Eating Disorders in Type 1 Diabetes
The diagnosis of Type 1 Diabetes mellites (T1DM) in adolescents heralds a major transition, not just for the patient but for the entire family. Due to the stress of living with a chronic disease, these young patients are more prone to psychiatric disorders.
Adolescence is a period of psychological, physiological, and emotional transition. It is a phase that is characterized by a struggle for self-acceptance and peer-acceptance.
If an adolescent is afflicted with a chronic illness such as diabetes, then it creates a very negative impact on the personality of the child. In addition, biological factors, such as increased levels of growth hormone, increased nutrient requirements during puberty and puberty-provoked insulin resistance makes management of diabetes difficult in the very young.
Other factors of resistance in disease management include embarrassment about the disease, lack of awareness regarding the disease, rebellion against authority, family pressure, negative peer relationships, and frustrations about overall life changes.
Young adults with diabetes are at increased risk for developing psychiatric comorbidities, including eating disorders. It is estimated that 14% of girls, and 7% of boys, in the age group of 9 to 14 years show behavioral patterns that are symptomatic of eating disorders. Among all the psychiatric illnesses, eating disorders have the highest mortality rate (nearly 20%).
A multitude of factors including, biological genetic, psychological and sociocultural are involved in the formation of eating disorders. These factors are more pronounced in young women with type 1 diabetes.
The researchers had observed that subthreshold eating disorders with milder symptom was more prevalent in T1DM patients (14%) in comparison to controls (8%). The eating disorders that persisted early during the manifestation of the disease tend to persist leading to poor glycemic control and other health complications, particularly microvascular complications, such as retinopathy. The most common eating disorder among T1DM patients was bulimia, although anorexia was also present in these patients.
Another eating disorder observed in 80% of young women with T1DM is binge-eating disorder (BED), which is characterized by recurrent consumption of large quantities of food, which leads to hyperglycemia. Eating disorders are commonly characterized by body dissatisfaction, dietary restraint, a preoccupation with food and body, substance abuse, mood disorders, electrolyte abnormalities and cardiac conduction changes.
A 10 -year follow-up of patients with T1DM and anorexia revealed a mortality rate of 34.6 per 1,000 person- compared to 7.3 for controls.
Insulin is the most viable treatment for T1DM but it is also associated with hypoglycemia and weight gain. Thus by omitting insulin intentionally the patient creates a hyperglycemic state resulting in polyuria and caloric reduction, a state that brings about weight loss. Omission of insulin in T1DM patients leads to dehydration, ketoacidosis, and fatigue (short term complications), higher rates of nephropathy, foot-related problems and increased possibilities of death (long-term consequences).
Once diagnosed with T1DM young patients should be adequately advised about the need to eat healthy and balanced diet to prevent hypoglycemia and associated complications. Regular screening for eating disorders in T1DM patients is necessary to prevent complications. A common feature in T1DM patients with eating disorder who are administered insulin therapy is that their BMI and weight would be normal. Therefore, identifying the disease in these patients, although not easy must be a part of the comprehensive management plan in these patients.
Thus the authors conclude that a supportive family is quintessential in managing TIDM and in preventing psychiatric illnesses in adolescents with the disease.
With timely diagnosis and appropriate treatment and support, T1DM can be adequately managed.
Reference: Disordered Eating in Type 1 Diabetes: Insulin Omission and Diabulimia; Lalita Prasad et al; US Pharmacist 2012