Disordered eating common in people with diabetes

People with diabetes need to constantly monitor their diet and weight, which can lead to a difficult relationship with food. And when body image is thrown into the mix, the situation can be more problematic.

A recent article from the ABC highlighted the prevalence of eating disorders in people living with diabetes, who may resort to dangerous tactics to control their weight.

Credentialed diabetes educator and pharmacist Angelica Rostov MPS said that because insulin can cause weight gain, impressionable young patients with type 1 diabetes may skip or reduce their insulin without supervision – a practice dubbed “diabulimia” – or engage in self-induced vomiting to keep slim.

The prevalence of underlying anxiety and depression in people with diabetes can further contribute to disordered eating, Ms Rostov said.

A lack of knowledge

It is common for patients living with diabetes to have a skewed understanding of what healthy eating to manage their condition looks like.

‘Patients will often have their own ideas when it comes to their diet,’ Ms Rostov told Australian Pharmacist.

‘Some might think it’s best to go gluten free, which will not control their diabetes, or others will become a vegetarian, which may lead them to seek sustenance by increasing their carbohydrate intake.’

Ms Rostov said some of her patients seek dietary advice via unauthorised online sources, social media or family and friends that is not catered to their type of diabetes and can therefore impact their condition.

The focus on when, what and how to eat can also influence how patients feel about food, according to the National Diabetes Services Scheme, which can lead to unhealthy fixations and skipped meals.

Pharmacist intervention

Ms Rostov said if a pharmacist suspects a presenting patient may have a comorbid eating disorder with their diabetes, they should initiate a conversation about their care.

‘Pharmacists can inquire whether the patient is seeing a diabetes educator, dietician, endocrinologist or GP, but it’s important not to stigmatise if they appear to be very slim,’ she said.

If they are not managing their diabetes under specialist care, pharmacists could offer to refer them to their GP, or to make an appointment with a diabetes educator or dietician on their behalf.

Ms Rostov said pharmacists can also emphasise the need to take insulin as advised when dispensing the medicine. 

‘We try to explain to our patients that if they have continued high blood sugar levels, they risk seriously damaging their health and organs,’ she said. 

Directing patients to accredited online diabetes resources, such as the Baker Heart and Diabetes Institute, Diabetes Australia, or their state-run diabetes service can also provide them with some guidance for managing their diet.

‘I always say to patients, “If you want to do your own research please visit government-accredited websites”,’ Ms Rostov said. 

‘Baker, for example, has fact sheets, carbohydrate-counting tools and advice from dieticians, and Diabetes Victoria has information about the different types of diabetes, along with prevention tactics, recipes, guidance around eating take away foods and exercise.’

Above all else, however, Ms Rostov said it’s important to tread lightly.

‘If you push these patients, they are unlikely to return or seek the specialist advice they need,’ she added.