Eating disorders in diabetes

Perhaps because of the constant emphasis on food and diet in diabetes, eating disorders are more common than is realized. Eating disorders associated with diabetes range from restriction of carbohydrate or omitting meals to reduce the blood glucose to a more sinister severe carbohydrate restriction to reduce the insulin dose and reduce weight. Some anorexic patients deliberately induce insulin deficiency and hypergly-caemia to lose weight. They tend to be admitted in biochemical chaos and ketoacidosis. (Laxative abuse and insulin deficiency cause dangerous hypokalaemia.) Anorexia nervosa may alternate with bulimia. Bulimia produces gross fluctuations in glucose balance as the overeating may need large insulin doses, but the self-induced vomiting then precipitates hypoglycaemia. Such patients should be referred to a specialist diabetes service and be seen in conjunction with psychiatric and psychological support. Abnormal eating patterns may persist for many years before being detected and some people with diabetes never again have a normal attitude to food.

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