After learning about the relationship between diabetes and disordered eating behaviors, it’s important to learn how to move forward and manage these conditions—particularly when they occur together.

This post will explore the ways that disordered eating with diabetes may impact health and create challenges for individuals with these conditions. We’ll also share some practical tips for maintaining a balanced approach to food and health and the importance of a multidisciplinary team in addressing the unique needs of individuals with both conditions.

Disordered Eating and Diabetes Management

Co-occurring eating disorders and diabetes can cause some serious impacts on an individual’s overall health outcomes.

For example, if individuals with diabetes manipulate their insulin dosages, it can lead to a condition called diabetic ketoacidosis.¹ This happens when your cells don’t get the sugar they need for energy, and your body begins to burn fat for energy, producing ketones. These ketones can build up in your blood, making it more acidic and essentially poisoning your body.

Some other impacts of diabetes and unmanaged blood glucose may include: ² ³ ⁴

• Hypoglycemia and hyperglycemia: Hypoglycemia, or low blood sugar, can cause you to lose consciousness and be life-threatening. Hyperglycemia, or high blood sugar, can cause extreme thirst, fatigue, and nausea in the short-term, and other severe issues in the long-term.
• Kidney failure: Unmanaged blood glucose levels can cause stress to the kidneys and cause their function to decrease and potentially fail altogether.
• Neuropathy: High glucose can injure blood vessel walls, leading to burning, numbness, and tingling.
• Retinopathy: High glucose may also damage blood vessels in the eyes, leading to retinopathy and even blindness.
• And more: Unmanaged blood glucose levels with diabetes can also cause metabolic dysfunctions, skin and mouth issues, increase the risk of heart disease, and more.

There are also health impacts that can be caused by an eating disorder without the manipulation of insulin, which may include: ⁵ ⁶

• Changes in heart rate and heart function: Eating disorders can cause the heart muscles to shrink and beating to slow, or abnormalities in rhythm.⁷
• Dehydration: This can lead to kidney failure.
• Electrolyte imbalances: When levels of sodium, calcium, potassium, and other electrolytes are too low or too high, it can cause stroke, heart attack, and other complications.
• Hormone fluctuations: Disordered eating can impact our hormones, including estrogen, testosterone, thyroid hormones, and more.
• Loss of bone density: Over time, this can cause conditions including osteopenia or osteoporosis.
• Low or high blood pressure: These can cause other issues and put stress on our cardiovascular system.
• Uncontrolled blood glucose levels: Eating disorders can impact our blood sugar levels, independent of any complications caused by diabetes.

Both eating disorders and unmanaged diabetes can cause significant health impacts and increase mortality rates on their own. However, research shows that having both an eating disorder and diabetes can increase the mortality rate to 35%.⁸

This is why caring for our health and getting treatment is so important.

Navigating the Challenges of Co-Occurring Eating Disorder and Diabetes Treatment

Diabetes and eating disorders can both have co-occuring disorders, including other mental or physical health conditions. When diabetes and an eating disorder co-occur, this can cause a number of challenges, including:

• Increased focus on food: Managing diabetes often goes hand-in-hand with a hyper-focus on diet, food proportions, the kinds of food eating, and so forth. These practices are directly linked with a higher risk of eating disorder development.”⁹
• Eating disorder behaviors and thoughts: From body dissatisfaction to perfectionism and restriction to binge eating, eating disorder behaviors and thoughts can be challenging for many reasons.
• Transition to independence in diabetes management: As adolescents transition to adulthood and become independent over their diabetes care and management, this can cause stress as individuals learn to manage their condition themselves.
• Feeling a lack of control over one’s body: Both diabetes and an eating disorder can lead a person to feel out of control and disconnected from their body.
• Difficulty coping with the long-term effects and management of diabetes: This can be physically and mentally overwhelming, which can be a lot for a person to handle.
• Diet plans and misinformation from the media or healthcare professionals: From people claiming that “no carb” is the best way to eat to encouraging disordered behaviors, diet culture runs rampant in society and can be hard to navigate.¹º
• Lack of research to support care: While more research is ongoing, there is still a lack of here is still a lack of knowledge on optimal treatments to support someone with both diabetes and an eating disorder. This can present challenges for individuals living with both, especially if they are working with uninformed professionals.¹¹

Dietician Tips to Navigate Diabetes and Eating Disorders

As a dietitian, it’s our job to know how to support your health and help manage conditions like these.

Here are a few tips to navigate both of these conditions:

• Stick to a meal plan or meal schedule for daily meals and snacks: It’s helpful to eat every 2 to 3 hours to prevent feelings of being over-hungry, any complications from low blood sugar, and so forth.
• Incorporate a variety of foods, including carbohydrates: Our bodies need a wide range of nutrients to keep us healthy. All food is neutral — remember that food can’t be morally “good” or “bad.”
• Block or unfollow unhelpful social media accounts: Whether it’s your peers, influencers, or something the algorithm suggests, curate your feed to content that makes you feel good from the inside out.
• Look into and receive accurate diabetes education and information: With so much misinformation out there, it’s important to get your education and care from informed individuals. This may include a certified diabetes educator, a weight-inclusive registered dietician, an eating disorder-informed primary care provider, and so forth.
• Keep a journal or diary to better understand your food feelings and emotions: This can help you navigate the challenges that come with learning to manage these conditions.
• Self-care, taking care of yourself and your body: Self-care is not only a face mask or a bubble bath — it also means eating a variety of foods you love, staying hydrated, honoring your hunger cues, getting enough sleep, and engaging in joyful movement.
• Lean on community support: Reach out to friends and family, search for support groups, find others who can relate to what you’re going through, and seek a peer counselor for support.
• Get help from professionals: Although there is still more research needed, some initial research shows promise from CBT to help improve glycemic control and reduce the frequency of binge-eating episodes.¹²

