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Eating Disorder

A severe disturbance in eating behavior, such as extreme undereating or overeating. Some studies suggest that eating disorders may be more common in adolescent girls with Type 1 diabetes than in their peers who don’t have diabetes. Eating disorders can wreak havoc on diabetes control.

The three most common eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder. They predominantly affect adolescent girls and young women. Anorexia nervosa afflicts an estimated 0.5% to 3.7% of girls and women over the course of their lifetime. Individuals with anorexia nervosa tend to be intensely worried about gaining weight or becoming overweight, despite the fact that they are extremely underweight. They tend to have distorted perceptions about their own bodies, thinking they are heavier than they actually are, and to deny the seriousness of their low body weight. They may avoid meals, choose only a few types of food and eat them in small quantities, and painstakingly weigh and portion their food. They may use other measures to control their weight, such as exercising compulsively, forcing themselves to vomit, or abusing laxatives, enemas, or diuretics (“water pills”).

Anorexia carries a heavy toll: Girls with the disorder often have delayed onset of their first menstrual period or irregular menstruation, which may impair fertility and is associated with osteoporosis. The rate of death from anorexia is estimated at 0.56% per year of illness (meaning around 5.6% for those who have had anorexia for a decade). Individuals with anorexia nervosa tend to die from such complications as cardiac arrest or electrolyte imbalance, or from suicide.

In someone with Type 1 diabetes, the effects of anorexia nervosa can include poor diabetes control, growth delay, frequent bouts of the life-
threatening condition diabetic ketoacidosis (DKA), early onset of diabetes-related complications, and premature death.

The earlier anorexia nervosa is diagnosed and treated, the better the chances of successful treatment. Often, the first step is to hospitalize the person to restore the weight that was lost through excessive dieting and possibly purging, sometimes with the help of intravenous feeding. After the person begins to gain weight, psychotherapy is started to help improve self-esteem and correct distorted perceptions and behavior patterns. In some cases, certain antidepressant medicines in the class of drugs known as selective serotonin-reuptake inhibitors (SSRIs) may be used, notably fluoxetine (brand name Prozac). However, it is unclear how helpful SSRIs are in treating anorexia.

Bulimia nervosa affects an estimated 1.1% to 4.2% of girls and women at some point in their lives. It is characterized by repeated episodes of uncontrollable binge eating, followed by self-induced vomiting; abuse of laxatives, diuretics, or enemas; fasting; or excessive exercise to prevent weight gain. Like people with anorexia, bulimic individuals are afraid of gaining weight and are intensely dissatisfied with their bodies. Purging behaviors in bulimia can cause many complications. For example, exposure to stomach acids from frequent vomiting can cause a chronically inflamed and sore throat and can wear away at tooth enamel, leading to tooth decay. Laxative abuse can cause intestinal distress and irritation, and diuretic abuse can lead to kidney problems. The purging of fluids also sets the stage for severe dehydration. As one might expect, bulimia can disrupt blood glucose control in people with diabetes, causing repeated episodes of hypoglycemia.

Bulimia is treated with psychotherapy and other types of counseling, and with medication. Counseling is geared toward helping the person establish a regular eating pattern, improve negative attitudes, maintain a healthy exercise routine, and cope with any underlying mood or anxiety disorders. Sometimes SSRIs or other medicines may be helpful, as well.

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