Integrated treatment required for diabetes-eating disorder combination

Aug 3 2015

As they reach their teens, many with type 1 diabetes discover that the disease provides a secret weapon for losing weight. By restricting or reducing the amount of insulin they inject, they can eat just about anything they want and control their weight.

But the practice is dangerous: Restricting insulin leads to high blood sugar resulting in the buildup of toxic acids in the blood (ketoacidosis) and earlier onset of diabetes complications, such as blindness, kidney disease, heart disease and nerve damage.

Medical professionals who treat people with diabetes may not realize they likely have patients who also have an eating disorder, a combination called Eating Disorder-Diabetes Mellitus Type 1 (ED-DMT1), which some have nicknamed diabulimia. It's not uncommon, particularly in females. One study found that up to 40 percent of young girls and women with type 1 diabetes have developed or will develop an eating disorder. And catching this combination early can provide the care needed to help these girls avoid the potentially serious complications of this disorder.

Diabetes educators Marcia Meier, RN, CDE, and Lorraine Platka-Bird, PhD, RD, CDE, will present their insights on treating ED-DMT1, touching on effective strategies for identification and the importance of treating both simultaneously at the American Association of Diabetes Educators (AADE) Annual Meeting in New Orleans Aug. 5-8.

"Eating disorders and uncontrolled diabetes each are dangerous by themselves, so having both is a double whammy," said Platka-Bird. "Treating the diabetes without treating the eating disorder is like putting a band aid on a bullet wound. That's why it's vital that patients with diabulimia receive help from a treatment team that includes both a diabetes educator and an eating disorder specialist."

Those who treat people with type 1 diabetes should look for these warning signs of ED-DMT1 in any individual with type 1 diabetes, particularly teenage girls and young women:
- Poor metabolic control - Wide fluctuation of hyperglycemia or elevated A1C levels despite reported compliance is a red flag that a patient may be restricting insulin.
- Weight loss - Maintaining or losing weight despite eating more food is common.
- Recurrent hospitalizations - It's impossible to maintain healthy blood glucose levels when restricting insulin, so people with diabulimia typically have frequent incidences of diabetic ketoacidosis (DKA), often resulting in hospitalization.
- Lapses in testing - Patients who formerly were model patients often start testing their blood glucose less routinely, sometimes saying they "forgot." They may neglect to bring their meters or records to appointments.
- Fear of lows - Some patients express concern over hypoglycemia (low blood glucose), noting they don't like the feeling of lower energy or feeling "down."
- Long stretches between appointments - Not wanting to be lectured about poor blood glucose control, patients with diabulimia may schedule fewer appointments.
- Scale anxiety - People with eating disorders often don't like getting weighed because no matter how much weight they lose, it's never enough.
- Dry skin and loss of hair - Unhealthy weight loss can cause skin to become drier and hair to fall out.
- Classic symptoms of diabetes - Excessive urination, extreme thirst and constant hunger are signs of uncontrolled diabetes, which occurs when patients don't take their insulin correctly.
- Classic symptoms of eating disorders - Excessive exercise, fatigue, weakness and lethargy, being overly critical of appearance and lack of a regular menstrual period are some of the common signs of an eating disorder.

"It's important for medical professionals to identify patients who may have eating disorders in addition to diabetes," said Asha Brown, 30, a patient of Meier's who will speak at the AADE meeting about her experiences. "It's OK for them to acknowledge that they don't have the resources to treat these patients and refer them to those with expertise, such as diabetes educators."

Treating the combination of diabetes and an eating disorder requires professional help for both. For example, people with eating disorders are directed to stop reading food labels, because it feeds their obsessive behavior. But those with diabetes must read labels to know how many carbohydrates they are eating. Also, maintaining healthy blood glucose levels while exercising can be challenging. A diabetes educator can help with these and other complex issues.

Source; The American Association of Diabetes Educators (AADE)​