At some time during our diabetic self-discovery, we are told that diabetes -- like most chronic illnesses -- is often accompanied by a second "D": depression. Considering the amount of time we need to put into consideration of our diets, exercise, drugs, and doctor visits -- and how much that takes out of what would otherwise be disposable income -- it's hardly surprising. Nor should it come to anyone's surprise that this level of attention to detail often smacks of another mental-health issue: obsessive-compulsive disorder, or OCD. It is considered "normal" -- even encouraged -- for people with diabetes to arrange our lives around our blood glucose levels, logging every single reading, every single milligram of metformin or subunit of insulin, weighing and logging every single morsel of food or fluid that passes our lips, every step of exercise, every moment of every day of our lives. The result of "eating to our insulin" (or to our blood glucose levels) disconnects us from normal feelings of hunger and satiety; the number of foods which we are often denied (or our consumption drastically limited) encourages cravings
and what many of us would call "binges".
As a result, diabetic eating is disordered eating.
Today is the last day of National Eating Disorders Awareness Week, and one of the first times I've seen people in the diabetes blogosphere address diabetes-related eating disorders directly. That we make the world in general, and both our diabetes-related medical personnel and general mental-health personnel in particular, aware of diabetes-related eating disorders is essential in our quest for healthy living. Please check out Nici's post, Disordered?, on A sweet journey to motherhood, Kelly of Diabetesaliciousness's Diabetes Food Quirks, and Lee Ann's Peace of Cake over at The Butter Compartment. You can also take the dLife Quiz, Could You Have an Eating Disorder? and check out past posts on the subject here at Blogabetes and over in the dLife Community.
While the most-often discussed diabetes-related eating disorder is diabulimia (also known as "insulin omission" or "insulin manipulation"), it's hardly the only one. Diabulimia's relation to non-diabetes-related bulimia (also called "bingeing and purging") is that by taking a smaller dose of insulin than one's body requires, the body cannot make use of the ingested calories (which it has, as always, converted to sugars and amino acids) and dumps them out in the urine. The physical dangers of diabulimia include excessively-high blood glucose levels, complications of diabetes, diabetic ketoacidosis (DKA), and potentially death. A lot of downsides to something people may think of as a weight loss solution, eh?
On the flip side, those of us who have been taught not to eat until our numbers come into range, and either cannot force it with insulin or need to ration limited amounts of insulin, may develop diabetes-related anorexia nervosa. "Anorexia" technically means "loss of appetite", but in eating-disorder-speak, it means deliberately withholding food -- choosing to not eat enough calories for the body to function normally. One of the big difficulties in diagnosing diabetes-related anorexia nervosa is that those amongst us with those eating behaviors are generally not underweight -- we may, in fact, be overweight or obese, particularly if we are living with type 2. [Note that this shortcoming is common in diagnosing all causes of anorexia nervosa.]
There is a third, perhaps more controversial issue with diabetes and disordered eating. In "Peace of Cake", Lee Ann suggests that people with (non-diabetes-related) binge eating disorder may be more prone to developing diabetes because the sheer amount of calories a binge-eater consumes suggests a predilection towards obesity, triggering any preexisting genetic propensity towards type 2 diabetes. On the undernutrition side, I have at times suspected that even over the short term, unsupervised very-low-calorie (aka "starvation") diets may lead to the same types of systemic damage anorexics face -- at lower intensity, but still enough to trigger a propensity towards any type of diabetes.
Disordered eating, eating disorders, and diabetes have a strongly interconnected relationship -- one which our diabetes-health and mental-health professionals have, largely, not addressed. Accepting this relationship, and finding ways to help all of us deal with it, is an important public-health step in the prevention and management of diabetes and eating disorders, both individually and in combination.
