Eating Disorder Awareness Week: February 24 - March 2

The goal of National Eating Disorder Awareness Week in the US is to put a spotlight on the seriousness of eating disorders and to improve public understanding of them. This year's theme is "I Had No Idea" so to that end, I offer the following observations:

I had no idea...

  • Women with type 1 diabetes are 2.4 times more likely to develop an eating disorder than their non-diabetic peers.
  • Multiple studies show that 30%-35% of women with type 1 diabetes will restrict or omit their insulin in order to lose weight.
  • The intense focus on food, numbers, weight and exercise that comprise good diabetes management parallel the rigid thinking that is characteristic of an eating disorder.
  • Diabetes related complications such as retinopathy, peripheral neuropathy and kidney disease are 3.5 times more likely in someone with type 1 diabetes and disordered eating, especially with insulin omission.
  • Unexplained elevations in A1c and/or repeated episodes of diabetic ketoacidosis (DKA) may be an indicator of ED-DMT1 (eating disorder-diabetes mellitus type 1) commonly referred to as diabulimia.
    • This is especially true when accompanied with concerns about body image or food related obsessions.
    • Disordered behavior can be missed in a person restricting carbs or calories in order to avoid insulin as they will not have the telltale high A1c.
  • ED-DMT1 represents some of the most complex illnesses to treat both medically and psychologically as the diabetes and eating disorder must be addressed as an intertwined condition rather than treated separately.

If someone is exhibiting signs or thoughts of struggling with an eating disorder, intervening during the early stages of development can significantly increase the likelihood of preventing the onset of a full-blown eating disorder. It can also lead to greater chances of a full recovery, prevent years of struggle and can even save lives.

To learn more about the recognition and treatment of ED-DMT1/diabulimia as well as to find resources and support, visit Diabulimia Helpline, Diabetics with Eating Disorders and We Are Diabetes. For more information on eating disorders or to find a local eating disorder awareness event, visit National Eating Disorder Awareness.

Join us on at 1pm Pacific time on February 24 for a live interview with Asha Brown, founder of We Are Diabetes.

Great post Emily! Sorry I missed the interview yesterday. Most of these take place when I'm at work and in meetings all afternoon. Will Asha's interview be posted for playback on YouTube?

Emily, where does the term "ED-DMT1" come from? The ICD? Unfortunately there is no designation for diabulimia in the new DSM-5 that just came out (the manual of mental illnesses clinicians use for diagnosis). If someone doesn't meet the criteria for bulimia, anorexia or binge eating disorder they can be diagnosed under "Other Specified Feeding or Eating Disorder" but there is no listing of diabulimia symptoms.

Hey Zoe,

I don't know where the term ED-DMT1 originated, but it stands for Eating Disorder Diabetes Mellitus Type 1. You can find more information about it on We Are Diabetes.

My understanding from yesterday's conversation with TuDiabetes members and the founder of We Are Diabetes (the recording of which will be posted in our video archive early next week), is that "Other Specified Feeding or Eating Disorder" is the designation currently in use as a sort of catch-all for various forms of disordered eating that can present specifically among people with diabetes. That said, it's the first time I've heard the term, and this is not a specialization of mine :)

ED-DMT1 is clearly covered under the DSM-V eating disorder section. There is already work that has been done to make sure that professionals can properly diagnose ED-DMT1 and map it into DSM-5. I don't think anyone would think that ED-DMT1 doesn't qualify as an eating disorder as defined by DSM-5.

Sorry, Brian, but I'm looking at my copy of the DSM 5 and don't see it. Also what you linked does not mention it but merely refers, as I mentioned above, to "other specified feeding or eating disorder."

I am not denying that diabulimia qualifies as an eating disorder - hardly - I am just stating that unfortunately it is not mentioned in the new DSM.It sounds like people were lobbying for it to be included, but it was not.

Thanks, Emily. It sounds like the Eating Disorder community (or at least some sections of it) is well aware of Diabulimia, and has made efforts to get the inclusion of its symptoms included in the manual that mental health professionals use to diagnose, but it didn't happen. If I, as a mental health professional (who also is a Type 1 and has 20 years recovery from an eating disorder) had someone with diabulimia in my office, I'd catch it. My colleagues? Not so much. Once again, the white coats are behind.

Eating disorders are discussed starting on page 329 and maps to ICD-9 diagnostic code 307. Under "Associate Features Supporting Diagnosis" for Anorexia Nervosa on page 341 it says:

Individuals with anorexia nervosa may misuse medications, such as by manipulating dosage, in order to achieve weight loss or avoid weight gain. Individuals with diabetes mellitus may omit or reduce insulin doses in order to minimize carbohydrate metabolism

The real problem with the DSM-V is that it has grown so much that everything under the sun is included and it results in everyone living being diagnosable as having mental illness and that they should be medicated.

Ah, I use the Desk Reference which just has the actual diagnoses and not all the ancillary material. (the actual DSM is way too expensive!). I'm glad to hear it's in there at least under "associate features" to anorexia. Better than nothing. Are the associate features also listed under bulimia and binge eating disorder?

Your last paragraph is a WHOLE other discussion beyond this topic. I see your point and agree to an extent with some qualifications: I think the more clearly specified something can be the more likely someone who does suffer from it can be identified. For example if diabulimia had been included as a specific diagnosis. Second, the criteria for mental illnesses are listed such that in the hands of a skilled clinician everybody would not be diagnosable.For example they have duration of symptoms, and other criteria to differentiate between every day experiences and ongoing, severe and disabling symptoms. Third, again a skilled clinician does not believe that "everybody with a mental illness should be medicated." Sometimes medication is not recommended at all, but other therapies, and nearly always when medication is recommended adjunctive therapy is recommended as well.

But yes, in a general sense I agree that there is over-diagnosis (especially with children), and too many people are medicated that should not be but imho this is often because they go to their primary doctors who are not qualified to treat mental illness and will just write a script without even a valid assessment. I always recommend anyone who thinks they might have some form of mental illness (including anxiety or depression) to see a qualified mental health professional.

Hi Dave,

Here is the recording of the live interview with Asha Brown!