Some people with diabetes can develop an unhealthy relationship or fixation on food. This can lead to something called disordered eating behaviour or possibly an eating disorder.
Diabetes and food are closely linked. Having diabetes can mean a bigger focus on diet, weight and body image, so it’s not surprising that some people can start to feel negatively about food. Here we look at eating disorders and diabetes and explore what can be done to overcome this.
Disordered eating isn’t the same as having a diagnosed eating disorder. But the signs and behaviours are similar, like skipping insulin for weight loss, or binge eating and making yourself sick. But one can lead to the other, so it’s really important you get help before things get worse.
These eating problems are more common than you think – you’re not alone in this. And they can happen to anyone, not just because you have diabetes. Here we’ll help you recognise disordered eating behaviour, find out what can cause it and you’ll read how some people have overcome this.
“I’ve realised I’m not the only one who’s been through something like this. Peer support was invaluable to me.”
- Lynsey, who had an eating disorder
How common are eating disorders?
It is estimated that up to 30% of people with type 1 diabetes have an eating disorder. Eating disorders are twice as common in people with type 1 diabetes than people without the condition.
It is estimated that 5 to 9% of people living with type 2 diabetes have binge eating disorder, although there needs to be more research in this area.
How to recognise an eating disorder with diabetes
If you’re worried that you have an eating problem, it’s important to know the warning signs so you can get the right support at the right time. This information is also for family members or friends who are worried someone they know with diabetes is developing an eating disorder.
Here are some of the signs of disordered eating:
- increase in HbA1c or blood sugar levels that are going up and down a lot
- going into diabetic ketoacidosis (DKA) or near DKA episodes
- severely restricting what food you eat
- binge eating (eating a lot of food very often and not feeling in control)
- secrecy about diabetes management
- trying to lose weight by making yourself sick or restricting insulin
- fear of weight gain and concerns about body image
- depression and anxiety
- fear of hypos
- diabetes distress
- feelings of guilt, shame and judgement about eating habits, blood glucose levels and weight or body shape
- denial of the seriousness of symptoms and conditions
- exercising a lot without eating enough to balance it out.
Over time, disordered eating behaviours like this can lead to eating disorders, like anorexia, bulimia or binge eating disorder.
We’ve put together some questions to help you think about your relationship with eating. If you’re answering yes to some of these, it’s important that you talk to someone.
- Do you make yourself sick because you feel uncomfortably full or do you feel guilty or ashamed about what you’ve eaten?
- Do you worry you’ve lost control over how much you eat?
- Have you lost quite a lot of weight in the last few months?
- Do you think you’re fat when others say you’re too thin?
- If you take insulin to treat your diabetes, do you ever take less insulin than you should?
Lots of people with diabetes have overcome these feelings and changed their eating behaviours. We've put together some next steps for you to think about, to get the support you need to overcome this.
Eating disorders and type 1 diabetes
Type 1 diabetes with disordered eating (T1DE), also known as diabulimia, is when you reduce or stop taking insulin to lose weight. This can happen alongside other behaviours such as restricting the food you’re eating, over-exercising, binging, making yourself sick and using laxatives to try to control weight. Some people don't reduce or stop their insulin but instead control their weight and shape through food restriction or over-exercise, which indirectly limits the amount of insulin required. This is really dangerous, and can cause serious damage now and in the future too.
Lynsey had diabulimia and is now recovered. In her video she talks about how diabulimia affected her and how she overcame her eating disorder.
"I’m constantly still thinking about my weight but I don’t miss my insulin any more. I consider myself recovered from diabulimia.”
Binge eating is when you eat a lot of food in a short space of time. Some people make themselves sick afterwards, but not everyone. This is a serious eating problem and you need to be aware of the damage it can cause to your body.
This behaviour doesn’t always develop into an eating disorder, but if it does it’s a very serious mental health condition.
It’s really important you talk to your healthcare team if you’re binge eating. They can help you start to look at food differently and change how you feel about it.
