The diagnosis of Type 1 Diabetes mellites
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.
is a period of psychological, physiological, and emotional transition. It is a
phase that is characterized by a struggle for self-acceptance and
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.
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
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
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.
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.
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.
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).
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
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