Eating disorders

Eating disorders are common among teenage and young adult women. They are much less common among males in the same age group. Researchers believe that eating disorders grow from an obsession about gaining control in a life that teenagers see as being out of control.

There are many possible causes of this obsession, depending on the individual’s experience. People with anorexia nervosa try to regain control by denying themselves food. People with bulimia nervosa try to regain control by excessive overeating or binging, then purging by vomiting or with the aid of laxatives.

These definitions aren’t cut and dried––people with one disorder sometimes show characteristics of the other. In the long term, anorexia can lead to severe weight loss and can be fatal. The constant binging and purging of bulimia can result in severe stomach ulcers and can be fatal. In teenage and young adult women with type 1 diabetes, it is common to have ongoing disturbances in eating attitudes and behaviours. Full-blown eating disorders occur in as many as 1 of every 10 teenaged girls with diabetes, but even milder problems can play havoc with blood glucose control.

Some diabetes-related factors may increase the chances of an eating problem. At the time of diagnosis there has often been weight loss. With insulin therapy this weight is quickly regained. In the vulnerable girl, this may trigger dissatisfaction with her body and the desire to be thinner again.

Also, meal planning is a key part of diabetes treatment. Such planning means that there will be some restraints on eating. This is another trigger to disordered eating. Finally, some girls discover that by skipping or reducing their insulin dose, they can lose sugar in their urine and keep themselves underweight.

Although this may be an effective way to control weight, it leads to poor diabetes control and, in the long run, earlier onset of diabetes-related complications. Warning signs of an eating disorder Eating disorders in people with type 1 diabetes can lead to wild, unexplained changes in blood glucose levels, often outside the safe range.

If a teen has many low glucose reactions (insulin reactions) or high glucose reactions (excessive thirst and urination, perhaps leading to urinary ketones), it may be a sign of an eating disorder. Some other signs of eating disorders include:

* a preoccupation with food and weight, beyond what is needed in diabetes management

* a stated desire to lose weight beyond what seems appropriate

* requests for a change to low-calorie, low-fat, vegetarian, or other diets to lose weight

* binge-eating episodes

* insulin manipulation

What you can do to help If you know someone with an eating disorder, there are several things you can do to help

* Express concern for the person’s health, while respecting the need for privacy. Eating disorders are usually a symptom of a greater psychological problem. The fact that you are there to help will be appreciated.

* Avoid power struggles around food. Forcing someone with an eating disorder to eat will probably make things worse.

* Examine your own attitudes around food and weight. Are you furthering the idea that “thin is in“?

* Talk about more flexible meal plans with the diabetes dietitian. Perhaps the current meal plan restricts eating too much, and reinforces the idea that the person with diabetes is different and deprived.

* Avoid commenting on weight, either positively or negatively. This only emphasizes the importance of appearance.

* Express your concern to the diabetes team and get support for the person.