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Eating Disorders

Eating disorders are bad news for anyone but an eating disorder with diabetes is particularly serious.

Basically eating disorders are serious preoccupations with food, weight and/or body image. Clinically there are 3 types:

  • Anorexia – self starvation triggered by an extreme fear of gaining weight.
  • Bulimia – a binge/purge cycle stemming from a fear of gaining weight.
  • Compulsive eating – bingeing thought to be caused by a need to numb negative emotions and negative self-image.

However, there is a range of eating disorders that happen to people with diabetes that do not fit into the ‘clinical’ definitions but need recognition.

A study published in the BMJ showed that teenage girls with diabetes are twice as likely to suffer from eating disorders as non-diabetic girls of the same age. Experts warn that intensive care treatment, which can cause weight increase, may be a contributory factor in the higher rates of eating disorders amongst young women with diabetes. They also warn that girls with diabetes and with eating disorders are at greater risk of the early complications of diabetes with a threefold risk of permanent eye damage.

1545 Canadian girls between the ages of 12 and 19 were studied and they found that girls with diabetes were 2.4 times more likely to have an eating disorder. 10% met the medical criteria for diagnosis of an eating disorder compared with 4% of young women without diabetes. Even more worrying, a third of the girls admitted to binge eating and 11% said they had either under dosed or stopped taking their insulin at some stage. [BMJ June 9 2000]

The following story by Michelle Tichy will be of interest to many but especially parents of children and young people with diabetes and to those affected by one of the eating disorders that we hear so much about. We are grateful to Michelle for sharing her story with us to not only help others in similar positions but to help give all of us a better understanding of these problems. The views are those of Michelle and are not necessarily those of IDDT, but we welcome this first-hand experience:

I was diagnosed with Type 1 diabetes in February 1982 – I was 7 years old. The first couple of years were OK aside from adjustments to the new routine and my parents increased fighting. I guess I blamed myself for their fights, I was always putting myself in the midst of these fights and often I tried to deflect their anger at each other on to myself. By the time I was 11, it was clear that they were headed to separation and divorce.

My response to the pain this caused me was self-inflicted pain and a warped perfectionism. I developed an eating disorder that can best be classified as ‘borderline anorexia’ in that my symptoms were: rigid food rituals, strict rules about the amount of food eaten, purging, excessive exercising and extreme fear of gaining any weight. At the same time I developed a fanatical fear of ever getting high blood sugar, so I ran normal to low. My eating disorder continued for the next 7or 8 years, made worse by puberty and I actually delayed menses until 6 months after I turned 15 which can be considered a symptom of anorexia. Since my weight never went below normal, the only clinical diagnosis I ever received was ‘borderline anorexia’ and this was inaccurate because of the purging bulimia. This is one reason that I choose not to use clinical definitions for eating disorders that do not take into account the realities of all sorts of eating and body image problems.

My eating disorder was never caught by any of my doctors, in fact I was their star diabetic patient because I kept my blood sugars so close to normal! Even the dietitians missed the fact that I was barely eating enough to continue functioning. I never lied to any of them but I never offered any information to them about my Eating Disorder.

I cannot pin point the cause of my eating disorder to one thing specifically, the following are the main causes I see:

  • Indoctrination by doctors on the importance of diabetics being thin.
  • Society’s standards of beauty.
  • Stress/perfectionism.
  • My family falling apart.

I have been in recovery now for 3 years – it is rough at times.

My view of the connections between diabetes and eating disorders.
People with Type 1 diabetes have eating restrictions placed upon them by doctors generally from diagnosis. They are told to follow a specific diet and from my experience as a 7year old, it felt like I had been locked into a cage and was only allowed to eat certain things, none of which was ‘fun stuff’. Some of my diabetic friends who were diagnosed as adolescents felt direct pressure to be fanatical about food and their weight. It seems to me that direct pressure from doctors to be thin and constantly concerned about food is a clear way to create the groundwork for eating disorders. My assertion is validated by research on diabetics and other young people with chronic conditions which has shown that young diabetics have a higher probability of developing eating disorders than those in the same age group who have no chronic illness.

More common eating disorders related to diabetes:

  • Running high blood sugars [hyperglycaemia] so that your body produces ketones and in doing so, there is weight loss.
  • Reduction of insulin dosage so that you run high blood sugars and so that you don’t have to eat very much.

My views on being healthy with diabetes and avoiding or overcoming body image problems and eating disorders

  • Know yourself and what it feels like to be high or low.
  • Respect yourself, neither an eating disorder nor ignoring diabetes is healthy.
  • Doctors are resources to keep you healthy. If you don’t trust yours enough to be able to talk to them, maybe you need a different one.
  • Try to be the best you can – not some societal ideal.
  • Remember to try to get something from each food group at each meal.
  • Do everything in moderation from food to exercise. Find activities you enjoy to both ‘de-stress’ and be active [walking tennis etc]. Try meditation or yoga for stress relief and getting to know your body.
  • Find people to talk with about your insecurities. Join a support group.