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Diabetics can easily find themselves in a sticky situation when efforts to manage their disease through their food intake and weight find them a prime target for an eating disorder.

According to research conducted by Dr. Deborah Young-Hyman, pediatric psychologist at the Medical College of Georgia’s Georgia Prevention Institute, attempts to maintain healthy blood sugar levels and prevent weight gain may suggest an eating disorder when it is actually the disease and its treatment that are to blame.

“You can’t use the same criteria to diagnose eating disorders that you use in non-diabetic populations because what we actually prescribe as part of diabetes treatment is part of disordered eating behavior. Food preoccupation is one example,” she said.

Those who truly want to manage their disease must have a preoccupation with food, so questions such as, “What are you putting in your mouth? Did you know that was going to raise your blood sugar?” are very common among diabetics. And, just because a diabetic has to follow a specific diet does not mean he or she is not immune to the social pressures to be thin.

Side-by-side comparisons of young people with and without diabetes are necessary to truly answer fundamental questions about the incidence of eating disorders among diabetics. It is important to identify who is at risk and whether treatment can be modified to reduce the risk.

An extensive review of related literature was reviewed by Dr. Young-Hyman and her colleagues to gain a better understanding of the relationship between eating disorder behavior reported by some diabetics with the dysregulation of hunger-related hormones and/or inadequate management of insulin therapy.

For a type 1 diabetic, the immune system will attack the insulin producing cells of the pancreas, which complicates food metabolism. Treatment is generally provided in the form of an injected or pumped insulin, which can also spur hunger. If the insulin isn’t exactly calibrated with food intake, hunger could be increased even more as a result of raised blood sugar levels, which requires even more insulin.

If an individual winds up in a cycle of inexact insulin dosing, it can cause weight gain, which increases insulin requirements and even resistance. At the same time, insulin producing cells attacked by the disease make amylin, which works with other appetite regulating hormones such as leptin to regulate the sensation of fullness. As a result, diabetics can often experience difficulty in determining whether or not they are full.

“We need to document that these patients are experiencing dysregulation in satiety and that it’s not only connected with factors one usually associates with disordered eating behaviors such as societal pressure, anxiety and depression,” Dr. Young-Hyman said. “It’s also associated with having diabetes.”