About a year ago, my now 17 year old daughter was diagnosed with Type ! diabetes prior to which, she began having unusual mood swings and was lashing out at the whole family. She was eating everything in the house. I even caught her on the floor downing a container of maple syrup. Her behavior problems became so bad that I could not handle her. A couple of months later, she exhibited the classic symptoms of diabetes. I believe her behavior and crazy eating patterns were a result of prediabetes, but her doctors cannot say for sure. I feel guilty that I was not able to help her and that her problem was medical. I am just looking for answers.

It would be very unusual indeed for such a flamboyant eating disorder to be a herald of clinical type 1 diabetes, but it is nonetheless interesting to speculate on the possible links. It might have been, and I sense that the issue is now resolved, that this was some unconnected teenage emotional disorder where the attendant stress precipitated insulin dependence in someone in whom the autoimmune damage to the islet cells was already well advanced.

Certainly in other situations where glucose becomes unavailable for energy serious appetite problems do not seem to occur. Occasionally too, at a time when insulin producing capacity is severely damaged there is a failure in what is called ‘first phase insulin release’ which means that insulin instead of being promptly secreted in response to a glucose load comes an hour or two later at which point it may actually lead to hypoglycemia which in turn can certainly cause a mood change and a craving for sugar.

Yet another and rather remote possibility, is that if she did not have a positive antibody test at the time of diagnosis, that she in fact has type 2 diabetes. It is now realised that the two types are not always easy to distinguish at onset on clinical grounds alone. The appetite problem might have been more sustained and led to insulin resistance, a phenomenon that is increasingly common in North America in both childhood and teen years.

At the present time there is a rapidly expanding understanding of many new hormones like Ghrelin, PYY, Glp-1, Leptin and many others that are part of an intricate matrix for normal appetite control so that in a few years episodes like your daughter’s may be explicable in molecular terms.

DOB