Eating Disorders and Diabetes: What’s the Connection?

This week, from February 23 to March 1, is National Eating Disorders Awareness Week. You might be ready to tune out and skip reading this — after all, only women get eating disorders, right? And young women, at that.

Chances are, when you hear or read the words “eating disorder,” you think of an underweight teenage girl. That’s certainly one of the faces of eating disorders, but it’s important to know that adults, including men, can have an eating disorder, too. There are also different types of eating disorders. My goal this week is to increase your awareness about this issue and, if you think you might have some type of disordered eating, to inspire you to get help.

Facts and figures
According to the National Eating Disorders Association (NEDA):

• About 20 million women and 10 million men in the US struggle with an eating disorder at some point in their lives

• The prevalence of eating disorders has been increasing since 1950

• The incidence of bulimia in women ages 10–39 tripled between 1988 and 1993

• All ethnicities are affected by eating disorders, although anorexia is more common in white women.

How are diabetes and eating disorders connected?
There appears to definitely be a link between having diabetes and an eating disorder. The American Diabetes Association estimates that women with diabetes are nearly three times more likely to have an eating disorder compared to women without diabetes. Of course, having diabetes doesn’t mean that you have disordered eating, but researchers think that people with diabetes are at a higher risk than people without diabetes.

Why? There’s no definite answer, but having diabetes means paying closer attention to food intake and activity level and, for many, reaching and staying at a healthful weight. It’s not uncommon for people with diabetes to develop the mentality that there are “good” and “bad” foods in terms of weight and blood glucose management; the same attitude can develop in people with an eating disorder.

Also, control plays a central role in both diabetes and disordered eating. Along with the “good” and “bad” foods come feelings of guilt, failure, or anger when blood glucose levels are too high or too low or if a complication[1], such as diabetic eye disease, occurs. Focusing on eating and medication management are ways to help get and keep blood glucose levels in a safer range. People with anorexia or bulimia may also exert a level of control in their lives by manipulating food and/or exercise to avoid or limit fluctuations in their weight.

What are the different types of eating disorders?
There are a number of eating disorders. Here’s a rundown of some of the more common types:

Anorexia nervosa. This is characterized by inadequate food intake that leads to a very low (and unsafe) body weight. A person with anorexia is extremely fearful of gaining weight and often develops obsessive types of eating and exercise habits to prevent weight gain.

Bulimia nervosa. This is characterized by consuming large quantities of food followed by certain behaviors, such as vomiting or using laxatives, to prevent weight gain. Binge episodes are related to strong feelings of being out of control.

Diabulimia[2]. This disorder is more common in women with Type 1 diabetes[3] who, like other young women, may experience feelings of low self-esteem and body image concerns. Women with diabulimia often restrict or stop taking their insulin as a means of causing high blood glucose levels which, in turn, leads to a loss of calories in the urine and subsequent weight loss. As you might imagine, serious consequences can occur if insulin is omitted, such as diabetic ketoacidosis[4], dehydration, nausea, blurred vision, and a higher rate of diabetes complications.

Binge eating disorder. As with bulimia, a person who has binge eating disorder will consume a very large amount of food at any given time, but he does not purge himself afterwards. Feelings of shame, guilt, and loss of control are common with this eating disorder.

Orthorexia. While not considered to be an “official” eating disorder, orthorexia is similar to other types of eating disorders. Orthorexia is characterized by an obsession with food quality and purity. People with this condition become fixated on eating “perfect” foods to the point of agonizing over which vegetable is the healthiest. They may impose a very rigid eating structure on themselves (as can be the case with diabetes management) and strive every day to do better. They also spend an inordinate amount of time choosing foods and managing their food intake. The motivation is good health, but there may be underlying issues of low self-esteem, the need for control, and the desire to find spirituality through food.

Do diabetes and eating disorders go hand in hand?
It’s important to note that having diabetes does not mean that you are going to develop an eating disorder. But, it’s equally important to pay attention to how you eat and how you manage your food and exercise, especially around weight and blood glucose issues. Having diabetes generally means that you need to follow some type of eating plan that, for the most part, can seem somewhat restrictive. You might also feel pressure to be thin. Or you might be struggling with having diabetes in the first place and turn to food for comfort. Rest assured that these feelings are normal, but if you have them, it’s time to address them.

What if you suspect you may have an eating disorder?
It might seem awkward or embarrassing to bring the issue up, but if you think you have any type of eating disorder, let your health-care team know. It may seem easier to try and ignore or forget about it, but doing so can lead to very real and serious health issues if it’s not addressed. Talk to your health-care team. Treatment is available. Also, if you want to learn more, check out the National Eating Disorders Association Web site[5].

  1. complication:
  2. Diabulimia:
  3. Type 1 diabetes:
  4. diabetic ketoacidosis:
  5. National Eating Disorders Association Web site:

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Amy Campbell: Amy Campbell is the author of Staying Healthy with Diabetes: Nutrition and Meal Planning and a frequent contributor to Diabetes Self-Management and Diabetes & You. She has co-authored several books, including the The Joslin Guide to Diabetes and the American Diabetes Association’s 16 Myths of a “Diabetic Diet,” for which she received a Will Solimene Award of Excellence in Medical Communication and a National Health Information Award in 2000. Amy also developed menus for Fit Not Fat at Forty Plus and co-authored Eat Carbs, Lose Weight with fitness expert Denise Austin. Amy earned a bachelor’s degree in nutrition from Simmons College and a master’s degree in nutrition education from Boston University. In addition to being a Registered Dietitian, she is a Certified Diabetes Educator and a member of the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators. Amy was formerly a Diabetes and Nutrition Educator at Joslin Diabetes Center, where she was responsible for the development, implementation, and evaluation of disease management programs, including clinical guideline and educational material development, and the development, testing, and implementation of disease management applications. She is currently the Director of Clinical Education Content Development and Training at Good Measures. Amy has developed and conducted training sessions for various disease and case management programs and is a frequent presenter at disease management events.

Disclaimer of Medical Advice: Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information, which comes from qualified medical writers, does not constitute medical advice or recommendation of any kind, and you should not rely on any information contained in such posts or comments to replace consultations with your qualified health care professionals to meet your individual needs.