My sister has diabetes, and I am worried she may have an eating disorder. I am thinking about approaching her, but I wanted to have some facts when I do so. All the information I find doesn’t tell me whether or not an eating disorder affects a person with diabetes any differently. Are the long-term complications of a person with an eating disorder any different for people with diabetes?

Eating disorders are very serious and potentially life-threatening, whether a person has diabetes or not. When a person has diabetes, the eating disorder can often look different than is typically described in the literature, and therefore the correct diagnosis and treatment can be delayed. The difference is that someone with diabetes can eat an enormous amount of food, and then not give any insulin. This allows the person to basically urinate all of the calories consumed, thereby not gaining any weight. This is a very effective, but extremely dangerous way to lose weight. As you know, if you do not give insulin, your blood sugars become high, and you soon develop ketones, and DKA [diabetic ketoacidosis] is among the leading causes of death.

Your sister needs help immediately . She is in great danger. You may wish to go with her to talk with her diabetes team about your concerns and get their advice about where she can receive the help she needs. Your sister is very lucky to have you. You may be saving her life.

JWB