Adolescent females and young women with type 1 diabetes have about twice the risk of developing eating disorders as their peers without diabetes.

This may be because of the weight changes that can occur with insulin therapy and good metabolic control and the extra attention people with diabetes must pay to what they eat.

Researchers estimate that 10 to 20 per cent of girls in their mid-teen years and 30 to 40 per cent of late teenaged girls and young adult women with diabetes skip or alter insulin doses to control their weight. Studies of eating disorders and diabetes also show a higher rate of bulimia in girls with diabetes compared with healthy controls. Ten per cent of adolescent females with type 1 diabetes are diagnosed with an eating disorder.

In people with diabetes, eating disorders can lead to poor metabolic control and repeated hospitalizations for dangerously high or low blood sugar. Chronic poor blood sugar control leads to long-term complications, such as eye, kidney and nerve damage.

Individuals with type 2 diabetes who have depressive symptoms may experience night eating syndrome (NES). This is characterized by the consumption of more than 25% of daily calories after the evening meal and waking at night to eat, on average, at least 3 times per week. NES can result in weight gain, poor glycemic control and an increased number of diabetic complications.

Early warning signs of an eating disorder

  • Extremely high A1C test results
  • Frequent bouts of and hospitalizations for poor blood sugar control
  • Anxiety about or avoidance of being weighed
  • Frequent requests to switch meal-planning approaches
  • Frequent severe low blood sugar
  • Widely fluctuating blood sugar levels without obvious reason
  • Delay in puberty or sexual maturation or irregular or no menses
  • Binging with food or alcohol at least twice a week for 3 months
  • Exercise more than is necessary to stay fit
  • Severe family stress

If you think that you or a loved one has an eating disorder, talk to your doctor or diabetes health-care team. They will
recommend a mental health professional who will work with the diabetes team to help you and your family deal with this problem. It is important to be nonjudgmental and supportive. It is also extremely important to seek evaluation and treatment.