Eating disorders in people with diabetes
Diabetes is a disease characterized by increased blood glucose levels, a condition called hyperglycemia. It can occur as a result of decreased insulin production by the beta cells of the pancreas, insufficient insulin activity, genetic causes, or certain diseases or drugs.
Insulin is a hormone necessary for the body to use the energy provided by food. In people with diabetes, however, glucose from food is not properly utilized by tissue cells, leading to serious metabolic problems and weight loss .
Type 1 diabetes begins in childhood or adolescence, although the age of onset can be extended until around the age of thirty. It is caused by an immune alteration that leads the body itself to destroy the beta cells of the pancreas, which are specialized in the manufacture of insulin. Its treatment consists of the administration of subcutaneous insulin several times a day . Type 1 diabetes is caused by multiple factors that coincide in the same individual : a genetic predisposition on which a series of factors act that trigger the entire process of destruction of beta cells (infectious, dietary factors, stress, etc.).
In people with diabetes, glucose from food is not used by tissue cells, and this leads to serious metabolic problems and weight loss.
Type 2 diabetes , on the other hand, usually appears in adulthood, although more and more cases are being detected in children and adolescents with obesity . The most important causes are obesity associated with an inadequate diet and lack of physical activity, but it is more common to appear if there is a family history. In this case, the beta cells of the pancreas still produce insulin, but it does not work completely well or the amount produced is not enough to keep blood glucose levels within normal limits . Many people can treat diabetes by losing weight, changing their diet and doing more physical exercise .
Relationship between diabetes and eating disorders
Food is one of the fundamental pillars in the treatment of diabetes. In type 1, it is necessary to know and take into account different aspects related to food (calculating portions, weighing food, measuring blood sugar, etc.), and it is also necessary to know how to deal with hypoglycemia and hyperglycemia. In the case of type 2 diabetes, treatment guidelines require constant control over diet, weight and physical activity. This increased concern and knowledge about food , with other added factors, could be related to the development of eating disorders . In addition, the diagnosis and treatment of diabetes affects people's quality of life due to the demands that come with controlling the diet and insulin doses, and this can cause stress, fear of hypoglycemia or hyperglycemia, anxiety and symptoms of depression.
When healthy eating becomes an obsession
There are studies that conclude that people with diabetes have up to 2.4 times more risk of developing an eating disorder, favored by the need to calculate daily insulin doses and monitor everything they eat, such as carbohydrates. (Colton et al., 2015). An excess of these cares can act as a triggering factor for an eating disorder, which will produce poor metabolic control.
People with diabetes have up to 2.4 times greater risk of developing an eating disorder, favored by the need to calculate daily insulin doses and monitor everything they eat.
It is very important to prevent eating disorders in people with diabetes to avoid the negative repercussions they can have on health, especially in people with type 1 diabetes, since ACTs can increase the development of early complications of the disease, due to worsening glycemic control. Thus, an eating disorder in a person with diabetes can accelerate the development of chronic complications (retinopathy, neuropathy, diabetic nephropathy, blindness and osteoporosis) and acute complications (diabetic ketoacidosis, hypoglycemia), and even death. As for people with type 2 diabetes and eating disorders, in addition to the increase in chronic complications, overweight and obesity are associated.
Warning signs and early detection of TGs in people with diabetes
The warning signs of an eating disorder in people with type 1 diabetes are:
- Eating less food than would correspond to the insulin administered (food restriction).
- Administering less insulin than recommended (diabulimia), a purgative method specific to diabetes treated with insulin.
They may also present other symptoms similar to those of people with ED without diabetes, such as:
- Having an irregular eating pattern
- Restricting foods like sweets to lose weight
- Skipping meals
- Do physical exercise to control weight.
Sometimes, food restriction, compensatory physical exercise and insulin avoidance can be accompanied by binge eating, which generates great feelings of guilt, failure and anxiety.
Furthermore, in the case of type 1 diabetes, the diagnosis of an eating disorder is very common in the context of an acute complication (diabetic ketoacidosis), which is related to weight loss prior to diagnosis.
What are the main warning signs of eating disorders?
What is diabulimia?
Diabulimia is a condition in which a person with diabetes deliberately skips or reduces their insulin dose in order to lose weight. If the person does not take the necessary insulin, glucose accumulates in the blood and is excreted through the urine, resulting in weight loss. Currently, this condition is not recognized in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM 5), used by psychologists and psychiatrists.
Deliberately omitting or reducing the dose of insulin in order to lose weight can have serious consequences for the person.
This practice can have consequences for the affected person, such as the appearance of infections ; kidney problems that can degenerate into dialysis; retinopathy, which can cause blindness; diabetic foot; and neuropathies. If the lack of glycemic control persists over time, problems related to eating disorders may also appear: lack of menstruation, slow growth and development, in the case of childhood or adolescence, and gastric, dental and skin problems.
On the other hand, people with diabulimia do not necessarily present behaviors such as food restriction, vomiting or compensatory exercise, and this can make it difficult to detect. Lack of awareness of the problem does not help either and can be confused with misuse of insulin due to non-compliance with treatment.
Some of the warning signs of diabulimia are:
- Frequently high glycosylated hemoglobin.
- Frequent hospitalizations for diabetic ketoacidosis.
- Blood glucose controls with unreliable results or a direct lack of controls.
- Lack of menstruation or irregular cycles.
- Unexplained weight changes.
- Excessive concern about weight and dissatisfaction with body image.
- Irregular eating patterns.
- Discomfort when administering insulin in front of other people.
- Binge eating.
- Low awareness of the problem.
- Skipping visits with reference professionals.
- Depression, anxiety, mood swings and fatigue.
Treatment in people with diabetes and TG
It is recommended that people with diabetes and ED receive care from an interdisciplinary team , with the involvement of the endocrinology and mental health teams. The goals of treatment are as follows:
- Recovery of eating habits and a healthy relationship with food.
- Recovery and maintenance of a healthy weight.
- Improved mood and recovery of socialization.
- Improvement of self-esteem, self-concept and body satisfaction.
- Correction of insulin administration and improvement of blood sugar levels.
- Acquisition of awareness of illness and motivations for improvement.
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