Many Girls With Diabetes, PKU Have Symptoms of Eating Disorders
The patterns of the eating disturbances varied according to which disease the participants had. For instance, the diabetic group was more concerned about avoiding fatty foods. Those with PKU, meanwhile, were more preoccupied with self-control and with perceived pressure from others to gain weight.
Psychologically, diabetic girls and women with eating problems tended to have lower self-esteem and a more negative body image than those without these problems. And the PKU patients with eating problems had poorer judgment and lower self-esteem than the others.
Further, diabetic females with eating disorders were less likely to follow other aspects of their treatment regimens. For instance, they were less likely to monitor their blood sugar levels, follow a meal plan, maintain their blood sugar at appropriate levels, and appropriately treat hypoglycemia (low blood sugar) than those without eating disturbances. This lack of adherence to treatment may result in greater health risks, Chrisler tells WebMD.
"My message for both parents and physicians who deal with girls with illnesses like diabetes and PKU is to watch out for any sign that they may be engaging in disordered eating, because that could be devastating to their health condition," Chrisler tells WebMD. "We can't assume they are going to cope well with this. They're going to need support from their family and health care providers."
Gary Rodin, MD, professor of psychiatry at the University of Toronto, tells WebMD that he agrees that the problem of eating disorders in diabetic women often goes unrecognized by physicians.
"In diabetes, we know now that any girl with poorly controlled blood sugars for unexplained reasons should be considered to have an eating disorder until proven otherwise," he says. He says doctors should talk to their patients about their concerns with body image, weight, dieting, binge eating, and, particularly, failing to take enough insulin.
"By the time they get to age 18, about one-third of diabetic girls admit to taking less insulin at some time for the purpose of preventing weight gain," Rodin says. This practice is extremely dangerous, says Rodin, whose own research found that diabetic girls with eating disorders had a threefold increase in the risk of retinopathy (damage to the retina of the eye).
"In diabetes, we know that dietary restriction is a risk factor for [eating disorders]," he says. "This study also suggests that in another disease in which there is dietary restriction, PKU, there may be a similar increase in eating disorders." He suggests more study is needed to confirm the findings.
"Historically, the message for treating diabetes has been one of a restrictive diet and a tighter approach to regulation and management. In diabetic girls, we know that's been counterproductive, leading to binge eating and omitting insulin. Now, there's a tendency to normalize eating and try to tailor insulin to the diet," Rodin says.