As many as 20% of people with diabetes may have an eating disorder.¹ Regardless of whether a person has type 1 or type 2 diabetes, both conditions may go hand-in-hand with disordered eating behaviors.

Regardless of whether the diabetes or disordered eating behaviors came first, both can have significant impacts on one another, and the effects can be devastating.

It’s important to be aware of the relationship between the two and the potential impacts they can have on a person’s health. Both diabetes and disordered eating require delicate care to keep a person feeling their best — inside and out.

The Relationship Between Eating Disorders and Diabetes

Eating disorders can develop after a diabetes diagnosis as a person is learning to navigate and manage their condition. However, it’s also important to note that in those who have an eating disorder first, the development of type 2 diabetes can exacerbate their condition and make a diabetes diagnosis challenging to navigate.²

Diabulimia

What is diabulimia? 

“Diabulimia” is a commonly used term for an eating disorder when a person with type 1 diabetes reduces or withholds their insulin dosages in an attempt to lose weight.³

As a person’s body doesn’t make enough insulin, their body instead begins breaking down fat and muscle for energy — however, this causes high blood sugar levels that can be dangerous to a person’s health.

This isn’t the only way that eating disorders can manifest in individuals with diabetes.

Individuals with both type 1 and type 2 diabetes may struggle with a range of disordered eating behaviors without changing their insulin regimens. This may include:⁴

• Restricting: Either in a specific calorie amount or by cutting out foods or whole food groups
• Objective binge eating: Consuming large amounts of foods in a short period while feeling out of control, guilty, or shameful
• Subjective binge eating: When a person feels a loss of control but doesn’t necessarily eat large amounts of food
• Disordered eating and development of diabetes: Individuals who have eating disorders — particularly binge eating disorder and bulimia — may be at an increased risk of developing type 2 diabetes.⁵ Regardless of what disordered eating habits a person may have, a diabetes diagnosis and learning to manage this condition, which puts emphasis on the body, can put an increased focus on behaviors and, therefore, make a person more likely to engage in them.

The Complex Relationship Between Disordered Eating Behaviors and Diabetes

You may be wondering: “Can diabetes cause an ED?”

Diabetes can cause complicated feelings around how a person feels about their body, eating habits, and how they manage their condition. There are several ways this complex relationship can trigger disordered eating habits and contribute to a full-blown eating disorder.

Perfectionism and Fear

When a person is living with diabetes, there is often an increased focus on what and how much they eat, their relationship with movement, and their body shape and size.⁶ Healthcare providers may take a fear-based approach to try and ensure a person cares for themselves — however, this can have a negative impact as that person tries to navigate their diagnosis.

A person may also struggle with feelings about their body shape and size and begin to try to manipulate their medication or insulin dosages to lose weight. Or, they may become tired of trying to manage their condition and stop taking steps to manage it as closely.⁷

People with type 1 diabetes may feel if they haven’t “perfectly” controlled their blood sugar, then they’ve failed. However, a variety of factors — including stress and illness — can cause levels to fluctuate. This means that even if a person took their insulin as prescribed, it can still be out of range. However, they may blame themselves, what they ate, or their habits and feel guilt, shame, and disappointment.

These can all trigger disordered habits as a person aims to be “perfect” — whether it’s by only eating foods they deem morally “good” or trying to lower their insulin consumption to manipulate their body shape and size.

Weight Changes Before and After Diagnosis

It’s not uncommon for people with type 1 diabetes to lose weight before they are diagnosed with their condition.⁸ As they begin to manage their insulin levels and care for their bodies, they may restore or gain weight. These changes can cause feelings of shame and body dissatisfaction, which may trigger disordered behaviors.

Fluctuating Blood Sugar Levels

Low blood glucose levels can cause feelings of extreme hunger, which may induce binges. High blood glucose levels can numb emotions and reduce anxiety.

Some individuals may try to trigger this feeling on their own. This can trigger the abstinence violation-effect, which in regard to a disordered eating behavior is when people who have a rigid rule and then break it react by overeating.⁹ This can create a cycle of creating rules, breaking them with binges, and starting the cycle over again.

Body Distrust

Those with diabetes may feel that they cannot trust their hunger levels, satiety, or their body cues, which can trigger diabetes distress and behaviors as they attempt to “perfectly” manage the condition.¹º

Risk Factors for Eating Disorders and Diabetes

Individuals with diabetes and eating disorders may experience a combination of feelings of guilt, shame, and remorse, which can be extremely challenging.

Eating disorders are almost never caused by one single thing but rather are often developed from a combination of psychological, social, and economic factors. Eating disorders and diabetes may cause a person to have a complicated relationship with food, their body, and their diabetes management.

There’s no such thing as “perfect” — in managing diabetes or existing as a human. However, those pushing for or pursuing perfectionism in diabetes care management may be at increased risk for eating disorders.

