Eating disorders (ED) such as anorexia nervosa, bulimia nervosa,and binge eating disorder are characterized by persistent and abnormal eating patterns that pose a serious threat to an individual’s physical and mental health. In addition, eating disorders are directly linked to high rates of medical complications. Eating disorder treatment centers address both physical, physiological and psychological problems by providing medical treatment and a variety of psychotherapies designed to help teens with eating disorder manage depression, anxiety and obsessive-compulsive behaviors.
Eating Disorder Patients with Type 1 Diabetes
Adolescents with type 1 diabetes mellitus (T1DM or juvenile diabetes) present unique difficulties for doctors and eating disorder therapists. For example, taking insulin often leads to weight gain, which can exacerbate eating disorder behaviors such as food restriction, binging or purging. If the individual who is predisposed to developing an eating disorder takes insulin for Type 1 diabetes, they may adopt full-blown eating disorder behaviors in response to the stress of managing a chronic disease, associated depression and dissatisfaction with body appearance.
In addition, the comorbidity of teens with Type 1 diabetes and an eating disorder correlates with poor glycemic control and increased risk of diabetic complications. It is essential that parents learn how to recognize signs of an eating disorder in T1DM teens as early as possible to get them the treatment they need at an eating disorder recovery center.
What Is Type 1 Diabetes?
While type 1 diabetes mellitus more frequently affects children and adolescents, it can be diagnosed in adults. Characterized by the inability of the pancreas to produce insulin, T1DM destroys cells called “islet” cells responsible for insulin creation. Insulin is necessary for allowing blood glucose (sugar) to enter and be utilized by all cells. Since insulin reduces the amount of sugar in your bloodstream, the pancreas responds by lowering insulin release.
For cells to use glucose for energy, insulin production needs to be stable and responsive to changes in the bloodstream. Storage of glucose (as glycogen) is the responsibility of the liver. When someone hasn’t eaten for a while (anywhere between six and ten hours), the liver starts breaking down and converting glycogen into glucose.
Teens with T1DM do not have enough insulin to allow glucose into body cells. This means sugar accumulates in the bloodstream and significantly increases their risk of suffering numerous serious health problems.
What Is the Difference Between Type 1 and Type 2 Diabetes?
The difference between Type 1 and Type 2 diabetes involves the body’s ability to produce little insulin or no insulin. People with Type 1 produce no insulin and need to take daily insulin injections. Individuals diagnosed with Type 2 make a little insulin, but not enough to maintain glucose levels. Sometimes all that is required to regulate Type 2 is adopting a Type 2 diabetes meal plan along with taking glucose tablets when necessary. However, both types of diabetes require a strict nutritional plan comprised of foods containing complex carbohydrates, fiber, and protein.
Symptoms of T1DM
- Extreme thirst
- Urinating more than usual
- Increased appetite
- Overwhelming fatigue/sleepiness
- Inexplicable weight loss
- Wounds that take a long time to heal
- Itchy, dry, scaly skin
- Periodic nausea and occasional vomiting
- Tingling in extremities, especially the feet
- Blurry vision
- Amenorrhea in teenage girls
Children with type 1 diabetes mellitus may present symptoms that teenagers and adults do not, such as crankiness, whining and throwing unusual tantrums. Parents should also be aware that the first symptom of Type 1 diabetes in younger children might be sudden incidences of bedwetting when there had previously been no problems with bedwetting. In diabetic girls, excess blood glucose creates an optimal environment for the Candida bacteria responsible for yeast infections.
How is Type 1 Diabetes Mellitus Diagnosed and Treated in Teenagers?
If your family physician suspects your teen’s symptoms indicate T1DM, they will order a fasting glucose blood test be performed, which measures blood glucose after a person has not eaten anything for at least eight hours. Other tests your doctor may want to be done include hemoglobin A1c test which reveals the average glucose level over a period of two to three months. Normal glucose levels for children from six to 12 are between 90 and 180 mg/dl. Adolescents who are 12 to 17 years old should have levels between 90 and 130 mg/dl.
Treatment with insulin injections or tablets typically stabilizes glucose levels in teens with Type 1 diabetes mellitus.
How Are Teens with T1DM Diagnosed with an Eating Disorder?
Unless weight loss is significant and serious medical complications are affecting teens with an eating disorder and T1DM, diagnosing an eating disorder may be difficult simply because teens and adults with eating disorders go to great lengths to hide or deny their ED. Although diagnostic questionnaires are available to help doctors detect an eating disorder, they are not always appropriate for teens with type 1 diabetes mellitus. These standardized questionnaires do not focus on identifying eating disorder behaviors unique to teens with T1DM (insulin omission, for example).
Additionally, self-reporting eating disorder questionnaires sometimes inflate the existence of abnormal eating behaviors in teens with T1DM. Concern about food choices, eating when not hungry and reducing consumption of certain foods are all integral parts of a diabetic care program. They are not necessarily signs of an eating disorder.
