D and ED (Eating Disorders)

Eating disorders and disordered eating are a greater issue among people with diabetes than we are often willing to discuss. Let’s face it – how can they not be, when our minds have to take the place of organs that mean as much to the body’s nutrition processes as do our islet cells?

After years of quiet silence, this issue is finally beginning to come out of the closet. Diabulimia has been addressed on dLife TV, and has been the subject of both a Diabetes Talkfest forum discussion and Ikonic’s last two blog posts on Diabetes Talkfest.

Diabulimia, however, is only one of the spectrum of Eating Disorders (and it’s younger sister, Disordered Eating) that affect the diabetes community. Diabulimia – by its very definition (insulin manipulation to minimize nutrient absorption) – can only affect insulin-dependent diabetics. Other types of disordered eating affect us all.

Many of us develop borderline orthorexia as we consistently and insistently cut out various types of carbohydrate-bearing foods, both to minimize our dependence upon pharmaceuticals, and to moderate the amplitude and duration of after meal highs. Others of us restrict our caloric intake for the same reasons. Still others of us may have received, at some point, instructions to not eat until our blood glucose levels drop to “safe” numbers (or possibly borderline hypoglycemic numbers) – resulting in us restricting our caloric intake to that of clinical anorexia nervosa. Exercise bulimia (sometimes also referred to as “anorexia athletica”) is another condition common to those of us trying to lower stubbornly-high blood glucose levels or to minimize the weight gain associated with insulin secretagogues or insulin itself. It is characterized by an obsession with exercise and a psychological need to “burn off” all calories consumed (and then some) in exercise. Most of these disordered-eating issues include a psychological need to control one’s body that places them in the spectrum of Obsessive Compulsive Disorders (OCD) as well.

Mind you, it’s a sticky wicket as to whether or not the gold standard of “tight control” is borderline OCD as well. (We see it as necessary to high quality of life; “outsiders” see it as indicating severe illness or poor control. I’ve never asked psychologists how they see it.)

Heading further back into our lives, an anecdotal few of us suspect that extreme caloric restriction as non-diabetic teenagers – even for durations as short as one or two months – may have been partly responsible for us developing diabetes later in life. While there is some indication that short-term restriction at that age can be responsible for long-term physiological damage, there has not been (to my knowledge) any long-term study of eating-disordered teens against the development of mid-life metabolic disorders. (I should very much like to see that sort of study done – or the results of such a study, if it already exists.)

In short, ED and disordered eating may (unproven) be partly responsible for our diabetes – and paradoxically, it may also be necessary to keep its progression at bay.

What concerns me is that the psychological effects of these “everyday necessity” restrictions to control our glucose metabolisms could progress to full-spectrum ED and OCD. Are we trading physical health for mental health, or vice-versa? Or do the definitions of ED and OCD change because of our status as Diabetics or Persons With Diabetes?

I think you missed overeating, which is also an eating disorder, even though many people see it as greed. I know a few other diabetics who did this and I did too. My life as a Type 1 seemed so restrictive I just rebelled and ate what I wanted. I always took my insulin but had no idea of dosage, I always took the same amount no matter what I ate.

When you say that calorie restriction may cause diabetes, are you talking about Type 1 or Type 2?

While my interest is skewed more towards Type 2, I’ve also heard of one coincidence of clinical anorexia nervosa followed by a diagnosis of T1 at around age 20. If you subscribe to the “trigger event” theory of T1 diagnosis, clinical ED (anorexia or bulimia) could well be one of the triggers.

Not all overeating is an Eating Disorder, though one can argue that most – if not all – of the time, it is Disordered Eating. There are two specific overeating EDs, bulimia and Binge Eating Disorder (BED). “Eating what you want” is not necessarily overeating, but if you are consuming more calories than you burn and are not covering your food with sufficient insulin, then you may be looking at a subclinical (i.e., disordered but not officially ED) case of diabulimia, especially if weight is lost as a result. Habitually excessive caloric intake among non-diabetics – and I would presume non-diabetics, though I don’t know how (or if) diabetes affects the ghrelin-leptin (hunger-satiety) cycle – can be hormonal, social, or psychological in nature. ED is considered to be of psychological origin, with physical and hormonal manifestations.