Food is part of life – we cannot survive without eating. But for those with addictions or complex relationships with food, that presents a problem. Food is intimately a part of family events, cultural and religious holidays, and for many, enjoying a good meal is what makes them happiest
Living with diabetes means having to inject insulin, take oral drugs and monitor blood sugar levels carefully. However, for all types of diabetes, food plays an important role in the control of blood sugar and the amount of insulin needed to cover a meal. For these individuals, food is no longer just the nutrition they need to survive or a joyous moment in their lives, but a carefully assessed ingredient in the overall treatment program that is diabetes.
Many cultures show love through food, and when one says no to love, one can be faced with consequences, despite the reason. Someone who controls their food intake can seem overly uptight, not fun, and not a happy-go-lucky person. The reactions when you decline something unhealthy due to your disease can be strong, especially if the person serving the food does not know that you have a medical condition.
What is even worse is when the very food that is supposed to make you feel stronger and happier becomes your poison. and you just cannot indulge in even the smallest portions. This is how an eating disorder is born. For a person with diabetes, 200+ extra decisions have to be made daily, but there are still problems that can arise, even if all these decisions were made correctly. One controllable action is to restrict the food, eliminate any temptations and reduce the risk of failure- because failure means near and long term consequences such as passing out due to hypos, or losing your vision and kidney function due to highs.
I restricted my carb intake for several years to the extent that I could lower my insulin injections to a bare minimum and I never had to worry about going low or going high! If you do not eat carbs, and you do not inject large amounts of insulin, blood sugars are stable, but your body suffers due to actual lack of energy. That is not yet diabulimia, but it causes weight loss and an enormous fixation on food.
Diabulimia is an eating disorder in which an individual gives themselves less insulin than they need for the purpose of weight loss.
The transition to full blown diabulimia is dangerous and often happens as a “natural” progression of restriction – when the temptations of food are too great, and you start having some carbs, but you still do not inject insulin! Now, you are still avoiding the lows, but the highs are a constant presence and that is BAD for the long term.
The reverse is when people eat whatever they want, despite their diabetes and keep their blood sugars under control by overdosing on insulin. This may lead to “double diabetes,” which implies added insulin resistance and type 2 diabetes to the already diagnosed type 1 diabetes. Unfortunately, this is becoming a more common phenomenon due to the ease at which one can dose insulin through pumps or pens and the “politically correct” attitude of not restricting diets of especially young patients, of some doctors and parents.
So how do we avoid diabulimia and double diabetes? I believe in training the body to enjoy healthy but nutritious foods. As I mentioned, food is essential to life and it also can be a pleasure in life. The gut-brain relationship is becoming more well understood and I truly believe that if the gut gets exposed to low sugar, low carb but high fiber, lean protein and “good” fat ingredients, the bugs in our gut (microbiome) will start craving more of the same and the brain will feel good and satiated on foods that are not triggers for binging, glucose excursions and feelings of shame. The research area focusing on the microbiome is very interesting to me. The bugs that live in our guts seem to determine what foods we crave, whether we are thin or overweight and may even be part of the cause for autoimmune diseases such as inflammatory bowel disease, multiple sclerosis and type 1 diabetes.
Our call to action are several-fold:
1: Stop judging people for keeping healthy diets – that is a sign of strength, discipline and a will to survive
2: Be aware of the signs of diabulimia: people with insulin-dependent diabetes with very poor glucose control who when pushed will admit to under-dosing insulin to stay thin
3: Do not encourage double diabetes: when diagnosed with T1D, we cannot eat exactly what we want – that is a fact and an opportunity to be healthier than your peers
3: Learn what foods are good for you and what your systems likes. Stick to this diet for a period of time and you will learn to enjoy it, not just because you want to, but the gut-brain system will be re-trained and you will start dreaming about grilled salmon with mushrooms instead of pasta with cream sauce!