There is a strong connection between type 1 diabetes and eating disorders. Factors which can play a role include having a higher body mass index (BMI), sleep problems, concerns about shape and weight, body dissatisfaction, difficulties coping with a long-term condition, and how diabetes affects self-image and family interactions. People with type 2 diabetes may be living with overweight or obesity and experience binge eating, restrictive behaviours or skipping meals. This can impact insulin sensitivity and/or the stability of blood sugar levels.

Disordered eating and diabetes

Key signs

• Preoccupation with food
• Strict meal plans
• Fear of high blood sugar
• Negative body image
• Risky weight control behaviours
• Withdrawal from social eating activities
• Underdosing of insulin
• Excessive exercise
• Notable mood or emotional distress

Misuse of insulin

Fear of weight gain can be a predictor of insulin restriction. An intense dislike of, and feeling tired of, experiencing diabetes, can be part of why some people restrict their insulin intake. Trauma, such as abuse, bullying and family breakdown, feeling unsupported, feeling isolated, having depression, stress, other eating disorders and being misunderstood by others have also been identified as factors which can play a role.

Diabulimia

Diabulimia is where a person withholds or misuses insulin to order to lose weight. It may be noticeable through a combination of short, medium and long-term symptoms.

• It can be life-threatening
• Is not currently a formal diagnosis
• There is a lack of research on how to prevent, detect and treat it

Impact and risks

• Acute and risky complications such as diabetic ketoacidosis (DKA)
• Microvascular and macrovascular complications for example vision loss (retinopathy) and kidney damage (nephropathy)
• Increased the risk of death
• Feeling stigmatised

Treatment and support needs

• Psychological support through and after diagnosis
• Personalised psychotherapeutic interventions
• Nutritional counselling, personalised meal plans
• Diabetes education, glycaemic control
• An integrated approach that acknowledges both issues, enhancing overall well-being and quality of life
• Support for motivation, such as personal goals and reducing health complications
• Awareness amongst professionals and people with diabetes
• Positive relationships
• Meeting peers who have been through similar experiences

The Medical Emergencies in Eating Disorders (MEED) details specific points of further information for those in healthcare and clinical practice.