The ‘Most Dangerous Eating Disorder’: Diabulimia in T1D

When I diagnosed 10-year-old Katie with type 1 diabetes (T1D), I told her that her excess weight and diet were unrelated to her diagnosis. But a few months later, her school teacher singled her out for having diabetes in front of the entire class while declaring that the childhood obesity epidemic is out of control. Sitting in that classroom as her classmates stared, she must have wondered whether her childish chubbiness was really to blame.

People living with diabetes are exposed to nearly constant scrutiny about their weight and diet. Even teachers and others in positions of authority, who should know better, criticize students about their weight or eating habits. Parents and patients of all ages grow weary of constantly being asked, “Should you be eating that?”

Yes, diabetes does require meticulous monitoring and accounting for every bite of food in order to ensure good glycemic control. But that very scrutiny may also be the start of a perfect storm that can lead to a dangerous relationship with food.
‘I Just Want to Be Normal’

Even as diabetes technology improves, the sensors and pumps that are worn on the body are often difficult to completely conceal, especially when they alarm loudly and unpredictably.

One of my patients initially loved her continuous glucose monitor and the break it afforded her from sticking her finger four or more times daily. But when she was admitted to the hospital in diabetic ketoacidosis, she confessed that she had not been wearing it. She had tired of her classmates’ constant questions about the device. “I just want to be normal,” she whispered.

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