Type One Diabetes and Eating Disorders in Children and Adolescents

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Eating disorders can affect anyone, regardless of their gender, age, background, or medical history. But young people with type one diabetes (T1D) are even more likely than other children or adolescents to develop the disorder.

Young people with T1D may also try to use different methods to change their shape or weight than other adolescents, such as restricting their insulin intake.

Eating disorders among young people with T1D are a serious, widespread, and sometimes life-threatening problem. It’s crucial that disordered eating behaviours are identified quickly, so young people can access the effective support they deserve.

While recovery isn’t always an easy journey, evidence shows that professional treatment methods can help teenagers and adolescents with T1D  overcome eating disorders and reclaim healthy lives.

This blog offers information on the causes of eating disorders among young people with T1D and the symptoms of the condition. It also explores the preventative interventions and treatment options available for young people globally.

Understanding Type 1 Diabetes

Type 1 diabetes usually develops during childhood or adolescence, although it can be diagnosed at any age. It’s a chronic disease that affects the body’s ability to produce insulin, a hormone that controls blood sugar (glucose).

This means that, without treatment, blood sugar levels can become too high, damaging the body and leading to potentially life-threatening health conditions.

Young people with type 1 diabetes can manage the condition by regularly taking insulin and following a balanced diet. Children, adolescents, and their families also need to be aware of the signs of high or low blood sugar so they can quickly intervene when it’s needed.

Many young people with T1D also face challenges with their mental health. They may experience anxiety, depression, eating disorders, and other psychological disorders. These conditions can make managing T1D more complicated.

How Common Are Eating Disorders in Young People with Type 1 Diabetes?

Almost all research shows that adolescents with T1D are more likely to develop eating disorders or disordered eating behaviours than other young people. One study found that eating disorders were around twice as common in female adolescents with T1D than in those without.

Another analysis that grouped several studies found that on average, 7% of adolescents with T1D met the criteria for an eating disorder, compared with 2.8% among those without T1D. Some experts suggest that up to 30% of people with T1D may have an eating disorder.

Without treatment and support, eating disorders usually continue from adolescence into adulthood. This means that accessing effective treatment and intervening early is crucial for young people’s health and futures.

What Causes Eating Disorders in Children and Adolescents with T1D?

While there is no single cause for eating disorders, there are several risk factors that make the development of eating problems more likely. These include experiences of trauma, exposure to beauty ideals in the media, low self-esteem, and family approaches to body weight and shape.

Among young people with T1D, there are some specific factors that may make them especially vulnerable to eating problems. These include:

Being Aware of and Monitoring the Carbohydrate Content of Food

Carefully monitoring the carbohydrate content of food is an important part of managing type 1 diabetes. But having to spend so much time thinking about food, diet, and nutritional content may put young people at a greater risk of developing disordered eating habits. Young people may also experience a focus on their weight when they visit a clinic.

Consequently, adolescents may start to value themselves on the food they eat, how ‘healthy’ they are, or their body shape and weight, thinking patterns that can underpin eating disorders.

Research shows that some pre-teen and teenage girls restrict their carbohydrate intake more than they need to because of concerns about food. Young people may also crave foods that are ‘forbidden’, sometimes leading to binge and purge cycles. 

Changes in Weight with T1D Treatment

When young people start treatment for type 1 diabetes, it’s normal for them to experience changes in their weight. Children and adolescents are often losing weight before they start taking insulin because their body is unable to properly absorb energy from the food they eat. When treatment begins, they often gain this weight back as their body begins to function normally again.

Some young people may struggle with gaining weight and experience body dissatisfaction or body image concerns, especially if they are vulnerable to eating disorder pathology.

These feelings may cause them to engage in disordered eating behaviours to try and change their shape or weight. Cultural and social norms about body image often present certain ideas of an ‘ideal’ body that can drive these behaviours.

Treating Hypoglycemia (Low Blood Sugar)

When young people with T1D experience episodes of hypoglycemia, they need to eat or drink sugar or carbohydrates to raise their blood sugar levels. Sometimes, this may cause weight gain or feelings of guilt that can lead to disordered eating.

