Trigger warning - eating disorders.
When insulin dependent diabetics have an eating disorder, it can be more fatal and detrimental than for those who do not have diabetes. This is not to diminish others’ experiences with eating disorders, but it is especially true when considering eating disorders focusing on the use of insulin or lack thereof to manipulate one's weight.
“People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat,” is a working definition of anorexia made by The National Eating Disorders Association (NEDA). Diaanorexia, however, shares all of these behaviors but also includes the refusal of taking necessary insulin dosages and eating in hopes of losing weight.
Under normal circumstances, refusal to eat puts the body into starvation mode where it stores what little carbohydrates it gets in preparation for the times it doesn’t get any. For diabetics, by not eating and not taking insulin, blood sugars to rise to unhealthy high levels. This can cause excessive ketones in their system, which leads to the blood becoming too acidic and can lead to irreparable small blood vessel and organ damage (NEDA). Because of how toxic excessive ketones can be, their bodies work overtime to reduce the blood’s toxicity by expelling it in any way it can, like vomiting and urinating. When the body is trying to purge itself of these toxins, it inevitably purges itself of necessary nutrients to maintain good health. This results in weight loss. However, prolonged acidity can lead to Diabetic Ketoacidosis (DKA). This condition is treatable and curable, but it can lead to coma and death.
Diabulimia on the other hand focuses more on restricting insulin to lose weight. The results are the same: weight loss, but also the possibility of DKA, coma, and/or death.
Through my research into these conditions, I realized that my self-destructive behaviors in terms of my diabetes management line up with a lot of what the NEDA was talking about. I am also terrified of low blood sugars because they have resulted in having seizures in the past, which has caused me to take less insulin than I know I need sometimes. I am obsessed with how much I eat and how many carbohydrates are in what I eat. I obsessively weigh myself every day and log the numbers. I lost a lot of weight but I wasn’t exercising and surely wasn’t eating any healthier. My glycated hemoglobin, or A1c, has been consistently over 9.0 when it should be between 4.8 and 5.6.
While my behaviors lined up with diabulimia, I never once considered that I might have an eating disorder. My research has opened my eyes and made me see that my self destruction will have lasting effects on my health if it persists. As someone who already has a complicated medical history, do I really want to have to add retinopathy (black lines or dots disrupting the vision due to bleeding in the eye), kidney disease, liver disease, heart disease? Let me answer that: no. However, acknowledging that there is a problem is much, much easier than seeking help for the problem. But, it is not impossible to treat eating disorders in diabetics, or people without diabetes, for that matter.
There are ways to turn things around. Recovery is possible. It has to start with you. You have to want to help yourself get to a better place with your health. A good way to start is to start working with a nutritionist and a therapist. There are healthier ways to lose and manage weight without restricting food, manipulating insulin doses, or over exercising. By working with a nutritionist and a therapist, not only will you work on the thought processes that lead to eating disorders, but you will work together to create a healthy diet and exercise regimen that will be significantly better for your body.
If you find yourself exhibiting the aforementioned behaviors or find yourself feeling this way about your body, do not hesitate to reach out to a professional. There will always be someone to help.
The American Diabetes Association has a list of therapists that are familiar with diabetes here. It may be helpful to utilize this list if you have T1D and are seeking treatment for a diabetes-related eating disorder.