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Poorly controlled diabetes and
Eating Disorders
Micki Bennett
Community Eating Disorder Services
Manager
Why this talk?
• 40% of Type 1 admit to abusing insulin to manage
their weight.
• Consequences of doing so are serious and
permanent
• Highest incidence of death in Type 1 diabetes is in
the age group 16-25
• Highest incidence of eating disorder onset is
under 25 – Coincidence?
• 41% people with diabetes estimated to have poor
psychological wellbeing
What about Type 2
• Type 2 is increasing in prevalence
• Happening at a younger age
• Increasingly using Insulin as treatment.
• Weight management is prioritised in Type 2
Consequences
• Addiction – this is how sufferers describe it.
• Ketoacidosis
• Blindness
• Amputations
• Death
Numbers
• Type 1 Diabetes 24.5 per 100,000
• Type 2 Diabetes 400 per 100,000
• At least 40% = 169.8 people potentially at risk
because the behaviour is reported to be addictive
• Eating disorder prevalence is thought to be
around 6.5% of population. It is higher in those
with diabetes
• Of those 169.8 at least 26 will have an eating
disorder
BUT
• The county wide eating disorder service
currently has no insulin dependent diabetics
on its books.
• Where are these people?
• Where is their support?
• Why are they not being referred?
• Every insulin dependent diabetes sufferer is in
contact with a health professional.
• Every insulin dependent diabetes sufferer has
blood tests. HbA1c.
• Blood tests show treatment compliance long
term.
• Any evidence of high blood sugars from these
tests are treated with an increase in
prescribed insulin. So that’s alright then?
BUT
• What if you are not asked whether you take
your insulin regularly?
• What if you are not honest about it because
you have an eating disorder (a serious mental
illness)?
• What if you never see a professional with
experience of eating disorders?
• Why would you not ask for help?
• It’s not just insulin abuse.
Fear
• Abusing insulin is easy – just this once!
• Managing diabetes is hard anyway.
• Weight management is valued socially.
• Weight management is encouraged in
diabetes.
• Admitting you abuse insulin is a bad thing.
• Admitting you would rather be thin.
But what if you do admit it?
• Who knows how to treat this?
• I have no experience of diabetes.
• I know what works in eating disorders.
• We need a team approach.
• We need sensitivity to the risk of this dual
diagnosis.
• We need the courage to ask difficult questions.
• We need to know what to do with the answers.

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Poorly controlled diabetes and eating disorders

  • 1. Poorly controlled diabetes and Eating Disorders Micki Bennett Community Eating Disorder Services Manager
  • 2. Why this talk? • 40% of Type 1 admit to abusing insulin to manage their weight. • Consequences of doing so are serious and permanent • Highest incidence of death in Type 1 diabetes is in the age group 16-25 • Highest incidence of eating disorder onset is under 25 – Coincidence? • 41% people with diabetes estimated to have poor psychological wellbeing
  • 3. What about Type 2 • Type 2 is increasing in prevalence • Happening at a younger age • Increasingly using Insulin as treatment. • Weight management is prioritised in Type 2
  • 4. Consequences • Addiction – this is how sufferers describe it. • Ketoacidosis • Blindness • Amputations • Death
  • 5. Numbers • Type 1 Diabetes 24.5 per 100,000 • Type 2 Diabetes 400 per 100,000 • At least 40% = 169.8 people potentially at risk because the behaviour is reported to be addictive • Eating disorder prevalence is thought to be around 6.5% of population. It is higher in those with diabetes • Of those 169.8 at least 26 will have an eating disorder
  • 6. BUT • The county wide eating disorder service currently has no insulin dependent diabetics on its books. • Where are these people? • Where is their support? • Why are they not being referred?
  • 7. • Every insulin dependent diabetes sufferer is in contact with a health professional. • Every insulin dependent diabetes sufferer has blood tests. HbA1c. • Blood tests show treatment compliance long term. • Any evidence of high blood sugars from these tests are treated with an increase in prescribed insulin. So that’s alright then?
  • 8. BUT • What if you are not asked whether you take your insulin regularly? • What if you are not honest about it because you have an eating disorder (a serious mental illness)? • What if you never see a professional with experience of eating disorders? • Why would you not ask for help? • It’s not just insulin abuse.
  • 9. Fear • Abusing insulin is easy – just this once! • Managing diabetes is hard anyway. • Weight management is valued socially. • Weight management is encouraged in diabetes. • Admitting you abuse insulin is a bad thing. • Admitting you would rather be thin.
  • 10. But what if you do admit it? • Who knows how to treat this? • I have no experience of diabetes. • I know what works in eating disorders. • We need a team approach. • We need sensitivity to the risk of this dual diagnosis. • We need the courage to ask difficult questions. • We need to know what to do with the answers.

Editor's Notes

  1. Parents I have spoken to report that their adolescent kids were never asked about their insulin compliance. Why would you lie? There is no reason why someone with diabetes would not engage in food restriction or vomiting to manage their weight. There is encouragement to restrict carbohydrates.
  2. Once you have tried it and found that you can binge on foods which normally should be limited