Diabetes Over View

Bulimia Nervosa In Adolescent Diabetic Girls

Eating disorders are one of the most critical associated disorders among teens with diabetes. The prevalence rate of eating disorders among the general population is reported to be between 1.3% and 11%, and research suggests that the prevalence among young women with type1 diabetes may be much higher.

Bulimia nervosa is characterized by all of the following:

• Repeated episodes of binge eating with frequent compensatory behaviors to prevent weight gain, which may include vomiting or misuse of laxatives and diuretics.
• Lack of control during binge episodes.
• Self-evaluation unduly influenced by weight.

Bulimia nervosa patients usually maintain a normal weight for age and height, though weight may fluctuate considerably. The central issue for persons with bulimia nervosa is a feeling of living behind a facade. An adolescent girl with bulimia tends to believe everyone, thinks she is pretty or mature and capable, and she fears that others will find out that she is not really that perfect and will be angry and disappointed with her. Although perfect blood glucose control is not a realistic expectation for persons with diabetes, adolescent girls with bulimia and diabetes need to present a facade of perfection to hide their “failure” from parents and health care providers. Thus, bulimic girls with diabetes frequently report excellent blood glucose control and “no difficulties” with diabetes management but have very elevated hemoglobin A1c levels. Because of the strong inverse correlation between bulimic symptoms (binging and purging) and metabolic control in teenage girls with diabetes, persistent hyperglycemia should alert health care providers to suspect bulimia.

Predisposing Factors For Eating Disorders.

Families of children with eating disorders have been characterized as enmeshed and overprotective, unable to resolve conflict, and rigid in their interactions. In addition to diabetes management issues, diabetes treatment outcomes and outcome measures may be risk factors for disordered eating among adolescent girls with diabetes. The use of weight as a method of evaluating diabetes control is a major risk factor. Weight loss is an indicator of poor control and weight gain a possible indicator of lack of adherence to the prescribed food plan. Finally, the stress related to having a chronic illness can exacerbate other difficulties for both the patient and the family and make the eruption of a latent eating disorder more likely.

Treatment Of Eating Disorders

Treatment of any eating disorder should use a coordinated team approach that includes a therapist, a nutritionist, and a physician or a nurse practitioner. Although in some ways these girls may make a real effort to recover, they frequently undermine their treatment by surreptitiously not adhering to the recommended treatment plan. Unfortunately, the prognosis remains guarded for diabetic adolescents with bulimia. Among patients with diabetes, treatment of eating disorders must be closely coordinated with diabetes management. Allowing more flexibility in the target blood glucose range and adjusting food choices may be necessary until the eating disorder improves. Otherwise, the treatment should not differ from that of patients without diabetes.