Eating disorders and type 1 diabetes as a significant problem

Dear Sir, People with type 1 diabetes, especially young women, are much more likely to have eating disorders than those without.[1] These disorders most often take the form of food restriction, binging and vomiting, excessive exercise, and the use of laxatives. One of the forms of eating disorders in patients with type 1 diabetes is “Diabulimia,” affecting as many as 60% of patients.[2] Diabulimia is a deliberate reduction of insulin, resulting in weight loss.[3] This term is not currently recognized as a formal diagnosis, but due to the specificity of the problem, numerous studies in this area are underway and guidelines for the best treatment of people deliberately limiting insulin are being developed.[1,4] Factors that may increase the risk of eating disorders in people with type 1 diabetes, in addition to concerns about body shape and weight, include the need to cope with a chronic disease and constant control of food intake along with insulin dosing. In this letter, we would like to draw your attention to the particular danger of coexistence of both of these diseases. Reducing the supply of insulin in people with type 1 diabetes results in an increase in blood glucose concentration, followed by catabolic changes and glucosuria resulting in a rapid loss of calories. Such manipulation of insulin doses allows patients to lose weight quickly but has serious health consequences. Among the effects of insulin restriction, ketoacidosis can be distinguished as an acute complication of diabetes. Long-term complications associated with diabulimia include retinopathy and nephropathy.[5] Patients with type 1 diabetes, limiting the supply of insulin to lose weight quickly and easily, often underestimate the health consequences of such decisions. The vast majority of patients are aware of the serious complications that result from such management, but they still decide to further reduce insulin doses.[1] Due to the commonness of the problem of diabulimia, special vigilance should be maintained in the care of patients with type 1 diabetes. Alarming symptoms suggesting the possibility of co-occurrence of eating disorders are sudden and significant weight loss, large changes in the daily dose of insulin, and significant fluctuations in blood glucose levels (both hyper- and hypoglycemia). In the treatment of eating disorders, apart from diabetes education, psychological care of the patient is very important, which is why cooperation between specialists is essential. Interdisciplinary care for a patient with type 1 diabetes is, therefore, needed both in the treatment and prevention of eating disorders.[4] Due to the increasing scale of the problem described, we hope that this letter will contribute to increasing vigilance for the appropriate diagnosis and multidirectional treatment of patients with type 1 diabetes and comorbid eating disorders. Authors’ contribution KM and AB contributed equally to this article. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.