The behaviours of someone managing their diabetes, and someone in the grips of an eating disorder, are often similar. This is where many people with diabetes and an eating disorder run into problems – what is ‘good’ diabetes management, and what is disordered eating? Often, we are praised by healthcare professionals for behaviours that would ring alarm bells for anyone else. Weighing your food, obsessively counting carbohydrates, and monitoring your weight are seen as optimum management for us, but are a concern for anyone else!
So how do look out for disordered eating signs in yourself or a loved one, when so many of them interchange with our day-to-day life with diabetes?
The key is to analyse the behaviour, and evaluate whether the behaviour is affecting your life in a negative way. Remember that eating disorders in diabetes do not just revolve around insulin omission – the omnipresent nature of diabetes means that normal patterns of eating can easily become disorderd.
-Are you restricting to the point where you are scared to treat a hypo?
– Do you ‘under-bolus’ for a particularly indulgent meal?
– Do you get scared to eat over a certain number of carbs per day?
– Have you withdrawn from things you like to do because of the food that may be involved?
More specific signs and symptoms relating to insulin omission may include (but are not limited to):
► Repeated episodes of DKA (Diabetic Ketoacidosis) or hospital admissions
► Unexplained elevated HbA1c levels
► Weight fluctuations
► Early onset of complications from diabetes
► Frequent hyperglycaemia or hypoglycaemia
► Extreme concerns about body weight and image
► Change in eating patterns (restricting or bingeing)
► Extreme thirst and going to the toilet often *
*Ruth-Sahd, L, Schneider, M., & Haagen, B. (2009). Diabulimia: What it is and how to recognize it in critical care. Dimensions of Critical Care Nursing, 28 (4), 147-153