Managing disordered eating in adolescents with type 1 diabetes

On March 15, 2022, at the 44th National Conference on Pediatric Health Care, data was presented on the increased risk of mortality among adolescents with type 1 diabetes (T1D) and disordered eating behaviors (DEB), along with how parents can recognize signs of DEB in their children.

The risk of DEB is significantly higher in adolescents with T1D. Results from a large prospective study in Finland indicated a 112% increased risk for male patients to develop DEBs besides anorexia and bulimia, a 71% increased risk for female patients to develop anorexia, 222% to develop bulimia, and 153% risk to develop other DEBs.

Reasons for increased risk in patients with T1D include greater prevalence of mental health conditions. These conditions may arise from anxiety over low blood sugar, long-term diabetes complications, and a feeling of defeat when blood sugars are out of range.

Aspects of diabetes management, such as constant focus on food, dietary restrictions, eating to treat hypoglycemia, and weight gain from insulin, may also increase the risk of DEB. Patients may neglect taking insulin to cope with diabetes distress, or because they have fears of hypoglycemia or anxiety of needles. They may also learn it will reduce weight.

Individuals with T1D and DEB are also at a greater risk of retinopathy, neuropathy, and nephropathy. They may also experience decreased functioning of the immune system, reproductive difficulties, liver disease, heart disease, osteoporosis, and death.

Women with T1D were reported to have 3.2 times increase in the relative risk of death. The mean age of death was also found to be lower, at 45 years vs 58 years. Comorbidity of T1D and DEB was found to increase the risk of death by 17 times compared to individuals with only T1D.

When presenting this data, Elizabeth Doyle, DNP, APRN, PPCNP-BC, CDCES, discussed the difficulties for families in detecting red flags in diagnosing diabulimia, a condition when an individual restricts insulin administration to lose weight. These red flags can include throwing insulin out after drawing it up, fabricating blood sugar readings, asking parents to order insulin on time, and having bolus doses drip out on floor by disconnecting a pump set.

Behavioral symptoms of DEB include complimenting individuals with thin bodies, showing anxiety over weight gain, discussing how insulin affects weight, and showing low self-esteem or a negative body image.

Physical symptoms of DEB include excessive thirst, fatigue, abdominal pain, nausea or vomiting, rapid weight loss, irregular heart rate, blurred vision, frequent yeast infections, urinary tract infections, irregular heart rate, and dry skin or nails. Diabulimia risk is greater in individuals with T1D, a diagnosis of anxiety or depression, and a family history of eating disorders.

There are multiple questions which may help screen for DEB in adolescents with T1D. These include questions on insulin intake, feelings and behaviors toward weight, and if they have ever skipped or reduced insulin to lose weight. A 16-item tool called diabetes eating problem survey – revised has also been developed to screen for DEB in adolescents with T1D.

Earlier detections and treatment will lead to better outcomes, according to Doyle. It is important to know why an adolescent is neglecting insulin andprovide treatment through a multi-disciplinary team.

Reference

Doyle E. Unique disordered eating behaviors in adolescents and young adults with type 1 diabetes: screening in primary care can save lives. Presented at: 44th National Conference on Pediatric Health Care. March 15-19, Orlando, Florida.