Frequently Asked Questions

In 2008 an international focus group composed of top experts in the field of eating disorders and diabetes recommended that the term ED-DMT1 be used to designate the comorbidity Eating Disorder-Diabetes Mellitus Type 1. This was done to cover the wide spectrum of eating disorder behavior that can exist in Type 1 diabetics in addition to, or outside of insulin omission. 
The term ED-DMT2 has since been coined to designate eating disorders in people with type 2 diabetes. 
The term T1ED is also used in the UK and several European countries to designate eating disorders in people with type 1 diabetes. 
Physical
  • A1c of 9.0 or higher on a continuous basis.
  • Unexplainable weight loss.
  • Constant bouts of nausea and/or vomiting. 
  • Multiple DKA or near DKA episodes.
  • Frequent bladder, yeast, and/or UTI infections.
  • Irregular or lack of menstruation.
  • Deteriorating or blurry vision.
  • Persistent thirst and frequent urination. 
  • Fatigue and/or lethargy.
  • Dry hair and skin.
Non-Physical 
  • Secrecy about diabetes management.
  • Extreme increase or decrease in diet.
  • Avoids diabetes related appointments.
  • Fear of hypoglycemia
  • Changes in sleep pattern.
  • Fear that “insulin makes me fat”
  • Extreme anxiety about body image
  • Restricting food to lower insulin needs
  • Avoids eating with family or in public
  • Overly strict food rules
  • Preoccupation with food, weight and/or calories
  • Excessive and/or rigid exercise.​
  • Genetics: having a family member with an eating disorder puts you at greater risk for developing one yourself.
  • Brain chemical imbalances: although doctors don’t fully understand how brain chemistry contributes to eating disorders, imbalances of brain chemicals seems to play a role.
  • Negative body image: low self-esteem can lead to an obsession with weight.
  • Growth and development: At start of college/ adolescents can often struggle with physical changes that occur during puberty.
  • Diabetes treatment: closely monitoring diet is important for managing type 1 diabetes. But, it's easy for dietary monitoring to become an obsession rather than a positive health intervention.
  • Stress: stress often contribute to eating disorders. Individuals trying to cope with a major life change, ie: moving, divorce or loss of a loved one may focus on weight to regain a sense of control.
  • Research conducted by the Joslin Diabetes Center suggest that 30% of diabetic women between the ages of 15 and 30 manipulate or omit their insulin in order to lose weight.
  • Women with type 1 diabetes have a 2.4 times greater risk of developing an eating disorder than their non-diabetic peers.
The short-term consequences are
  • Muscle atrophy
  • Diabetic Ketoacidosis 
  • Clinical Depression
  • High cholesterol
  • Bacterial Skin Infections 
  • Yeast Infections
  • Menstrual Disruption 
  • Staph Infection 
​
Long term, the consequences become 
  •  Neuropathy 
  • Retinopathy
  • Gastroparesis 
  • ​Liver Disease 
  • Kidney Failure
  • Stroke
  • Death.
People with ED-DM often benefit from a multidisciplinary treatment approach that includes:
  • Close monitoring by your medical team to keep blood glucose under control
  • Nutritional counseling and support from a registered dietitian who specializes in eating disorders and diabetes management
  • Therapy from a licensed mental health professional experienced with eating disorders
  • Support from family and friends who may also wish to enter therapy to learn how to help their loved one​​
During treatment for eating disorders, the goal is often to keep blood sugar levels under control without striving for perfect results. Until the person receives the additional nutritional and mental health counseling they need, they may not be able to completely control their blood glucose. In addition to closely monitoring the patient’s diabetes management plan, a doctor may prescribe an antidepressant to address symptoms of anxiety and depression associated with eating disorders.
Nutritional counseling for eating disorders usually starts with a general discussion of the importance of nutrition and education regarding the health consequences of hyperglycemia. Then a personalized plan is constructed for the patient If the patient could benefit from weight loss, the medical team will work with them to develop a sensible nutrition plan and monitor progress to ensure that the patient does not begin severely restricting calories or binging.
Individuals with severe eating disorders may require hospitalization at the start of treatment. Others may only require outpatient mental health treatment, which may include one or more of the following:
  • Cognitive behavioral therapy: psychotherapy that explores the thoughts and feelings that contributed to the eating disorder & focuses on developing strategies to modify dangerous behaviors.
  • Group therapy: therapy given to a group of people with eating disorders. Talking with others who suffer from the condition can reduce feelings of isolation and allow individuals to learn from the experiences of others.
  • Family therapy: a form of counseling that involves all immediate family members. The person with an eating disorder has a chance to express their thoughts and feelings, and their parents, siblings, spouses or other family members can learn how to best support their loved one throughout treatment.
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