When the Psychological Effects of Diabetes Lead to an Eating Disorder

The psychological effects of carbs and carb counting on a type 1 has always been something I find fascinating. We as people with diabetes are taught to obsess about food from a young age — the makeup, the amount, and most importantly, the carbs. What does all this do to our psyche? Is it possible to obsess this way and still keep a healthy relationship with food? Does the fact that I was learning carb counting while others my age were learning kick ball effect my current self-image?

I’ve grown to find that most PWD that I meet in the clinic or “in the wild” have an odd relationship with food, myself included. What does this mean? Well honestly, I don’t completely know. The reason I say that it’s an “odd” relationship is because I can’t actually pinpoint it and it varies so much from person to person.

For many, this relationship has turned into an obsession with weight. For some, it turns into binge eating, purging, anorexia, or bulimia. For me, I just don’t really like food. I think it’s because of all the work that goes into my diabetes when I eat. I have to count my carbs, bolus 15 minutes early, then deal with the fact that I may have under or overestimated the carbs. Should I have used a combo bolus? Will I be exercising in the next four hours? It’s just all so complicated and frankly, it’s annoying.

Today, I want to talk about an eating disorder that I see all too often: diabulimia.

Diabulimia is a very dangerous eating disorder in which PWD withhold insulin to lose weight. Insulin is required to bring glucose from the bloodstream into the cells and when insulin is withheld, glucose accumulates in the blood. High BGs result, causing the kidneys to kick into overdrive (frequent urination). Because glucose cannot get into the cells, the body starves. This leads to quick weight loss with very severe consequences; diabetic ketoacidosis, kidney failure, heart attack, stroke, blindness, gastroparesis, and death.

According to the American Diabetes Association, as many as one third of type 1 women have done or will do this in their lifetime. I’m not sure of the stats for men, but I know diabulimia is prominent with them as well.

If this is so prevalent in diabetes management, why is there so little access to treatment? People with diabulimia are typically treated similarly to those with other eating disorders, but this isn’t always successful. Psychiatrist/psychologists specializing in diabulimia are few and far between.

For those who are willing to share, what have you done to cope with this disease?