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March 8, 2002


Question from Lincoln Park, Michigan, USA:

I was diagnosed with type 1 diabetes about 22 years ago and followed my diet to the letter for the first year or so (because I was scared I'd wake up dead if I didn't), but about two years later, I discovered that i could skip meals and be okay, and I also sadly discovered I could eat some sweets once in a while (which eventually became daily). Then. after another four years, I realized I could skip meals for days or weeks even and be "okay" because I was still under the impression then, that if I didn't eat, I didn't need insulin. (After all, my diabetes team said I had to take my medication when I ate.) Anyway, I spent a lot of my teenage days in the hospital because of DKA [diabetic ketoacidosis]. I had no idea the body will produce its own glucose if a person isn't eating. then, and now, as an adult, I guess I left the restriction behind and became a compulsive overeater, with anorexic tendencies (which for me means that I'll sometimes skip meals or even days and then other times once I start eating, I don't stop). Even if I do eat a "normal" portion of something, I still feel really guilty and like I way overdid it, and I've even caught myself in the bathroom with my finger down my throat. This is not something I want to do again, especially since, for the short time I did that it was always with Ipecac, and of course having diabetes adds so much to the guilt. How common is compulsive eating disorder with type 1 diabetes? I know anorexia is pretty common (especially in teens), but I am so curious about the other. I' m also wondering how one tells this food problem to a dietitian when trying to formulate a meal plan. I'm sure they'd look at you really "funny" if you said something to the effect of, well some days I eat any and every thing and on other days I won't eat anything. On some of those days, I'm actually really hungry and just afraid I won't be able to stop, while on others of those days the thought of any food at all literally makes me nauseated?


You need to work with a counselor, psychologist, or psychiatrist on this one as soon as possible. Compulsive overeating is not rare. Similar to anorexia, it is refractory to care and really messes up your diabetes. It has been shown that if you do not get on top of this eating disorder, it will cause you lots of problems down the line.

Recognizing you have the problem is the first step. The second step is finding a qualified medical professional to help you. I would suggest you go to your physician and ask for suggestions. Since the cornerstone of treating type 1 diabetes is giving insulin in concert with your food, you can’t get on top of the diabetes with this problem simmering, adding to the guilt and frustration you are already experiencing. I think it would be a good thing to call about it this week.