The Role of Healthcare Providers in Supporting Individuals with Disordered Eating and Diabetes

Experts agree on the importance of a multidisciplinary approach to navigate living with an eating disorder and diabetes and care for your health.

The National Institute for Health and Care Excellence recommends a “multidisciplinary, shared-care approach” to address the particular needs of both of these co-occurring conditions.¹³

Your team should include:

• A registered dietitian to provide education and nutrition counseling (Search for diabetes-informed dieticians and eating disorder-informed dietitians.)
• An eating disorder-informed primary care physician for medical supervision
• A therapist or psychologist to provide behavioral support and help you navigate your thought processes

Other experts note that an endocrinologist, or a hormone specialist, along with nutritional counseling and psychotherapy, are paramount to treating psychotherapy and helping improve body image.¹⁴

A strong support system of family and friends can be transformative in eating disorder recovery.¹⁵

In some cases, immediate emergency medical intervention and hospitalization, including nutritional rehabilitation or psychiatric stabilization, may be necessary.¹⁶ While undoubtedly life-saving, these are not long-term solutions and must be followed with a team care approach.

Cognitive behavioral therapy is a longstanding approach used in eating disorder recovery and can be a powerful tool to help individuals navigate co-occurring conditions.¹⁷

No single tool, treatment, or expert is key to eating disorder recovery and diabetes management — a multidisciplinary approach with an informed care team can provide the support and education you need to care for your health.

You Deserve Recovery and Care

While living with an eating disorder and diabetes can both be a challenge, it may feel insurmountable to have both. However, recovery is possible — and you deserve it. Asking for help and gathering a team of professionals is the first step.

If you believe that yourself or a loved one may be struggling with diabetes management, disordered eating behaviors, or a combination of both, schedule an appointment with Life Cycle Nutrition and allow us to support you on your journey to a more positive relationship with health, condition management, and food!

 

Works Cited

1. ADA. “Diabetic Ketoacidosis – Signs & Symptoms | ADA.” n.d. American Diabetes Association. Accessed August 29, 2024. https://diabetes.org/about-diabetes/complications/ketoacidosis-dka/dka-ketoacidosis-ketones.
2. IQWiG (Institute for Quality and Efficiency in Health Care). 2023. “Type 2 diabetes: Learn More – Hyperglycemia and hypoglycemia in type 2 diabetes.” NCBI. https://www.ncbi.nlm.nih.gov/books/NBK279510/.
3. Mayo Clinic. “Diabetes – testing title.” 2024. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444.
4. UCI Health. “Surprising consequences of uncontrolled diabetes.” 2020. UCI Health. https://www.ucihealth.org/blog/2020/02/controlling-diabetes.
5. NIMH. “Eating Disorders: About More Than Food – National Institute of Mental Health (NIMH).” 2021. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/eating-disorders.
6. NEDA. “Eating Disorder Health Consequences – NEDA.” National Eating Disorders Association. Accessed August 29, 2024. https://www.nationaleatingdisorders.org/health-consequences/.
7. Williamson, Laura. 2024. “How eating disorders can damage the heart.” American Heart Association. https://www.heart.org/en/news/2024/02/26/how-eating-disorders-can-damage-the-heart.
8. Fanik, Roula. 2024. “Insulin manipulation and eating disorders in young people with type 1 diabetes: Implications for schools.” Journal of Diabetes Nursing 18, no. 6 (June): 238-242.
9. NEDC. “Eating Disorders and Diabetes.” n.d. National Eating Disorders Collaboration (NEDC). Accessed August 29, 2024. https://nedc.com.au/eating-disorders/eating-disorders-explained/eating-disorders-and-diabetes.
10. Sissons, Beth. 2023. “What to know about diet culture.” MedicalNewsToday. https://www.medicalnewstoday.com/articles/diet-culture.
11. Morales-Brown, Louise. 2023. “What is the relationship between T2DM and eating disorders?” MedicalNewsToday. https://www.medicalnewstoday.com/articles/type-2-diabetes-and-eating-disorders.
12. Ibid.
13. NEDC. “Eating Disorders and Diabetes.”
14. Fanik, Roula. 2024. “Insulin manipulation.”
15. Equip. n.d. “The Importance of Support During Eating Disorder Recovery-NEDA.” National Eating Disorders Association. Accessed August 29, 2024. https://www.nationaleatingdisorders.org/the-importance-of-support-during-eating-disorder-recovery/.
16. NEDC. “Eating Disorders and Diabetes.”
17. Morales-Brown, Louise. 2023. “What is the relationship?”