Ask The Expert
Other Health Issues

Thank you for bringing up a very important problem. There is definitely good information available about this condition on diabetes websites. A very good one is from the American Diabetes Association (ADA). I typed in the words-eating disorder--in their search box, and found 90 documents, although many of them are from professional medical journals. I have several good articles from patient journals, such as Diabetes Self-Management and Diabetes Forecast. I highly recommend a book by Laurinda M. Poirier, MPH, RN, CDE and Katharine M. Coburn, MPH, called Women and Diabetes.

What are Eating Disorders:

As you so well said, many young girls have an eating disorder, regardless of their medical condition. Our society has influenced many women to try to aim for an impossible thinness through the media-thin models, celebrities, commercials, etc. Although many women feel vulnerable to this pressure to be thin, some react by developing an eating disorder. According to an article by Laurinda Poirier in the November 2001 Diabetes Forecast, those at greatest risk are teenage girls and women through their late 30s.

Two Common Disorders:

• Anorexia nervosa, is the pursuit of extreme thinness. People with this problem have a distorted body image, so they severely restrict food and are overly concerned with the food they consume-often causing serious health problems. The cause of this disease is not known, but genetics, family, and culture all seem to play a role.
• Bulimia nervosa is characterized by episodes of binge eating, or uncontrolled consumption of large amounts of food. Afterward, the person induces vomiting, or takes laxatives or diuretics, exercises vigorously, or omits insulin, or goes on a severe fasting diet. Women with this disorder often pursue a thin body ideal through calorie and food restriction, but since this drastic restriction is impossible, the cycle of binge eating followed by food restriction or purging begins again.

Eating disorders pose a serious health threat, as they can cause hormonal disturbances, anemia, brittle bones, and even death.

Effect on Diabetes:

Managing diabetes is challenging enough, with the attention required to regulate food, blood glucose, diabetes medication, exercise and weight. Sometimes when diabetes control improves, a person will gain weight. A diabetes-specific form of an eating disorder can develop in which a person skips insulin in order to lose weight rapidly. People with diabetes who have an eating disorder run a much higher risk of developing serious medical complications including kidney, eye, and nerve disease. A more immediate risk for people with type 1 diabetes is developing diabetic ketoacidosis, which can be a potentially life-threatening condition.

In Women and Diabetes, the authors conclude:

"Any preoccupation with your body weight and size that interrupts how frequently and what type of nutrients you put into your body or your commitment to follow your diabetes treatment plan is a call for help. Whether or not you label your relationship with food as having an eating disorder doesn't matter. Any time that food becomes a source of pain or shame, a woman needs support and guidance from professionals who are trained to help them face the issues that cause this struggle. It is complex and no one can do it alone. No matter what method or reason a woman might use, experts understand that hidden pain and unhealed wounds lead to unhealthy relationships with food. If you find yourself facing this battle, we hope that you reach out for the professional support that you deserve. A solid, supportive healthcare team, including a mental health professional and dietitian, can help you gradually set more realistic, attainable goals and safer ways to cope with your eating and weight concerns."