Page 14 - Today's Dietitian (February 2020)

Diabetes By Hadley Turner

diagnosis of an eating disorder and type
1 diabetes.
Brown described her experience with
ED-DMT1 to a packed room of diabe-
tes educators and RDs at the Ameri-
can Association of Diabetes Educators
(AADE) annual meeting in Houston in
August 2019. Her message to practi-
tioners: ED-DMT1 is overlooked and
undertreated, and it can kill.
Knowing how to speak with younger
type 1 diabetes patients can help RDs
not only effectively screen for ED-DMT1
but also avoid and discourage lan-
guage and patterns of thinking that
could unintentionally trigger an eating
disorder.

Branches of ED-DMT1
ED-DMT1 can involve any eating disorder
seen in the general population, and each
manifests differently within ED-DMT1,
1
including in the following ways :
• Anorexia: Patient will limit or reduce
food intake and/or avoid taking
insulin.
• Bulimia: Patient will binge with com-
pensatory behavior such as insulin
omission, overexercising, vomiting,
Eating Disorders and diuretic or laxative abuse. This is
the most common eating disorder in
2
type 1 diabetes.
in Type 1 Diabetes • Binge eating disorder: Patient will
overdose insulin to “justify” a binge.
A Primer on What They Are, Why They Happen, • Purging disorder: Patient will con-
and How RDs Can Help sume food normally with compensa-
tory behaviors involved in bulimia.
W hen Asha Brown was diagnosed with type 1 diabetes at commonly, but not always, is overused,
In any of these diagnoses, insulin
age 5, her father—who also has type 1—taught Brown
underused, delayed, omitted, or tam-
to manage her diabetes so well that it became second
nature to her. In fact, young Brown was proud to be “like
used. Compensatory behaviors, food
2,3
her dad.” She and her father were featured in American pered with to render it ineffective when
Diabetes Association fundraising advertisements in the 1990s. restriction, and bingeing also can occur
But at age 14, Brown became uncomfortable about having the dis- in those with type 1 without the patient
ease. Learning that type 1 diabetes and taking insulin are associated meeting formal criteria for one of the
with weight gain, she began omitting insulin occasionally for energy previously described eating disorders
and weight control. This intermittent habit turned into a routine— or the more generalized eating disorder,
omitting or not taking enough insulin, bingeing, restricting food, and not otherwise specified diagnosis, as
then promising herself she’d change, only to repeat the cycle. Brown defined in the Diagnostic and Statistical
th
continued this pattern until she was 24. Now in her 30s, she’s recov- Manual of Mental Disorders, 5 Edition;
ered from her eating disorder but lives with several chronic conditions these behaviors are commonly referred
4
resulting from a decade’s worth of insulin omission. to as disordered eating.
Until recently, Brown’s condition was called “diabulimia,” a port-
manteau of “diabetes” and “bulimia,” and a term with which many Consequences
RDs likely are familiar. However, this condition now is referred to as However an eating disorder, disordered
ED-DMT1—which loosely stands for “eating disorders in type 1 dia- eating, and insulin misuse manifest,
betes”—meant to more accurately and broadly describe the dual they all can result in young patients

14 TODAY’S DIETITIAN • FEBRUARY 2020