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Type 1 Diabetes with an Eating Disorder

What is T1DE (Type 1 Diabetes with an Eating Disorder)?

Having type 1 diabetes can involve biological and psychological implications which may lead to you having a higher risk of developing an eating disorder.

Some reasons for this increased risk of developing an eating disorder may include, for example:

Some people use the term ‘T1DE’ (which stands for type 1 diabetes with an eating disorder) or ‘diabulimia’ to refer to the experience of having disordered eating while they are living with this long term health condition. While ‘T1DE’ is not currently listed as a formal medical diagnosis, some people find this term helpful.

Insulin Restriction and other Medical Risks

Some people living with type 1 diabetes with an eating disorder may be at risk of restricting their insulin to attempt to control their calorie intake and weight. For someone with type 1 diabetes, this can be dangerous. Other medical risk factors include the management of hypoglycaemia (or low blood sugar level), starvation, and other purging behaviours such as vomiting, laxative misuse and exercise.

What is hypoglycaemia?

Hypoglycaemia is the term for when the level of sugar in your blood drops too low.

Some symptoms of low blood sugar which you may experience might include feeling disorientated or shaky, difficulty thinking clearly, feeling hungry or tired, sweating, looking pale, a fast pulse or heart palpitations or having a headache. This can be dangerous and, if it is not treated, severe low blood sugar can lead to loss of consciousness or death.

You can find out more information about this on the NHS website [1].

What are the psychosocial risks involved?

Having type 1 diabetes with an eating disorder can lead to disruption in many areas of your life, including work, education and social interactions. You may experience social withdrawal or conflict in relationships with family or friends.

Feelings of low self-worth and shame around your eating disorder are also common, and you may worry that health care professionals might judge you. Even so, it’s important to seek help if you experience any symptoms of T1DE, because the sooner you can receive treatment for your eating disorder, the greater the chances of recovery.

What are the psychological risks involved?

It can be common for people with T1DE may also experience other conditions such as depression, anxiety and diabetes stress. Research has also shown that some people with type 1 diabetes may respond less positively to conventional eating disorder treatment [2].

Treatment adapted for people with eating disorders living type 1 diabetes is still in the early stages of development. However, it has been agreed that people who deliver treatment for T1DE should ideally have knowledge and understanding in treating both eating disorders and type 1 diabetes.

What should healthcare professionals be aware of?

It’s important that health care professionals know about these risk factors when working with people with type 1 diabetes. Knowing how to spot the signs of an eating disorder, and address these risk factors in people with type 1 diabetes can help to prevent eating disorders and intervene early. You should also use sensitive language in consultations for diabetes, particularly when communicating messages around weighing and glucose management.

References

[1] NHS Online. ‘Low Blood Sugar – Hypoglycaemia’. Available from: https://www.nhs.uk/conditions/low-blood-sugar-hypoglycaemia/ (Accessed 16.12.2021)

[2] Custal N., Arcelus J., Aguera Z., Bove FI., Wales J., Granero R., et al. Treatment outcome of patients with comorbid type 1 diabetes and eating disorders. BMC Psychiatry. 2014; 14:140. Available from: doi:10.1186/1471-244X-14-140.

[3]Alicia S., Bennett M., Brewster S., Cross C., Figueiredo C., Hampton K., Nicholson E., Partridge H., Pinder C., Rouse L., Stacey N., Thompson A., ‘A Guide to Risk Assessment for Type 1 Diabetes and Disordered Eating (T1DE); medical, psychiatric, psychological and psychosocial considerations’ Wessex ComPASSIONTteam (2021) [Unpublished]..