Males with diabetes and eating disorders

Daniel Sher, a clinical psychologist, educates us on males with diabetes and eating disorders, in hopes of breaking down stigmas and misconceptions.

When we talk about diabetes and eating disorders (EDs), a topic often left in the shadows is their impact on males (men).¹ Traditionally, research in this realm has focused on females (women); and for good reason. Research shows that females who have diabetes are disproportionately affected by disordered eating.

However, in males, especially those living with diabetes, these disorders manifest uniquely and require our attention. Understanding this intersection is crucial, not only for providing effective care but also for breaking down stigmas and misconceptions surrounding EDs in men.

What are eating disorders?

Eating disorders are complex psychiatric conditions involving dysfunctional relationships to food and the body. People with diabetes (Type 1 and Type 2) are at risk of developing eating disorders, such as:

• Bulimia (intentional purging or vomiting);
• Anorexia (severe under-eating and weight loss);
• Binge eating disorder (episodes of extreme overeating); and
• Diabulimia (skipping insulin in an attempt at losing weight).

Binge eating disorder and sugar addiction both involve an over reliance on high carbohydrate foods in an attempt to regulate distressing emotions. Both of these conditions are important drivers for Type 2 diabetes in particular.

Males vs. females: The different shades of EDs

The presentation and experiences of EDs can differ significantly between males and females. Men are less likely to be diagnosed due to social stigma and a lack of awareness, both by healthcare providers and the men themselves. In men, EDs often co-occur with an emphasis on body shape and muscularity, rather than just weight loss.

Why are people with diabetes vulnerable?

Several risk factors contribute to the development of EDs in males with diabetes. These include genetic predispositions, psychological vulnerabilities (such as anxiety and depression) and increasing societal pressures for a certain body type (namely, a “shredded” muscular physique with limited body-fat). Perfectionism may also be a risk factor and this complex combination of variables can lead to an unhealthy preoccupation with food and body image, particularly in those with Type 1 diabetes.

Picture the following hypothetical scenario: a young man with diabetes is constantly bombarded by social media images of idealised male physiques; ones that emphasise muscle and leanness. He navigates a world where every meal and snack requires careful consideration and balancing with insulin, a world where food is not just nourishment but a mathematical equation impacting his health.

In this environment, his diabetes management starts to morph into a tool for body sculpting, subtly shifting from health-focused to appearance-driven. The lines blur between diligent diabetes care and an emerging obsession with body image. This scenario reflects a reality for many, highlighting the nuanced ways in which societal norms and diabetes management can converge to create a fertile ground for disordered eating behaviours.

The risks of co-occurring diabetes and EDs

Overlooked eating disorder tendencies in people with diabetes can be extremely dangerous, putting a person at risk of:

• Poor glycaemic management with higher A1Cs and increased blood-glucose variability;
• Heightened risk of long-term complications;
• More frequent DKAs which can be acutely life-threatening; and
• Increased risk of mental health disorders.

Altered brain function

A particularly worrying aspect of disordered eating in diabulimia is the impact on brain function. Insulin plays a crucial role in regulating blood glucose levels. Restricting insulin leads to heightened blood-glucose levels and these fluctuations can damage the brain (especially if sustained over time).

At the same time, eating disorders can lead to nutritional deficiencies which affect serotonin (a brain-chemical that is implicated in depression). Conditions, such as anorexia, have also been associated with changes to the brain’s grey matter. The structural and chemical changes to the brain can further trigger cognitive and emotional difficulties. All of this can lead to a nasty vicious cycle, making the challenging job of managing diabetes that much tougher.

What sort of help is available?

Treating EDs requires balancing the psychological and physical aspects of the condition, meaning that multi-disciplinary collaboration is hugely important. When it comes to diabetes and EDs, dietitians play an absolutely invaluable role. Best results shine through when there is a team approach between the patient, family, endocrinologist, dietitian and psychologist. At times, an eating disorder diagnosis may mean that a short-term admission is indicated.

When to seek professional help?

Recognising when to seek help is a critical step. What are some warning signs to look out for? These include sudden changes in eating patterns, hoarding or stealing food, obsessive thoughts about food or body image and deliberately skipping insulin to lose weight.

All of these may indicate a dysfunctional relationship to food and it’s crucial for men with diabetes to understand that seeking help for an ED is a sign of strength, not weakness. Don’t be ashamed to flag your concerns with your doctor or a mental health professional.

References

Araia, E., Hendrieckx, C., Skinner, T., Pouwer, F., Speight, J., & King, R. M. (2017). Gender differences in disordered eating behaviours and body dissatisfaction among adolescents with type 1 diabetes: Results from diabetes MILES youth—Australia. International Journal of Eating Disorders, 50(10), 1183-1193. https://doi.org/10.1002/eat.22746

Araia, E., King, R. M., Pouwer, F., Speight, J., & Hendrieckx, C. (2020). Psychological correlates of disordered eating in youth with type 1 diabetes: Results from diabetes MILES Youth-Australia. Pediatric Diabetes, 21(4), 664-672.https://doi.org/10.1111/pedi.13001

Broadley, M. M., Zaremba, N., Andrew, B., Ismail, K., Treasure, J., White, M. J., & Stadler, M. (2020). 25 years of psychological research investigating disordered eating in people with diabetes: What have we learnt? Diabetic Medicine, 37(3), 401-408.

Doyle, E. A., Quinn, S. M., Ambrosino, J. M., Weyman, K., Tamborlane, W. V., & Jastreboff, A. M. (2017). Disordered eating behaviours in emerging adults with type 1 diabetes: A common problem for both men and women. Journal of Pediatric Health Care, 31(3), 327-333.https://doi.org/10.1016/j.pedhc.2016.10.004

Dziewa, M., Bańka, B., Herbet, M., & Piątkowska-Chmiel, I. (2023). Eating disorders and diabetes: Facing the dual challenge. Nutrients, 15(18), 3955.https://doi.org/10.3390/nu15183955

Russell-Jones, D., & Khan, R. (2007). Insulin-associated weight gain in diabetes—causes, effects and coping strategies. Diabetes, Obesity and Metabolism, 9(6), 799-812. https://doi.org/10.1111/j.1463-1326.2006.00686.x

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