By Stuart Koman, Ph.D.

It’s well known that those who have type 1 diabetes are susceptible to medical conditions such as retinopathy, kidney disease and nerve damage.  It’s less well-known that they are also susceptible to eating disorders.

Studies show that a person with type 1 diabetes is more than twice as likely as the average person to develop an eating disorder.

The National Institute of Mental Health estimates that 0.6% of the U.S. population suffers from anorexia, 1% from bulimia and 2.8% from binge-eating disorder.

Why the dual diagnosis of diabetes and eating disorders is so common is not known for certain, but it may be because individuals with type 1 diabetes are so focused on food and managing what they eat, they may never deviate from a set diet, believing that doing so could be life threatening.  They may develop rigid ideas about “good food” and “bad food,” and their rigidity may lead to an eating disorder.

While those with type 1 diabetes have a high incidence of eating disorders, little research has been done about which types of eating disorders they typically have.

Anorexia.  It’s not surprising that anorexia, in which individuals severely restrict what they eat, is less common among those with type 1 diabetes, given that failure to eat meals regularly can be fatal for those with diabetes.

However, anorexia still exists among those with diabetes.  Individuals with diabetes and anorexia eat so little, they require very little insulin.  Because their body’s insulin needs are profoundly reduced, their blood sugar is not at an alarming level and their anorexia may go undetected.

Anorexia has the highest mortality rate of any psychiatric illness.  It can cause low blood pressure, an abnormally slow heart rate, reduced bone density, dehydration that can lead to kidney failure and other major illnesses.  And that’s before adding on the medical complications of diabetes.

Bulimia.  Bulimia is more common among those with diabetes.  Symptoms include regularly binging by eating an excessive amount of food, feeling a lack of control over the binging and compensating to prevent weight gain by self-induced vomiting; misuse of laxatives, diuretics or other medications; fasting, or excessive exercise.

Those who have bulimia often have an electrolyte imbalance that results in irregular heartbeats, increasing the potential for heart failure.  They often suffer from inflammation or tearing of the esophagus and swollen glands, and have irregular menstrual periods and lowered interest in sex.

Binge-eating disorder.  Those with binge-eating disorder eat unusually large quantities of food and feel that they have no control over their eating, but they do not purge.  Binge-eating disorder often leads to obesity and all of its related medical complications, including hypertension and high blood pressure.

Diabulimia.  Those with type 1 diabetes also frequently skip or reduce insulin injections, because insulin causes weight gain.  When insulin restriction becomes routine, an eating disorder develops called ED-DMT1 (Eating Disorder – Diabetes Mellitus Type 1), which is commonly referred to as “diabulimia.”

EDNOS.  As with the general population, many who have both type 1 diabetes and an eating disorder are classified as having an “eating disorder not otherwise specified” or EDNOS.  EDNOS includes any eating disorder that fails to meet all criteria established for the disorder in the Diagnostic and Statistical Manual of Mental Disorders.  Those who have diabulimia, for example, are classified as having EDNOS.

Those who have diabetes and eating disorders often also have other co-occurring disorders, such as depression and substance abuse.

Those who treat diabetes need to be aware of the signs that a patient has an eating disorder, just as those who treat eating disorders need to recognize that patients with diabetes require special treatment.

Dr. Stuart Koman

Stuart Koman, Ph.D. is President and CEO of Walden Behavioral Care and the nonprofit Walden Center for Education and Research, both in Waltham, Mass. He has 30 years of experience leading and developing behavioral healthcare companies.