Eating Disorders & Diabetes

What Is Type 1 Diabetes?

Type 1 Diabetes is a condition where the pancreas creates little or no insulin. There is no cure, but through proper treatment it can be maintained. This condition usually appears during childhood but can occasionally appear later in life for adults.

What Is Type 2 Diabetes?

Type 2 Diabetes is a long-term condition when there is too much sugar circulating in the bloodstream, as long-term high-blood sugar levels can lead to problems in your pancreas’ ability to produce insulin.

How Are Diabetes and Eating Disorders Related?

Studies show us that there is an increased risk of eating disorders in those who have Type 1 or Type 2 Diabetes.

People with Type 1 Diabetes may engage in insulin delays, decreases or omission to achieve weight loss or weight control. This dangerous process is often referred to as Diabulimia, where this manipulation of insulin is seen as a form of purging (although this is not a formal diagnostic and may be referred to as ED-DMT1).

An eating disorder or Type 1 Diabetes alone can be life-threatening issues, but when the two are combined, both can create an environment for an extremely dangerous situation.

People with Type 2 Diabetes and eating disorders face unique challenges. Patients may receive medical or nutritional advice about weight loss, weight management and food which may be in conflict with eating disorder recovery goals, such as challenging diet culture and integrating an intuitive eating practice where there are no good or bad foods.

Medical professionals may prescribe low calorie diets to improve Diabetes but this could result in harm to the patient who also has an eating disorder or may be triggering to someone who is predisposed to eating disorders.

In order for proper treatment for patients with both Type 2 Diabetes and an eating disorder, treatment must include a both/and approach here the goals include stabilizing blood sugars and successfully managing the diabetes as well as would take improvement of blood sugars into account as well as help patients heal their relationship with food and stop the restrict/binge/purge cycle.

Receiving a diagnosis of a chronic illness such as diabetes diagnosis can be highly stressful, and it is essential for individuals to have caring, compassionate and knowledgeable support that takes into consideration the psychosocial and emotional aspects (mental health) as well as physiological/medical care, particularly with co-occurring eating disorders – in addition to positive peer support from people who understand.

Reasons Understands Your Needs

  • A coordinated and multidisciplinary team approach is necessary: The Medical Doctor, Registered Nurse, Therapist and Registered Dietitian will assess the diabetic patient’s understanding of their condition to determine educational and care needs. This assessment will be communicated to the treatment team to develop a personalized and specialized care plan for diabetes and eating disorders.
  • These educational needs will be continually evaluated by the RN and RD to assess each patient’s response to their individual treatment regimen.
  • The Registered Dietitian will create an individualized meal plan and provide education to the patient regarding diabetes following guidance from the American Diabetes Association and the Academy of Nutrition and Dietetics.
  • The Nursing staff will observe closely for symptoms and administer Blood Glucose Checks. The Nursing staff will also encourage:
    • Cleanliness to avoid skin breakdown and infection
    • Good foot care

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Eating Disorders and Diabetes Treatment at Reasons

Protocol at Reasons: Initially the treatment team will take over diabetes management, which would include blood sugar checks and insulin dosing and administration. Over time and throughout treatment, we work with phases that allow the patient to resume management with assistance, oversight and eventually independence to prepare for their return home at discharge.

Goals for All Patients with Diabetes and an Eating Disorder:

  • Are to stabilize blood glucose levels
  • Teach appropriate use of insulin
  • Heal relationships with food and movement/exercise
  • Ensure the patient has an outpatient team of endocrinologists
  • Provide diabetes specific support groups and educate the family
  • Challenge the idea of good and bad foods
  • Practice eating on a consistent schedule
  • Healing relationships with food
  • Providing education on how to manage diabetes and blood sugars and not engage in restricting or purging or binge eating behavior
  • Challenging any internalized nutrition advice that is harmful in terms of ED recovery
  • Helping the patient learn to balance any conflicting goals and making recovery choices

Common Symptoms

Signs of Hypoglycemia:

  • Shakiness/nervousness or anxiety
  • Sweating, chills and clamminess
  • Irritability or impatience
  • Confusion, including delirium
  • Rapid/fast heartbeat
  • Lightheadedness or dizziness
  • Hunger and nausea
  • Sleepiness
  • Blurred/impaired vision
  • Tingling or numbness in the lips or tongue
  • Headaches
  • Weakness or fatigue
  • Anger, stubbornness, or sadness
  • Lack of coordination
  • Nightmares or crying out during sleep
  • Seizures
  • Unconsciousness

Signs of Insulin Shock:

  • Sudden hunger
  • Weakness or restlessness
  • Paleness of the skin
  • Increased perspiration
  • Emotional responses
  • Giddy, stubborn, sleepy, and ashen
  • Dizziness or vertigo
  • Convulsions or coma

Signs of Diabetic Ketoacidosis (DKA):

  • Drowsiness
  • Dry skin, reddened lips, and rosy checks
  • Increased respirations, and smell of acetone on the breath
  • Occasional nausea and vomiting, and stomach aches
  • Coma
  • Medical complications
  • Eye disease
  • Kidney damage
  • Nerve damage
  • Cardiovascular disease
  • Foot damage
  • Skin conditions