Page 15 - Today's Dietitian (February 2020)

with type 1 experiencing diabetes com- Disordered eating patterns that don’t constantly timing their insulin. Every-
plications—such as retinopathy, kidney meet the criteria for a formal eating dis- thing they do is constantly being
disease, and neuropathy—they might order diagnosis are more common; in counted,” she says. Weiner emphasizes
otherwise have encountered much later one 14-year study of 126 girls aged 9 to that multiple factors affect blood glu-
in life or not at all. 13, nearly 60% at the end of the study cose—including hormone levels, stress,
Jessica Setnick, MS, RD, CEDRD, an (when participants were at average age and menstruation—meaning it’s unre-
eating disorder expert and creator of the 23.7 years) reported disordered eating alistic to expect to have “perfect” blood
Eating Disorders Boot Camp training behaviors, with the most common disor- glucose levels all the time, something
workshop, explains that “dysfunctional dered behaviors being dieting and insu- many people with diabetes don’t real-
eating and insulin behaviors exacerbate lin omission. The young women in this ize. A desire for complete control—a trait
the potential long-term complications study received typical type 1 diabetes endemic to eating disorders and disor-
of diabetes. Whereas appropriate care, but researchers noted that eating dered eating patterns—over blood glu-
management of diabetes may stave off disorder and disordered eating behav- cose levels easily can lead to distorted
those complications for the next 30 or iors—especially and most concerning, views of food and unhealthful eating and
40 or 50 years, problematic behaviors insulin omission—increased during the insulin behaviors.
7
can cause the complications we’re used course of the study. Setnick adds that this hyperfocus on
to seeing in a 70-year-old person at a Overall risk of developing an eating food at such a young age compounds the
much younger age.” disorder is two to three times higher stress of growing up “in a world of disor-
Susan Weiner, MS, RDN, CDE, dered eating.” Indeed, adolescents with
FAADE, a speaker, author, and consul- type 1 diabetes aren’t immune to the
tant, who copresented the session on Knowing how to speak typical risk factors for eating disorders
ED-DMT1 with Brown at AADE 2019, with younger type 1 and disordered eating, including genetic
adds life-threatening diabetic ketoaci- factors, comorbid psychological disor-
dosis (DKA) as a potential consequence diabetes patients can help ders such as anxiety and depression,
of omitted or reduced insulin. In DKA, RDs not only effectively trauma, loss, social pressure, media
the body breaks down fat rapidly when exposure, and unhealthful/abusive rela-
it doesn’t have enough insulin to use screen for ED-DMT1 but tionships. Of note, depression and anxi-
glucose as fuel, leading to a buildup of also avoid and discourage ety are more common in type 1 diabetes
ketones in the bloodstream. Symptoms than in the general population, possibly
1,3
include weakness and fatigue, frequent language and patterns further increasing eating disorder risk.
urination, excessive thirst, nausea and of thinking that could In addition, the ways in which health
vomiting, confusion, and shortness of care professionals respond to the emo-
breath. Without immediate treatment at unintentionally trigger tions and visit outcomes of people with
an emergency department, DKA is fatal. 5 an eating disorder. type 1 diabetes can trigger—or help pre-
Increased mortality has been seen in vent—an eating disorder and disordered
observational studies on insulin restric- eating behaviors. When people with type
tion. In an 11-year study of 234 women 1 visit with a health care professional,
with type 1 diabetes (mean age 45), there many times they’re viewed only in terms
was a three-fold increased risk of mor- among women and girls with type 1 dia- of their A1c or blood glucose outcomes
tality with insulin restriction, as well betes than those in the general popula- as opposed to as a person, Weiner says.
as higher rates of nephropathy and foot tion. There’s no incidence data for men “And if [these metrics are] for whatever
problems. Thirty percent had reported and boys, though they, too, experience reason not within a targeted range, the
insulin restriction at baseline, and mean ED-DMT1. body language of a health care profes-
2
age of death was younger among these sional, let alone the verbal language of
participants (age 45 vs 58). 6 Why the Increased Risk? a health care professional, really sets
Why are patients with type 1 so much [individuals] off, and they feel blame,
Prevalence more likely to develop eating disor- shame, and guilt beyond anything we
As with eating disorders among the ders and disordered eating behaviors? want them to experience,” she says. “This
general population, exact figures for The reasons aren’t entirely clear, but it’s can sometimes lead to negative out-
ED-DMT1 are unclear due to poor thought that the emphasis on food that’s comes” such as eating disorders and dis-
detection. Some studies have esti- necessary to manage type 1 diabetes ordered eating.
mated prevalence of any eating disorder is a significant factor. There’s carbohy-
among the population with type 1 to drate counting, meal planning, blood Counseling Strategies
be 10% to 33%, compared with an esti- glucose checks, and the sense of failure How can RDs avoid making patients
mated 3.8% among the general popula- when glucose doesn’t fall within the pre- with type 1 diabetes feel this blame,
tion. Risk of onset is greatest during scribed range. shame, and guilt that can lead to disor-
7-9
the preteen and teen years for all young It’s a numbers game, Weiner says. “A dered eating or eating disorders, as well
people, the age range during which person with type 1 diabetes is count- as process the emotions that emerge
many type 1 diagnoses occur. 3 ing carbohydrates constantly. They’re throughout their diabetes journey?
FEBRUARY 2020 • WWW.TODAYSDIETITIAN.COM 15