Family Environment and Support

Research shows that a young person’s home environment and their parent’s attitudes towards food can increase (or decrease) the risk of eating disorders.

One study found that adolescents with T1D were more likely to show disordered eating behaviours if there was family conflict around diabetes, more food restrictions in the household, and less parental modelling of healthy eating. Parents’ concerns about their body shape and weight can also make young people place more value on their own bodies. 

Weight Loss and Insulin Omissions

Some young people with diabetes and an eating disorder restrict their diet or excessively exercise to try and lose weight. Some may also skip insulin doses, as well or instead of other behaviours.

Missing insulin doses is very dangerous for people with T1D. Regularly taking less insulin than required can cause long-term damage to the body, including loss of eyesight, kidney damage, and nerve damage.

Insulin omissions can also cause diabetic ketoacidosis, a life-threatening condition caused by high blood sugar. Diabetic ketoacidosis is a medical emergency that requires immediate care.

What Is Diabulima?

Diabulimia is a word used to describe eating disorders among people with type one diabetes when they restrict or stop taking insulin to lose weight. Some people may skip insulin doses, while others may restrict insulin indirectly, by reducing carbohydrates or over-exercising. 

Diabulimia is not a medical term but some doctors and other people may use it. Healthcare professionals now usually refer to diabulmia as T1DE.

Recognising the Signs of Diabulimia

Many people haven’t heard about diabulimia and may not recognise the signs of the disorder. Adolescents with T1D may also find it difficult to ask for help or feel ashamed about their thoughts, feelings, and behaviours.

However, seeking help for diabulimia is really important. Diabulimia can be life-threatening and requires immediate professional support. It’s usually very hard for a young person to recover from eating disorders by themselves, but with effective treatment, they can reverse the harmful cycles of diabulimia and recover physically and mentally.

Some signs of eating disorders among people with T1D include:

  • frequent hypoglycemic episodes, that may result from binge-purge cycles
  • difficulties maintaining healthy blood sugar levels
  • systematic calculations of the calorie content of foods
  • weighing foods
  • missing medical check-ups or refusing to be weighed
  • over-evaluation of body shape, weight, or appearance

Treating and Preventing Eating Disorders in Young People with Type One Diabetes

Recognising that a young person has an eating disorder can feel scary, but with the right support, recovery is possible for anyone. There are now several evidence-based treatment approaches available that are proven to effectively treat eating disorders, including cognitive-behavioural therapy (CBT-E), family-based therapy, and interpersonal therapy.

Many young people benefit from trauma therapy alongside or integrated into eating disorder treatments, as well as those that address co-occurring disorders like anxiety or depression.

Individual and group therapy sessions should address the underlying causes of eating disorders, such as perfectionism, low self-esteem, or interpersonal difficulties.

Family therapy sessions can help parents and family members create a home environment with positive attitudes towards food and role-model helpful behaviours. Some diabetes technologies like insulin pumps may also help to reduce disordered eating behaviours.

Given that young people with T1D are particularly vulnerable to developing eating disorders, early interventions and preventative strategies are important.

This might involve addressing issues of low self-esteem or body dissatisfaction among children and adolescents with T1D, supporting young people to increase their self-confidence and embrace body positivity. Educating families on healthy diabetes management strategies may also help to protect against the development of eating disorders.

The Wave Clinic: Setting the Global Standard for Private Youth Mental Healthcare

The Wave Clinic offers specialist recovery programs for young people, supporting them to plan and build fulfilling futures. Our whole-person approach emphasises skill development, self-confidence, and personal growth as teenagers and young adults discover new life paths and develop their sense of self. 

Our clinical programs offer the highest quality medical and psychological healthcare, drawing on expertise from around the world. We understand that young people require treatment tailored to their developmental age, rooted in scientific evidence, practice, and experience.

If you’d like to find out more about our programs, don’t hesitate to reach out to us today. We’ll find the best path for your family.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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