process actually works and what the best treatment approaches are, is where research is sorely needed.

About the Author

Ann Goebel-Fabbri, Ph.D.

Ann Goebel-Fabbri, Ph.D., is an Assistant Professor in Psychiatry at Harvard Medical School. 

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