Diabetes Self-Management Articles

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Eating Disorder

It is estimated that 2% to 5% of Americans have binge-eating disorder in any given six-month period. Binge-eating disorder is characterized by episodes of uncontrollable over-eating, with no purging behavior. People with binge-eating disorder tend to eat much more rapidly than normal, eat until they feel uncomfortably full, or eat large amounts of food when they’re not feeling hungry. Often they feel shame or guilt about their binges. In people with diabetes, binge eating can be triggered by episodes of hypoglycemia (low blood glucose). Even small binges in people with diabetes can disrupt blood glucose control and lead to negative feelings. People with binge-eating disorder are generally treated with SSRIs and psychotherapy, particularly a type of psychotherapy called cognitive-behavioral therapy.

Some eating disorders are unique to people with diabetes. People with Type 1 diabetes sometimes skip insulin injections or reduce the size of a dose to lose weight or to prevent weight gain. This is sometimes called “diabulimia.” Without sufficient insulin, glucose cannot get into the body’s tissues to be stored as fat. Instead, it builds up in the bloodstream, raising blood glucose levels, and then gets excreted in the urine. According to various studies, between 5% and 39% of young women with diabetes omit or decrease insulin doses for weight loss. This is an extremely dangerous practice, as it can lead to diabetic ketoacidosis (DKA), a serious and life-threatening condition. Frequent periods of high blood glucose also increase the risk of developing diabetes-related complications, sometimes very early in life.

Night-eating syndrome is characterized by heavy snacking (consuming at least one-quarter of the day’s food intake) after the evening meal and/or frequently waking up at night to eat. People with night-eating syndrome also tend to eat foods rich in carbohydrate and fat. Often they wind up eating at night in response to emotional triggers such as anger, sadness, loneliness, or worry. A study published recently in the journal Diabetes Care showed that people with either Type 1 or Type 2 diabetes who have night-eating syndrome tend to be more obese, have higher HbA1c levels (a measure of blood glucose control), and have more diabetes complications than those without night-eating syndrome.

Treatment for night-eating syndrome involves treating underlying mood disorders such as anxiety or depression through psychotherapy and/or medicines such as SSRIs. Psychotherapy involves helping a person find other ways of coping with negative emotions and may include relaxation therapy or cognitive-behavioral therapy.

If you or someone close to you has signs of an eating disorder, discuss your concerns with your health-care team. Eating disorders are serious but treatable medical conditions.

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