Eating disorder treatment centers provide professional doctors, counselors and therapists experienced in accurately recognizing signs and symptoms of eating disorders in teens with T1DM. The best way to have a teen with T1DM diagnosed for a possible eating disorder is to take them to an eating disorder treatment center for evaluation.
The Stress of Dealing with a Chronic Disease Like Type 1 Diabetes
Managing a chronic disease can be stressful and alienating for teenagers. Insulin injections, frequent doctor’s visit, monitoring blood glucose levels and adhering to a strict diet can make some teens feel “different” from their peers. The risk for T1DM teens to develop depression is nearly double than that of teens who do not have a chronic disease. Depression and general anxiety seem to increase the likelihood for diabetic teens to develop an eating disorder. The same study also found that depressed girls with Type 1 diabetes mellitus scored much higher on eating disorder questionnaires (75 percent) than teens diagnosed with just depression (45 percent).
Since insulin treatment often causes weight gain, teens trying to cope with their T1DM may feel even more depressed if they put on noticeable weight. Depression, anxiety and decreased sense of self-esteem can lead to teenagers secretly restricting their insulin (insulin omission) and adopting eating disorder behaviors to lose weight. Managing diabetes also involves following a dietary program that could lead to cravings for sugary, high-carb foods. Teens and adults with T1DM may develop binge eating disorder when they cannot control their craving for “forbidden” food. They may start binging and purging to avoid diabetic complications and weight gain.
Symptoms of anorexia nervosa and bulimia nervosa can also emerge from recurring hypoglycemic (low blood sugar) episodes when teens with T1DM do not comply with dietary restrictions or take their insulin as prescribed. A hypoglycemic episode is characterized by intense hunger and cravings for sweetened drinks and foods. After eating high-fat, sugary foods, teens often feel guilty and will severely restrict food intake or purge. Not eating and purging not only disrupts blood chemistry but often leads to repeated hypoglycemic episodes and continuance of eating disorder behaviors.
Managing type 1 diabetes mellitus also involves counting carbohydrates, which can lead to an obsessive preoccupation with dieting and food. Carb counting and the cycle of losing weight at the onset of diabetes and ensuing weight gain after starting insulin treatment adds to the risk of susceptible teens adopting behaviors of an eating disorder. Dietary modifications should focus on teaching teens to make healthy food choices involving low-calorie alternatives offering high satiety indicators.
Cognitive Behavioral Therapy for Treating Eating Disorders Complicated with Type 1 Diabetes
Cognitive behavioral therapy and other psychotherapies are effective, evidence-based techniques for helping teens and adults understand the biopsychosocial implications of eating disorders. CBT provided by eating disorder recovery therapists can significantly improve a person’s ability to modify and transform negative and/or obsessive thought patterns into productive, positive thought patterns.
In addition, teenage eating disorder treatment addresses body dissatisfaction, personality disorders and low self-esteem with intensive individual and group therapy sessions with peers experiencing similar issues. In many cases, psychiatrists are needed to assist in treatment because they are medical doctors and can help teens deal with depression and eating disorders associated with the physical and psychological complications of type 1 diabetes mellitus.
Psychoeducation may also be helpful for some teens with an eating disorder and T1DM. This therapeutic intervention involves weekly group sessions with other patients at an eating disorder treatment center that involves in-depth, counselor-guided discussions concerning the science behind eating disorders, why they occur and medical complications arising from anorexia nervosa, bulimia nervosa or binge eating disorder. A study found that psychoeducation provided for six weeks to groups of teens with eating disorders and T1DM was associated with reductions in body dissatisfaction, dieting and obsessive thoughts about eating and remaining thin.
Group CBT intervention also improved rates of glycemic control, stress related to T1DM and depression in patients participating in an eating disorder recovery program. Since family dynamics have a strong influence on the development of an eating disorder (with or without a diagnosis of T1DM), family-based treatment (FBT) is a vital component of a teen’s recovery.
Medications for Teens with Type 1 Diabetes and Eating Disorders
Diabetics have to be extremely careful about what medications they take. Certain antidepressant medications may be prescribed for treating depression, anxiety, and obsessive-compulsive behaviors. These medications may include newer SSRIs, or selective serotonin reuptake inhibitors, such as:
While taking medications for EDs, teens should closely monitor their blood glucose and visit their doctor at the first sign of unusual side effects. Psychiatrists working at teenage eating disorders treatment centers can perform and evaluate tests necessary for preventing problems with eating disorder medications.
When to Get Eating Disorder Treatment for Teenagers
Eating disorders and Type 1 diabetes mellitus do not develop rapidly. Instead, parents may start noticing symptoms and behaviors of teens with both conditions as these conditions progress beyond their early stages. Signs of an eating disorder, such as extreme weight loss, avoiding meals, hoarding food, presenting odd food rituals (cooking for others but not eating, moving food around on a plate but never taking a bite) and developing a critical obsession of their appearance could indicate a teen with an eating disorder. Getting assistance from residential eating disorder recovery centers represents the safest, most effective way parents can get immediate help for a teen who they suspect may be have an eating disorder.