“Really having to look at my relationship with food and break down where so much of the negativity around it all has come from, so I can start breaking the cycle. It's a frustratingly slow process as it's been decades in the making, but with my family’s help, the psychologist I'm seeing, and studying ‘intuitive eating’, I can see that I'm making progress.”
- Lucinda has been battling with binge eating disorder
Anyone can develop eating problems. They don’t just affect people with diabetes.
How they start is complicated and can vary for different people. Some people can feel depressed and binge eat for comfort, or some can get fixated with food because of certain pressures around them.
You might feel:
- unhappy with your body
- your life is out of control
- diabetes is taking over too much of your life
- depressed or anxious
- pressured or controlled by others focusing on food
- fixated on blood sugar levels being perfect.
“My family will say things like, ‘You shouldn’t eat that!’. They have no idea how hurtful that is to me. I know they’re just trying to help, but I wish they wouldn’t. It just makes me feel so inferior, so bad about myself.”
- Julia, 45
These feelings and behaviours won’t always develop into an eating disorder. So understanding what might be causing these negative emotions can be the first step in overcoming them. Take a look at our information on feelings and food when you have diabetes.
How eating disorders can affect your body
Eating problems can seriously damage your body. This can affect you right now and in the future too.
Eating too much will make your blood sugar levels go too high. This is known as hyperglycaemia – hypers can make you feel really tired and cause headaches.
Restricting insulin will also make your blood sugar levels go too high. And this can quickly lead to a serious and life-threating complication called diabetic ketoacidosis, or DKA for short. You need emergency treatment for DKA.
Restricting insulin not only affects your blood sugars, it can also make you lose weight. But losing too much weight can make your bones and muscles weaker, which will affect how well you can get around.
If you’re making yourself sick to try and avoid putting on weight, you’re affecting your mouth health too. There’s a lot of acid in vomit and this can damage your teeth and gums.
If you have high blood sugar levels over a long period of time, it can seriously damage your blood vessels. Which can lead to complications in places like your feet, eyes and heart.
This might all sound scary or you might think these complications won’t happen to you, but knowing what’s at stake could help you prevent more problems.
"I’m just desperate that it doesn’t happen to loads of other people. I’ve lost some of my eye sight, it’s just not worth it."
This isn’t going to be easy. Eating problems are serious and complicated. But reading this information and finding out more about eating problems is a good first step to overcoming them. We can help you take the next one.
You can find out about services available in your local area, using the HelpFinder on the Beat Eating Disorders (Beat) website.
If you are a young person between the ages of 16-25 with an eating disorder you can self-refer to FREED to get rapid access to specialist NHS treatment across England.
FREED is aimed at targeting young people who have been living with an eating disorder for fewer than three years. Early treatment has shown to achieve results and help stop problems escalating.
You can self-refer through the website and you will be contacted within 48 hours. Treatment can begin as soon as two weeks later.
You may also find helpful information on The T1DE Podcast.
Talk to other people with diabetes
And if you’re a friend or family member of someone with diabetes and worried they’re developing an eating problem, show them this information and suggest they read our stories from Lynsey and Lucinda. It might help them realise they’re not alone.
Talk to your diabetes healthcare team
Whether you’ve been diagnosed with an eating disorder or you think you might have one, you can get specialist help from a healthcare professional. This could be your GP, a dietitian or your diabetes specialist nurse.
Your diabetes team is there to help you with all aspects of your diabetes, including how you feel about it. Share your feelings with them. They won’t judge you and together you can make a plan to manage your disordered eating.
They might refer you to a psychologist too. Who will give you really specialist advice and support, and talk you through different treatment options like talking therapies or medication.
Beat have information on how to talk to your GP about getting referred.
Write a food and feelings diary
Keeping a food and feelings diary can be helpful for understanding some of your eating patterns and emotions linked with food.
You can download My Food and Mood Diary (PDF, 36KB).
This is a great way to track what food you’ve eaten and the effect it could be having on your mood and your diabetes.
Think about bringing the diary to your next consultation (for instance, with a psychologist). They won’t judge you for anything you write down and it will really help them understand how you’re feeling. Try to be as honest as possible – the diary is there to help you.