Eating Disorders and Type 1 Diabetes
What is Type 1 Diabetes?
Type 1 Diabetes occurs when the immune system mistakenly attacks the insulin producing cells in the pancreas. Insulin is the hormone responsible for regulating glucose (sugar) in the blood. There is no unifying theory as to what triggers the immune system to react this way but common speculations include genetic factors, environment specific toxins and faulty virus response. Type 1 is rare and typically diagnosed in childhood or adolescence. Following diagnosis those with Type 1 Diabetes will be reliant on synthetic insulin (via injection or continuous pump infusion) and strict adherence to a specific regime to survive. Type 1 is not to be compared with Type 2 Diabetes which can be caused by lifestyle and diet factors, is commonly diagnosed in adults and is very common. Most Type 2 Diabetes can be treated with tablets or diet and exercise and rarely requires insulin.
What does this have to do with Eating Disorders?
When someone with Type 1 Diabetes does not take their insulin the level of (glucose) sugar in the blood increases. The lack of insulin means that glucose cannot be converted into glycogen for energy. This glucose is then lost in the urine meaning the calories it contains are not used. As this goes untreated the body responds to the lack of energy (glycogen) by burning it’s fat stores, it also burns muscle and if left for long enough tissue from major organs. This process produces byproducts known as ketones. Ketones are highly acidic and very dangerous to the body. Once a person with Type 1 Diabetes has a certain level of ketones in their system their body enters Diabetic Ketoacidosis (DKA). DKA is always fatal if left untreated.
Hypoglycemia
When there is too much insulin in the blood a Type 1 experiences hypoglycemia (commonly known as ‘a hypo’). Hypos are extremely distressing often leading to blackouts and if untreated a coma. To avoid over injecting many Type 1s cut back on their food and/ or insulin intake which can lead to accidentally learning the hyperglycemic process, it can also foster anorexic behaviours. When in a hypo the body sends signals to the brain to consume sugar as quickly as possible. This can become problematic and lead to binge/ purge cycles commonly associated with Bulimia.
Type 1 Diabetes Care
Type 1 Diabetes care has other aspects that contribute to eating disordered behaviour. To achieve good blood sugar control it is often necessary to follow a strict diet and exercise regime leading to moral judgments on foods and behaviours. This is often inadvertently encouraged by health teams and parents and can prove much to cope with at a time when most adolescents crave more control and independence.
How Dangerous is Deliberate Insulin Manipulation/Omission?
Extremely. Not only is there immediate danger of dying, having consistently high blood sugar dramatically increases the risk of Diabetes related consequences. These include Retinopathy, Nephropathy, Neuropathy, Infertility and Gastroparesis. The age of onset drops rapidly also meaning that we are seeing complications we would expect to see in those in their late 40s in those in their early 20s
Why ED-DMT1 and Diabulimia?
“New nomenclature was recommended at an international focus group held in Minneapolis in September 2008 composed of individuals with interest and expertise in eating disorders among individuals with Type 1 Diabetes. The group recommended that the term ED-DMT1 be used to designate those with an Eating Disorder and Type 1 Diabetes” (Diabetes Spectrum 2009, vol 22,). DWED has seen that among those with Type 1 Diabetes, Eating Disorders can present as they would in a non T1 but they can also have very specific Diabetes roots. The two are rarely unrelated when they evolve into the extreme. We use the term diabulimia also as this is the term many are comfortable with. We aim to be as inclusive as possible
