Eating disorder, type 1 diabetes a dangerous mix

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Despite the importance of nutrition in managing type 1 diabetes, eating disorders and unhealthy weight-control tactics are not uncommon in young women with the disease—and the combination can lead to serious complications, a new study shows.

UK researchers found that among 87 teenage girls and young women with type 1 diabetes who were followed over roughly a decade, 15 percent had a probable eating disorder, such as anorexia or bulimia, at some point during the study.

In addition, more than one-third reported cutting back on their insulin in an effort to keep their weight in check, while others said they had vomited or abused laxatives for weight control.

Instead of fading with age, these problems became more common in young adulthood compared with adolescence, according to findings published in the journal Diabetes Care.

The study included girls and young women ages 11 to 25 who were patients at a UK diabetes clinic in the late 1980s. They were interviewed about their eating habits, attitudes toward food and eating disorder symptoms at the start of the study, then again when they were between the ages of 20 and 38.

Type 1 diabetes is an autoimmune disease in which the immune system mistakenly destroys the pancreatic cells that produce insulin—a hormone that helps usher the sugar from foods out of the blood and into body cells to be used for energy.

People with type 1 diabetes must take daily insulin injections in order to live. They also have to be careful about what and when they eat to avoid dangerous blood sugar lows, while also sticking with their insulin regimens to keep blood sugar levels from soaring. Over time, poor blood sugar control can lead to complications such as kidney failure, nerve damage, vision problems and heart disease.

Despite the importance of healthy habits in type 1 diabetes, some patients are able to disguise the fact that they have an eating disorder, according to Dr. Robert C. Peveler of the University of Southampton, the lead author of the new study.

“Surprisingly, some patients do manage it for a time,” he told Reuters Health. “The deterioration in their health may be quite slow and therefore hard to spot.”

Among women in his team’s study, those with a history of eating disorders were five times more likely than their peers to suffer two or more diabetes complications—such as damage to the eye’s blood vessels, kidney dysfunction or nerve damage in the limbs—over 8 to 12 years of follow-up.

Women who had ever used unhealthy weight-control tactics or misused their insulin faced a similarly elevated risk of complications.

Overall, six women died during the study period, two of whom had bulimia, Peveler and his colleagues found.

Poor blood sugar control likely made a large contribution to the heightened complication risks, Peveler said, but poor nutrition may also have played a direct role. As an example, he noted that non-diabetic women with anorexia can develop diabetes-like nerve damage in the extremities.

It’s unclear, according to Peveler, whether there is something about type 1 diabetes that makes women with the disease vulnerable to eating disorders.

“We still can’t really be sure, but it looks as if there may be a slight increase in risk,” he said.

The fact that insulin injections can promote weight gain may play a role, as well as the stress of managing a chronic disease, according to Peveler. But for now, he noted, that is just speculation.

SOURCE: Diabetes Care, January 2005.

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