Some years ago, I joined an online "healthy eating forum", expecting support in eating healthy (fresh, whole, medically-appropriate) foods in reasonable amounts -- the same sort of community support one expects from a community in which people are looking to lose or maintain weight. What I found instead was a community of young women in various stages of recovery from eating disorders or disordered eating, or progressing from one type of disordered eating to another.

 

As a person whose diabetes is controlled mainly with diet and exercise, I'm not sure if the borderline obsessiveness I was practicing helped, or hindered, those forum members. What I did learn there was that the level of control needed to properly exercise "medical nutrition therapy" (what doctors and researchers call medical-condition-specific diets) would, in any other circumstance, be considered Disordered Eating. If unchecked and allowed to develop, Disordered Eating can develop into one or more Eating Disorders (ED).

 

Three of the most common types of ED are anorexia nervosa, bulimia, and binge eating disorder (BED). Another type of eating disorder, orthorexia, develops from trying to eat only "the right foods" in "the right proportions", and becoming increasingly restrictive on the foods, preparations, and combinations one is willing to eat.

 

Benno's recent blog post in the dLife Community reminded me of some of the posts in that "healthy eating" forum. The low-treatment he describes in "Glucose Roller Coaster" is similar to the binge-eating behavior of BED. By following that binge by overdosing insulin to treat the associated high blood glucose reading, he reminded me of the "purging" associated with (nondiabetic) bulimia.

 

Based on the comments to that post, Benno is not alone.

 

One of the biggest obstacles in treating people with eating disorders is acknowledging that these disorders exist. Another is finding a mental health professional that understands eating disorders and disordered eating. The third, and hardest obstacle, is getting a clinical diagnosis.

 

Inside the diabetes community, we have known about diabulimia -- for some time. Diabulimia is related to bulimia in the respect that the person practicing this behavior withholds insulin to purge the effects of her caloric intake. dLife has addressed diabulimia in a number of TV episodes, and provides links to a number of Web-based resources. The dLife page on Diabetes and Eating Disorders provides information on both diabulimia and non-diabetes-related eating disorders.

 

What I've not seen addressed in the diabetes and diabetes-care communities is the type of disordered eating that can develop from trying to control one's blood glucose levels (as opposed to trying to control one's weight). While on the surface, some of this looks a lot like mainstream anorexia nervosa and/or orthorexia, the justifications given are completely different, and are (at least in my mind) harder to argue with. Neither have I seen anyone address the sort of "rebound" disordered eating that happens when we tire of what we perceive as overly restrictive dietary regimes, or when we suffer what Dr. William Polanky refers to as "Diabetes Burnout". Just as a number of the young women on the "healthy eating" forum recovered from bulimia only to develop BED, we may become "fed up" with Atkins, low-carb, low-fat, and exchange diets and start bingeing on the theory "I can eat anything as long as I bolus for it" -- or we may start to deliberately overcorrect our lows and highs in a blood-glucose-level binge-purge cycle similar to (nondiabetic) bulimia.

Because I'm not a health professional, or a mental health professional, I can't do much more than point my finger at the issue and cry, "Help us!" We need our diabetes care providers to understand how the intersection of "diabetic" diets, medical nutrition goals, and diabetes-management goals can disorder our eating, and find ways of bringing us back to optimal mental and physical health.

 

(Shameless Plea: If you've seen these issues addressed in the diabetes/mental-health literature, please lead us to the resources we need to get help and to help each other.)

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