As shared by the National Eating Disorders Association, there are a wide range of factors that may put an individual with diabetes at increased risk of developing an eating disorder, including:¹²

Diabetes and Eating Disorders Psychological Risk Factors

• Anxiety
• Depression
• Diabetes burnout
• Diabetes distress
• Heightened emphasis on disordered eating characteristics, including body dissatisfaction, control, perfectionism, a drive for thinness, rigidity, and more
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Weight gain related to diagnosis or a change in medication and/or a higher weight 
• And more

Diabetes Social and Economic Risk Factors

• Becoming independently responsible for diabetes management; pediatric to adult care transition
• Culture of shame in how someone should or shouldn’t manage their diabetes (emphasis on perfectionism) — often toward those with mental health disorders
• Language and content surrounding diabetes education
• Lectures based in fear on possible future diabetes complications
• Negative and/or dismissive comments from care providers surrounding diabetes and co-occurring disordered eating behaviors or eating disorders
• People who try to control or micromanage someone’s diabetes care
• And more

How to Identify Disordered Eating in Diabetes

With a constant emphasis on food and health, disordered eating behaviors in diabetes is a slippery slope. However, there are warning signs and “red flags” to look out for, indicating that one may be struggling.

Some diabulimia symptoms and symptoms of disordered eating in those with diabetes, as shared by the National Eating Disorders Foundation, include:¹³

Behavioral and Emotional Indicators

• An obsession with calories, food, and weight
• Avoiding appointments related to diabetes
• Body image concerns
• Fear surrounding blood sugar levels or that insulation causes weight gain
• Food rules, especially when they cut out entire groups and create restriction
• Infrequently managing or avoiding medication
• Restriction to intentionally lower insulin dosages
• Significant increases or decreases in diet
• Upset surrounding having diabetes
• And more

Physical Indicators

• A1C continually above 9.0, below 6.0, or inconsistent with meter readings
• Dry hair and skin
• Fluctuating, inconsistent blood glucose levels
• Frequent nausea or vomiting
• Frequent bladder, skin, and/or yeast infections
• Low potassium and/or sodium levels
• More than one diabetic ketoacidosis (DKA) or near-DKA episode
• Unexplained weight gain or loss
• And more

Any of these signs or a combination of them can be strong indicators that a person needs guidance and extra care in managing their condition.

Support Your Health with Holistic Diabetes and Nutritional Care

Diabetes can be an overwhelming condition to manage — and even more so when it’s linked with disordered eating thoughts and behaviors — but you don’t have to do it alone. There is zero shame in seeking extra support. 

If you believe you 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. We will support you on your journey to a more positive relationship with health, condition management, and food!

Sources

1. National Institute of Diabetes and Digestive and Kidney Diseases. 2021. “Eating Disorders and the Patient with Diabetes.” National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/eating-disorders-and-the-patient-with-diabetes .
2. Diabulimiahelpline.org. n.d. “Eating Disorders and Diabetes.” National Eating Disorders Association. Accessed July 21, 2024. https://www.nationaleatingdisorders.org/eating-disorders-and-diabetes/.
3. Cleveland Clinic. 2022. “Diabulimia: What It Is, Symptoms, Risk Factors & Treatment.” Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22658-diabulimia.
4. National Institute of Diabetes and Digestive and Kidney Diseases. “Eating Disorders.”
5. Diabetes Care. 2023. “Can Eating Disorders Cause Diabetes?” Diabetes Care Community. https://www.diabetescarecommunity.ca/living-well-with-diabetes-articles/mental-health-articles/can-eating-disorders-cause-diabetes/.
6. American Diabetes Association. n.d. “Newly Diagnosed with Diabetes.” American Diabetes Association. Accessed July 21, 2024. https://diabetes.org/living-with-diabetes/newly-diagnosed.
7. Ibid.
8. Berkley, Cherie. 2022. “How Is Rapid Weight Loss Related to Diabetes?” Verywell Health. https://www.verywellhealth.com/rapid-weight-loss-5101064.
9. Neighbors, Clayton, Kristen P. Lindgren, Lindsey Rodriguez, Judy Tidwell, and Ivori Zvorsky. 2013. “Chapter 27 – Cognitive Factors in Addictive Processes.” Principles of Addiction: Comprehensive Addictive Behaviors and Disorders 1 (February): 259-269.
10. American Diabetes Association. n.d. “ADA Mental Health Workbook: Chapter 3: Diabetes Distress.” American Diabetes Association. Accessed July 21, 2024. https://professional.diabetes.org/sites/default/files/media/ada_mental_health_workbook_chapter_3.pdf.
11. Akers, Erin M. 2020. “More Than a Number.” Florida State University Libraries. https://diginole.lib.fsu.edu/islandora/object/fsu%3A759843/datastream/PDF/view.
12. Diabulimiahelpline.org. “Eating Disorders and Diabetes.”
13. Ibid.